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NASAL POLYPOSIS
Moderator -Dr.Jyothi Swarup
Presenter-Dr.Razal
1
Definition
• Nasal polyp are non-neoplastic mass of edematous
nasal or sinus mucosa.
• An inflammatory reaction involving the mucous
membrane of nose ,the paranasal sinus ,often lower
airways.
• Presents with grape like appearance having a body and
a stalk.
2
Epidemiology
• Prevalence rate is about 1-4%
• Increase with the age(peak at the age of 50s
• Male: Female ratio is about 2:1
3
Histo-pathology
• Histologically, nasal polyps are characterized by a
pseudostratified ciliated columnar epithelium and few
nerve endings. The stroma of nasal polyps is
edematous.
• Eosinophil cells are the most commonly identified
inflammatory cell, occurring in 80-90% of polyps.
• Neutrophils in 7% of polyps
4
Sites
Commonest sites in order of frequency are;
1. Ethmoids
2. Maxillary antrum
3. Sphenoids
5
Causes
1. Allergic rhinitis, Allergic fungal sinusitis
2. Asthma-7% of patient shows polyp
3. Cystic fibrosis(disease of Exocrine glands)
4. Kartagener syndrome(Bronchiectasis,Chronic Sinusitis situs
inversus,ciliary dyskinesia)
5. Nickel exposure
6. Young’s Syndrome- It consists of chronic rhiniosinusitis, nasal
polyposis, bronchiectasis and azoospermia.
7. Churg-Strauss Syndrome-Affects small to medium-sized
arteries and veins.
6
The Aspirin triad
• A triad of nasal polyposis ,asthma and aspirin
intolerance.
• It is a non allergic entity.
7
ETHMOIDAL POLYP
• Multiple polyps always arise from lateral wall of nose,
usually from middle meatus.
• Common sites are uncinate process, bulla ethmoidalis,
medial surface of middle turbinate
8
Symptoms
• Nasal obstruction bilaterally.
• Partial or total loss of smell
• Headache
• Sneezing(Excessive) /watery nasal discharge
9
Signs
• Smooth, glistening, grapelike masses, Multiple and
bilateral.
• Often greyish-pale in color, long standing polyps may
appear pinkish.
• May be sessile or pedunculated, insensitive to touch,
does not bleed on touch and probe can be passed all
around the mass.
• Long standing cases may present with broadening of
nose and increase in inter-canthal distance.
10
• Anterior Rhinoscopy • Nasal Endoscopy
Findings
11
Differential Diagnosis
• Hypertrophied turbinates (pink in colour,sensitive to
touch, probe cannot be passed laterally)
• Inverted papilloma-Irregular surface, pink in color,
common in middle aged female and arises from lateral
wall.
• Malignant tumors-Blood tinged nasal discharge,
irregular proliferative growth.
12
Treatment
• