NASAL POLYP

• Non neoplastic masses of edematous nasal or sinus mucosa

TYPES • 2 Types bilateral ethmoidal polypi

antrochoanal polypi

Bilateral ethmoidal polyp

Aetiology

Chronic rhinosinusitis

Sampter’s triad

Cystic fibrosis

Allergic fungal sinusitis

kartagener’s syndrome

Young’s syndrome

Churg strauss syndrome

nasal mastocytosis

PATHOGENESISAetiology

Collection of extracellular fluid

Edema of nasal mucosa

PATHOLOGICAL CHANGES

Ciliated columnar epithelium (normal)

Atmospheric irritation

Metaplastic change to transitional and squamous type

• Sub mucosa- large intercellular space filled with serous fluid

• Infiltration with eosinophils and round cells

COMMON SITES

Uncinate

process

Bulla ethmoidalis

Ostia of

sinusMedial surface

and edge of middle turbinate

SYMPTOMSNasal stiffness—Nasal obstruction

Loss of smell

Head ache

Sneezing

Watery nasal discharge

Mass protruding from nostrils

SIGNSAnterior

rhinoscopy---smooth glistening grape like mass

Nasal cavity---purulent

discharge

Long standing cases---broadening of nose

and increased intercanthal distance

DIFFERENTIAL DIAGNOSIS

Hypertrophy of turbina

te

Cystic middle turbin

ate

TREATMENT

Medical treatmentAntihistaminics

Steroids

Surgical treatment

Polypectomy

Intranasal etmoidectomy

Extranasal etmoidectomy

Trasantral etmoidectomy

FESS

ANTROCHOANAL POLYPI

Antral

ChoanalNasal

AETIOLOGY• Common in children and young

adults• Nasal allergy +sinus infection-most

common cause• Usually single and unilateral

SYMPTOMS

Unilateral nasal

obstruction

Thick and dull

voice

Nasal dishar

ge

SIGNSanterior rhinoscopy

Large polyp-greyish mass+nasal

discharge

small polyp-

masked

Soft&can be

moved up&down with probe

Posterior rhinoscopy

Globular mass filling the

choana/oropharynx

Large polyp-hang ddown beneath soft

palate&present in oropharynx

DIFFERENTIAL DIAGNOSIS

A blob of mucus

Hypertrophied

middleturbinate

Angiofibroma

neoplasm

INVESTIGATIONS

• X-ray of paranasal sinuses• X-ray of softtissue nasopharynx

TREATMENT

Avulsion through nasal/oral route

Caldwell-luc operation

Endoscopic sinuss surgery