NASAL POLYPSNASAL POLYPS

MAJ ZEESHAN AYUBMAJ ZEESHAN AYUB

MBBS, MCPS, FCPSMBBS, MCPS, FCPS

CLASSIFIED ENT SPECIALISTCLASSIFIED ENT SPECIALIST

NASAL POLYPSNASAL POLYPS

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

TYPESTYPES

Two main typesTwo main types

1.1. Simple / mucosal / Ethmoidal nasal Simple / mucosal / Ethmoidal nasal polypipolypi

1.1. Antrochoanal nasal polypAntrochoanal nasal polyp

Other nasal polyps / Resembling Other nasal polyps / Resembling polypipolypi

1.1. Bleeding polypus Bleeding polypus hemangioma / hemangioma / fibroangioma / granulomafibroangioma / granuloma

2.2. Malignant growths Malignant growths CA , Lymphoma CA , Lymphoma , Melanoma & sarcoma, Melanoma & sarcoma

3.3. Nasopharyngeal angiofibromaNasopharyngeal angiofibroma

4.4. RhinosporidiosisRhinosporidiosis

EtiologyEtiology

AllergicAllergic InfectionInfection Vasomotor imbalanceVasomotor imbalance Mucopolysaccharide changesMucopolysaccharide changes Bernoulli's phenomenonBernoulli's phenomenon Genetics : Monozygotic twinsGenetics : Monozygotic twins Aspirin allergyAspirin allergy

PathologyPathology

Collection of edema fluid in submucosa Collection of edema fluid in submucosa with collection of cells e.g. eosinophils , with collection of cells e.g. eosinophils , plasma cells & macrophagesplasma cells & macrophages

Covered with ciliated columnar epithelium, Covered with ciliated columnar epithelium, long standing exposure long standing exposure squamous squamous metaplasiametaplasia

Edematous swelling hangs down due to Edematous swelling hangs down due to gravity / Bernoulli’s phenomenon & gravity / Bernoulli’s phenomenon & assumes polypoidal shapeassumes polypoidal shape

Scanty blood supplyScanty blood supply InsensativeInsensative

Clinical FeaturesClinical Features

Common in adults , incidence Common in adults , incidence increases with age increases with age

A/C polyp common in teensA/C polyp common in teens If polyps in young children If polyps in young children Cystic Cystic

fibrosis to be excludedfibrosis to be excluded Male predominance ( 3 : 1 )Male predominance ( 3 : 1 )

Nasal obstruction , unilateral / bilateralNasal obstruction , unilateral / bilateral Hyposmia / AnosmiaHyposmia / Anosmia PNDPND SnoringSnoring Speech changesSpeech changes Nasal discharge , Watery / Nasal discharge , Watery /

mucopurulentmucopurulent HeadacheHeadache

EpiphoraEpiphora Blockage earsBlockage ears Broad nose / Frog noseBroad nose / Frog nose ProptosisProptosis Grayish white ( grape like ) pedunculated Grayish white ( grape like ) pedunculated

masses , soft , smooth , freely mobile & masses , soft , smooth , freely mobile & insensitive to touchinsensitive to touch

Probe can be passed around themProbe can be passed around them If metaplasia If metaplasia pink / red color pink / red color

Differential DiagnosisDifferential Diagnosis

1.1. Enlarged turbinatesEnlarged turbinates

2.2. Nasopharyngeal AngiofibromaNasopharyngeal Angiofibroma

3.3. Malignant growthMalignant growth

4.4. Antochoanal polypAntochoanal polyp

5.5. Foreign bodyForeign body

6.6. RhinolithRhinolith

InvestigationsInvestigations

Blood CP,ESRBlood CP,ESR Blood sugarBlood sugar X-RAY PNSX-RAY PNS X-RAY Chest PAX-RAY Chest PA BiopsyBiopsy Nasal secretions for Cytology & C/SNasal secretions for Cytology & C/S Tests for AllergyTests for Allergy

TreatmentTreatment

Conservative:Conservative:1.1. Treatment of underlying causeTreatment of underlying cause2.2. ? Antihistamines? Antihistamines3.3. Topical steroids / ? Short course of oral Topical steroids / ? Short course of oral

steroidssteroids Surgical:Surgical:1.1. Intranasal polypectomyIntranasal polypectomy2.2. Ethmoidectomy (Intranasal / external)Ethmoidectomy (Intranasal / external)3.3. FESSFESS

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ANTROCHOANAL POLYPANTROCHOANAL POLYP

Arises in the Max. sinus , enters the Arises in the Max. sinus , enters the nose through it’s osteum , traverse nose through it’s osteum , traverse to choana & may hang into to choana & may hang into nasopharynxnasopharynx

CAUSESCAUSES: :

1.1. InfectionInfection

2.2. AllergyAllergy

3.3. Retention cystRetention cyst

Clinical FeaturesClinical Features

Teen age--- Young adultsTeen age--- Young adults Nasal obstructionNasal obstruction RhinorrheaRhinorrhea Hyposmia / AnosmiaHyposmia / Anosmia SnoringSnoring Impaired hearingImpaired hearing Post nasal dripPost nasal drip May be seen on ant. Rhinoscopy but May be seen on ant. Rhinoscopy but

commonly visible on Posterior rhinoscopycommonly visible on Posterior rhinoscopy

TreatmentTreatment

Pre-op. investigations: Same as for Pre-op. investigations: Same as for mucosal polyps.mucosal polyps.

SURGERYSURGERY

1.1. Polypectomy Polypectomy Intranasal / Oral Intranasal / Oral routeroute

2.2. Cald Wel Luc’s operationCald Wel Luc’s operation