Nasal Polypi Flashcards
Nasal polypi are
non-neoplastic masses of oedematous nasal or sinus mucosa
two main varieties:
Bilateral ethmoidal polypi.
Antrochoanal polyp.
AETIOLOGY of BILATERAL ETHMOIDAL POLYPI
- 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.
Samter’s triad
nasal polypi, asthma and aspirin intolerance.
Kartagener syndrome
This consists of bronchiectasis sinusitis, situs inversus and ciliary dyskinesis
Young syndrome
consists of sinopulmonary disease and azoospermia.
Churg–Strauss syndrome
Consists of asthma, fever, eosinophilia, vasculitis and granuloma.
Nasal mastocytosis
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.
PATHOGENESIS of BILATERAL ETHMOIDAL POLYPI
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.
PATHOLOGY BILATERAL ETHMOIDAL POLYPI
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.
SITE OF ORIGIN of BILATERAL ETHMOIDAL POLYPI
lateral wall of nose, usually from the middle meatus
Common sites for BILATERAL ETHMOIDAL POLYPI
uncinate process, bulla ethmoidalis, ostia of sinuses, medial surface and edge of middle turbinate
Allergic nasal polypi almost never arise from
the septum or the floor of nose
SYMPTOMS of BILATERAL ETHMOIDAL POLYPI
- 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
Headache in BILATERAL ETHMOIDAL POLYPI is due to
associated sinusitis
BILATERAL ETHMOIDAL POLYPI is Mc in age group
Adults
In BILATERAL ETHMOIDAL POLYPI Sneezing and watery nasal discharge due to
allergy
SIGNS of BILATERAL ETHMOIDAL POLYPI On anterior rhinoscopy
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
Long-standing cases of BILATERAL ETHMOIDAL POLYPI present with
broadening of nose and increased inter- canthal distance.
A polyp may protrude from the nostril and appear pink and vascular simulating neoplasm
Probing of a solitary ethmoidal polyp may be necessary to differentiate it from
hypertrophy of the turbinate or cystic middle turbinate.
DIAGNOSIS
clinical examination.
Com- puted tomography (CT) scan of paranasal sinuses
histological exami- nation
Why CT is done for BILATERAL ETHMOIDAL POLYPI
exclude the bony erosion and expansion suggestive of neoplasia
histological exami- nation of BILATERAL ETHMOIDAL POLYPI is done to exclude
malignancy
CONSERVATIVE TREATMENT for BILATERAL ETHMOIDAL POLYPI
- antihistaminics control of allergy and oedematous mucosa
- steroids for asthma and polypoidal nasal mucosa and to prevent recurrence after surgery
Contrain- dications to use of steroids in BILATERAL ETHMOIDAL POLYPI
hypertension, peptic ulcer, diabetes, pregnancy and tuberculosis
SURGICAL TREATMENT for BILATERAL ETHMOIDAL POLYPI
Polypectomy Intranasal ethmoidectomy Extranasal ethmoidectomy Transantral ethmoidectomy Endoscopic sinus surgery
ANTROCHOANAL POLYP is also called as
KILLIAN’S POLYP
ANTROCHOANAL POLYP arises from the
mucosa of maxillary antrum near its accessory ostium, comes out of it and grows in the choana and nasal cavity.
Parts of ANTROCHOANAL POLYP
- Antral, which is a thin stalk.
2. Choanal, which is round and globular. 3. Nasal, which is flat from side to side.
AETIOLOGY of ANTROCHOANAL POLYP
- Exact cause is unknown
- Nasal allergy coupled with sinus infection
MC age group for ANTROCHOANAL POLYP
children and young adults
Usually they are single and unilateral.
SYMPTOMS of ANTROCHOANAL POLYP
Unilateral nasal obstruction
Voice may become thick and dull due to hyponasality.
Nasal discharge, mostly mucoid, may be seen on one or both sides.
presenting symptom of ANTROCHOANAL POLYP
Unilateral nasal obstruction
Obstruction may become bilateral when antrocoanal polyp
grows into the nasopharynx and starts obstructing the opposite choana
SIGNS of ANTROCHOANAL POLYP
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.
A large ANTROCHOANAL POLYP can
protrude from the nostril and show a pink congested look on its exposed part
Posterior rhinoscopy of ANTROCHOANAL POLYP
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
In ANTROCHOANAL POLYP Examination of the nose with an endoscope may reveal
a choanal or antrochoanal polyp hidden posteriorly in the nasal cavity
A blob of mucus often looks like a polypus but it would disappear on
blowing the nose
Hypertrophied middle turbinate is differentiated from ANTROCHOANAL POLYP
its pink appearance and hard feel of bone on probe testing.
Angiofibroma is differentiated from ANTROCHOANAL POLYP by
history of profuse recurrent epistaxis.
It is firm in consistency and easily bleeds on probing.
neoplasms may be differentiated from ANTROCHOANAL POLYP by
their fleshy pink appearance, friable nature and their tendency to bleed.
In ANTROCHOANAL POLYP X-rays of paranasal sinuses may show
opacity of the involved antrum
In Antrocoanal polyp X-rays lateral view soft tissue nasopharynx, reveals
a globular swelling in the postnasal space
It is differenti- ated from angiofibroma by the presence of a column of air behind the polyp.
TREATMENT of Antrocoanal polyp
removed by avulsion either through the nasal or oral route
Recurrence in Antrocoanal polyp is
uncommon after complete removal
For recurrent Antrocoanal polyp rx
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
