Nasal Polyps Definition 0 Non neoplastic oedematous prolapsed

Nasal Polyps

Definition 0 Non neoplastic oedematous prolapsed nasal or sinus mucosa 0 2 types 0 Ethmoidal polyps 0 Antrochoanal polyps

Ethmoidal Polyps 0 Aetiology: Allergic Chronic rhinosinusitis Asthma & Aspirin intolerance – Samter’s triad – 7 -36% Cystic fibrosis -20% Allergic fungal sinusitis Kartagener’s syndrome - Bronchiectasis, Situs inversus, Ciliary Dyskinesis. 0 Young’s syndrome - Sinopulmanory disease & azoospermia. 0 Epithelial cell defects/gene deletions 0 Churg-Strauss Syndrome – Asthma, Fever, Eosinophilia, vasculitis & granuloma 0 0 0

Pathogenesis 0 Collection of extracellular fluid and oedema of the mucosa around middle turbinate and meatus. 0 Initially sessile, later become pedunculated due to the effect of gravity and sneezing 0 Lining epithelium is respiratory, later may turn to transitional and squamous due to irritation 0 Submucosa: serous fluid filled spaces with infiltration of eosinophils and round cells.

Sites of origin 0 Uncinate process 0 Bulla ethmoidalis 0 Ostia of sinuses 0 Middle turbinate

Sites of origin

Symptoms 0 Adults and elderly 0 Bilateral nasal obstruction 0 Partial or total anosmia 0 Sneezing and watery nasal discharge 0 Headache 0 Mass coming out of the nose

Signs 0 Pale, pulpy, painless, probable mass 0 Glistening and grape like 0 Multiple, bilateral 0 External deformity – broad nose with increased intercanthal distance 0 Big polyps may simulate malignancy

Diagnosis 0 Clinical examination 0 CT Scan of nose & PNS 0 Blood for eosinophilia 0 Nasal secretions for cytology and culture 0 Biopsy to rule out malignancy

Treatment - Medical 0 Antihistaminics 0 Systemic & topical steroids

Treatment - Surgical 0 Endoscopic polypectomy/FESS 0 Ethmoidectomy – Intranasal/external/transantral

Antrochoanal Polyp 0 Arises from mucosa of maxillary antrum near its accessory ostium, comes out and goes towards the choana 0 3 parts: 0 Antral 0 Choanal 0 Nasal

Aetiology 0 Infection 0 Allergy 0 Both

Symptoms 0 Adolescents and young adults 0 Unilateral nasal block, rarely bilateral 0 Thick dull hyponasal voice 0 Mucoid nasal discharge

Signs 0 Smooth greyish mass covered by nasal discharge as seen on postnasal examination 0 A large polyp may hang down in the oropharynx

Why AC Polyps go posteriorly 0 Accessory ostium is posterior 0 Choana is bigger than anterior nares 0 Inspiratory air currents are more powerful than expiratory air currents 0 Mucociliary clearance is towards the choana

D/D 0 Blob of mucus 0 Hypertrophied middle or inferior turbinate 0 Angiofibroma 0 Inverted papilloma 0 Glioma, encephaloceles

Investigations 0 X-ray PNS 0 X-Ray Nasopharynx – lateral view 0 CT PNS

Treatment 0 Endoscopic polypectomy 0 Caldwell Luc operation

Differences between AC polyp & Ethmoidal polyp Criteria Antrochoanal Polyp Ethmoidal Polyp Age Adolescents Elderly Aetiology Infective Allergy Number Single Multiple Side Unilateral Bilateral Origin Maxillary sinus Ethmoidal sinus Growth Backwards Anteriorly Size & shape Large, globular, trifoliate or dumbell shaped Small, grape like Recurrence Less common More common Treatment Surgical - FESS Medical & Surgical - FESS

Polyp V/S Tumors 0 Polypus – red & fleshy, friable, granular surface, 0 older age -- ? Malignancy. 0 Simple nasal polyp - malignancy – Histopathology. 0 Polyp in child – Glioma, Encephalocele, Meningoencephalocele - Aspirate for CSF analysis, CT Scan. 0 Epistaxis & Orbital symptoms - ? Malignancy.

Causes of Unilateral nasal obstruction 0 Vestibule 0 Furuncle 0 Vestibulitis 0 Stenosis/atresia 0 Nasoalveolar cyst 0 Papilloma 0 Squamous cell carcinoma Nasopharynx Unilateral choanal atresia 0 Nasal Cavity 0 0 0 0 0 FB. DNS. Hyprtrophic Turbinates. Concha Bullosa. AC Polyp. Synechia. Rhinolith. Bleeding polypus of septum. Benign/Malignant Tumors of Nose/PNS.

Causes of B/L Nasal Obstruction 0 Vestibule 0 0 B/L Vestibulitis. Collapsing Nasal Alae. Stenosis of Nares. Congenital Atresia. 0 Nasopharynx 0 0 0 Adenoid Hyperplasia. Large Choanal polyp. Thornwaldt’s Cyst. Soft palate & PPW Adhesions. Large Benign/Malignant Tumors. Nasal Cavity. Acute/chronic rhinitis Acute/chronic rhinosinusitis Rhinitis medicamentosa Allergic rhinitis Hypertrophic turbinates DNS Nasal Polypi Atrophic rhinitis Rhinitis sicca Septal hematoma/abscess Bilateral choanal atresia