NASAL POLYPOSIS

Moderator -Dr.Jyothi Swarup Presenter-Dr.Razal

Definition • Nasal polyp are non-neoplastic mass of

edematous nasal or sinus mucosa.• An inflammatory reaction involving the mucous

membrane of nose ,the paranasal sinus ,often lower airways.

• Presents with grape like appearance having a body and a stalk.

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Epidemiology

• Prevalence rate is about 1-4%• Increase with the age(peak at the age of 50s• Male: Female ratio is about 2:1

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Histo-pathology• Histologically, nasal polyps are characterized by a

pseudostratified ciliated columnar epithelium and few nerve endings. The stroma of nasal polyps is edematous.

• Eosinophil cells are the most commonly identified inflammatory cell, occurring in 80-90% of polyps.

• Neutrophils in 7% of polyps

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Sites Commonest sites in order of frequency are;

1. Ethmoids2. Maxillary antrum3. Sphenoids

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Causes1. Allergic rhinitis, Allergic fungal sinusitis 2. Asthma-7% of patient shows polyp3. Cystic fibrosis(disease of Exocrine glands)4. Kartagener syndrome(Bronchiectasis,Chronic Sinusitis

situs inversus,ciliary dyskinesia)5. Nickel exposure6. Young’s Syndrome- It consists of chronic rhiniosinusitis,

nasal polyposis, bronchiectasis and azoospermia.7. Churg-Strauss Syndrome-Affects small to medium-sized

arteries and veins.

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The Aspirin triad• A triad of nasal polyposis ,asthma and aspirin

intolerance.• It is a non allergic entity.

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ETHMOIDAL POLYP• Multiple polyps always arise from lateral wall of

nose, usually from middle meatus.• Common sites are uncinate process, bulla

ethmoidalis, medial surface of middle turbinate

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Symptoms• Nasal obstruction bilaterally.• Partial or total loss of smell• Headache• Sneezing(Excessive) /watery nasal discharge

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Signs• Smooth, glistening, grapelike masses, Multiple

and bilateral.• Often greyish-pale in color, long standing polyps

may appear pinkish.• May be sessile or pedunculated, insensitive to

touch, does not bleed on touch and probe can be passed all around the mass.

• Long standing cases may present with broadening of nose and increase in inter-canthal distance.

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• Anterior Rhinoscopy • Nasal Endoscopy

Findings

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Differential Diagnosis

• Hypertrophied turbinates (pink in colour,sensitive to touch, probe cannot be passed laterally)

• Inverted papilloma-Irregular surface, pink in color, common in middle aged female and arises from lateral wall.

• Malignant tumors-Blood tinged nasal discharge, irregular proliferative growth.

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Treatment

• Includes intranasal or systemic steroids and Leukotrine inhibitors.

• A short course of systemic steroids can serve as ‘medical polypectomy’.

• In more severe cases surgery is required, FESS.

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ANTROCHOANAL POLYP• Syn Killian’s polyp• They are benign polypoid lesions

arising from the maxillary antrum and they extend into the choana.

• A-C Polyps usually have three componentso Antral Parto Nasal Parto Choanal Part

• A-C Polyps are almost always unilateral, although bilateral A-C Polyps have been reported.

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• Arises from maxillary and passes through the maxillary ostium into the middle meatus, and then extends towards the nasopharynx / oropharynx.

• mostly originates from the posterior, inferior, lateral or medial walls of the maxillary antrum.

• They are most commonly seen in young adults and in 3rd to 5th decades.

• They are slightly more common in males compared to females.

ANTROCHOANAL POLYP

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Endoscopic View

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Symptoms• Nasal obstruction• Rhinorrhea• Snoring• Headache• Mouth breathing• Hyposmia• Halitosis• Dyspnea• Nasal pruritis

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Plain X-ray film• Waters View• Unilateral

opacification of the maxillary sinus

• Nasopharyngeal mass is occasionally seen

• Frequently bilateral sinus involvement

Investigations

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Computed Tomography • Defined mass with mucin

density is seen arising within the maxillary sinus

• Widening of maxillary ostium and extending in to nasopharynx

• No associated bony destruction but rather smooth enlargement of sinus

Investigations

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Differential Diagnosis • Juvenile angiofibroma• Meningoencephalocele• Inverted papilloma• Mucocele• Mucus retention cyst• Tornwalt's cyst• Grossly enlarged adenoids• Lymphoma• Nasopharyngeal malignancies

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Treatment• The treatment of A-C Polyp is always surgical. • Simple polypectomy and for recurrent polyps

Caldwell Luc procedure were the previously preferred methods for surgical treatment.

• In recent years, functional endoscopic sinus surgery (FESS) became the more preferred surgical technique.

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