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Nose > Nasal Polypi > Flashcards

Nasal Polypi Flashcards

1
Q

Nasal polypi are

A

non-neoplastic masses of oedematous nasal or sinus mucosa

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2
Q

two main varieties:

A

Bilateral ethmoidal polypi.

Antrochoanal polyp.

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3
Q

AETIOLOGY of BILATERAL ETHMOIDAL POLYPI

A
  • Chronic rhinosinusitis➡️ allergic and nonallergic origin (Nonal- lergic rhinitis with eosinophilia syndrome (NARES))
  • Asthma
  • Aspirin intolerance
  • Cystic fibrosis due to abnormal mucus
  • Allergic fungal sinusitis
  • Kartagener syndrome
  • Young syndrome
  • Churg–Strauss syndrome
  • Nasal mastocytosis.
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4
Q

Samter’s triad

A

nasal polypi, asthma and aspirin intolerance.

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5
Q

Kartagener syndrome

A

This consists of bronchiectasis sinusitis, situs inversus and ciliary dyskinesis

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6
Q

Young syndrome

A

consists of sinopulmonary disease and azoospermia.

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7
Q

Churg–Strauss syndrome

A

Consists of asthma, fever, eosinophilia, vasculitis and granuloma.

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8
Q

Nasal mastocytosis

A

It is a form of chronic rhinitis in which nasal mucosa is infiltrated with mast cells but few eosinophils. Skin tests for allergy and IgE levels are normal.

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9
Q

PATHOGENESIS of BILATERAL ETHMOIDAL POLYPI

A

Nasal mucosa, particularly in the region of middle meatus and turbinate, becomes oedematous due to collection of extracellular fluid causing polypoidal change. Polypi which are sessile in the beginning become pedunculated due to gravity and excessive sneezing.

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10
Q

PATHOLOGY BILATERAL ETHMOIDAL POLYPI

A

In early stages, surface of nasal polypi is covered by ciliated columnar epithelium like that of normal nasal mucosa but later it undergoes a metaplastic change to transitional and squamous type on exposure to atmospheric irritation. Submu- cosa shows large intercellular spaces filled with serous fluid. There is also infiltration with eosinophils and round cells.

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11
Q

SITE OF ORIGIN of BILATERAL ETHMOIDAL POLYPI

A

lateral wall of nose, usually from the middle meatus

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12
Q

Common sites for BILATERAL ETHMOIDAL POLYPI

A

uncinate process, bulla ethmoidalis, ostia of sinuses, medial surface and edge of middle turbinate

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13
Q

Allergic nasal polypi almost never arise from

A

the septum or the floor of nose

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14
Q

SYMPTOMS of BILATERAL ETHMOIDAL POLYPI

A
  • Nasal stuffiness ➡️ leading to total nasal obstruction
  • Partial or total loss of sense of smell
  • Headache
  • Sneezing and watery nasal discharge
  • Mass protruding from the nostril
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15
Q

Headache in BILATERAL ETHMOIDAL POLYPI is due to

A

associated sinusitis

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16
Q

BILATERAL ETHMOIDAL POLYPI is Mc in age group

A

Adults

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17
Q

In BILATERAL ETHMOIDAL POLYPI Sneezing and watery nasal discharge due to

A

allergy

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18
Q

SIGNS of BILATERAL ETHMOIDAL POLYPI On anterior rhinoscopy

A

polypi appear as smooth, glistening, grape-like masses often pale in colour. They may be sessile or pedunculated, insensitive to probing and do not bleed on touch. Often they are multiple and bilateral

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19
Q

Long-standing cases of BILATERAL ETHMOIDAL POLYPI present with

A

broadening of nose and increased inter- canthal distance.

A polyp may protrude from the nostril and appear pink and vascular simulating neoplasm

20
Q

Probing of a solitary ethmoidal polyp may be necessary to differentiate it from

A

hypertrophy of the turbinate or cystic middle turbinate.

