NASAL POLYPS

NASAL POLYPS MAJ ZEESHAN AYUB MBBS, MCPS, FCPS CLASSIFIED ENT SPECIALIST

NASAL POLYPS • An edematous , pedunculated mass arising from mucous membrane of nose or paranasal sinuses

TYPES • Two main types • Simple / mucosal / Ethmoidal nasal polypi • Antrochoanal nasal polyp

Other nasal polyps / Resembling polypi • Bleeding polypus  hemangioma / fibroangioma / granuloma • Malignant growths  CA , Lymphoma , Melanoma & sarcoma • Nasopharyngeal angiofibroma • Rhinosporidiosis

Etiology • Allergic • Infection • Vasomotor imbalance • Mucopolysaccharide changes • Bernoulli's phenomenon • Genetics : Monozygotic twins • Aspirin allergy

Pathology • Collection of edema fluid in submucosa with collection of cells e.g. eosinophils , plasma cells & macrophages • Covered with ciliated columnar epithelium, long standing exposure  squamous metaplasia • Edematous swelling hangs down due to gravity / Bernoulli’s phenomenon & assumes polypoidal shape • Scanty blood supply • Insensative

Clinical Features • Common in adults , incidence increases with age • A/C polyp common in teens • If polyps in young children  Cystic fibrosis to be excluded • Male predominance ( 3 : 1 )

Nasal obstruction , unilateral / bilateral • Hyposmia / Anosmia • PND • Snoring • Speech changes • Nasal discharge , Watery / mucopurulent • Headache

Epiphora • Blockage ears • Broad nose / Frog nose • Proptosis • Grayish white ( grape like ) pedunculated masses , soft , smooth , freely mobile & insensitive to touch • Probe can be passed around them • If metaplasia  pink / red color

Differential Diagnosis • Enlarged turbinates • Nasopharyngeal Angiofibroma • Malignant growth • Antochoanal polyp • Foreign body • Rhinolith

Investigations • Blood CP,ESR • Blood sugar • X-RAY PNS • X-RAY Chest PA • Biopsy • Nasal secretions for Cytology & C/S • Tests for Allergy

Treatment • Conservative: • Treatment of underlying cause • ? Antihistamines • Topical steroids / ? Short course of oral steroids • Surgical: • Intranasal polypectomy • Ethmoidectomy (Intranasal / external) • FESS

ANTROCHOANAL POLYP • Arises in the Max. sinus , enters the nose through it’s osteum , traverse to choana & may hang into nasopharynx • CAUSES: • Infection • Allergy • Retention cyst

Clinical Features • Teen age--- Young adults • Nasal obstruction • Rhinorrhea • Hyposmia / Anosmia • Snoring • Impaired hearing • Post nasal drip • May be seen on ant. Rhinoscopy but commonly visible on Posterior rhinoscopy

Treatment • Pre-op. investigations: Same as for mucosal polyps. • SURGERY • Polypectomy  Intranasal / Oral route • Cald Wel Luc’s operation

NASAL POLYPS

NASAL POLYPS

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