21
Q

DIAGNOSIS

A

clinical examination.
Com- puted tomography (CT) scan of paranasal sinuses
histological exami- nation

22
Q

Why CT is done for BILATERAL ETHMOIDAL POLYPI

A

exclude the bony erosion and expansion suggestive of neoplasia

23
Q

histological exami- nation of BILATERAL ETHMOIDAL POLYPI is done to exclude

A

malignancy

24
Q

CONSERVATIVE TREATMENT for BILATERAL ETHMOIDAL POLYPI

A
  • antihistaminics control of allergy and oedematous mucosa

- steroids for asthma and polypoidal nasal mucosa and to prevent recurrence after surgery

25
Q

Contrain- dications to use of steroids in BILATERAL ETHMOIDAL POLYPI

A

hypertension, peptic ulcer, diabetes, pregnancy and tuberculosis

26
Q

SURGICAL TREATMENT for BILATERAL ETHMOIDAL POLYPI

A 
Polypectomy 
Intranasal ethmoidectomy 
Extranasal ethmoidectomy 
Transantral ethmoidectomy 
Endoscopic sinus surgery
27
Q

ANTROCHOANAL POLYP is also called as

A

KILLIAN’S POLYP

28
Q

ANTROCHOANAL POLYP arises from the

A

mucosa of maxillary antrum near its accessory ostium, comes out of it and grows in the choana and nasal cavity.

29
Q

Parts of ANTROCHOANAL POLYP

A
  1. Antral, which is a thin stalk.

2. Choanal, which is round and globular. 3. Nasal, which is flat from side to side.

30
Q

AETIOLOGY of ANTROCHOANAL POLYP

A
  • Exact cause is unknown

- Nasal allergy coupled with sinus infection

31
Q

MC age group for ANTROCHOANAL POLYP

A

children and young adults

Usually they are single and unilateral.

32
Q

SYMPTOMS of ANTROCHOANAL POLYP

A

Unilateral nasal obstruction
Voice may become thick and dull due to hyponasality.
Nasal discharge, mostly mucoid, may be seen on one or both sides.

33
Q

presenting symptom of ANTROCHOANAL POLYP

A

Unilateral nasal obstruction

34
Q

Obstruction may become bilateral when antrocoanal polyp

A

grows into the nasopharynx and starts obstructing the opposite choana

35
Q

SIGNS of ANTROCHOANAL POLYP

A

When large, a smooth grey- ish mass covered with nasal discharge may be seen

It is soft and can be moved up and down with a probe.

36
Q

A large ANTROCHOANAL POLYP can

A

protrude from the nostril and show a pink congested look on its exposed part

37
Q

Posterior rhinoscopy of ANTROCHOANAL POLYP

A

reveal a globular mass filling the choana or the nasopharynx. A large polyp may hang down behind the soft palate and present in the oropharynx

38
Q

In ANTROCHOANAL POLYP Examination of the nose with an endoscope may reveal

A

a choanal or antrochoanal polyp hidden posteriorly in the nasal cavity

39
Q

A blob of mucus often looks like a polypus but it would disappear on

A

blowing the nose

40
Q

Hypertrophied middle turbinate is differentiated from ANTROCHOANAL POLYP

A

its pink appearance and hard feel of bone on probe testing.

41
Q

Angiofibroma is differentiated from ANTROCHOANAL POLYP by

A

history of profuse recurrent epistaxis.

It is firm in consistency and easily bleeds on probing.

42
Q

neoplasms may be differentiated from ANTROCHOANAL POLYP by

A

their fleshy pink appearance, friable nature and their tendency to bleed.

43
Q

In ANTROCHOANAL POLYP X-rays of paranasal sinuses may show

A

opacity of the involved antrum

44
Q

In Antrocoanal polyp X-rays lateral view soft tissue nasopharynx, reveals

A

a globular swelling in the postnasal space

It is differenti- ated from angiofibroma by the presence of a column of air behind the polyp.

45
Q

TREATMENT of Antrocoanal polyp

A

removed by avulsion either through the nasal or oral route

46
Q

Recurrence in Antrocoanal polyp is

A

uncommon after complete removal

47
Q

For recurrent Antrocoanal polyp rx

A

Caldwell– Luc operation may be required to remove the polyp com- pletely from the site of its origin and to deal with coexistent maxillary sinusitis but endoscopic sinus surgery has superceded other modes

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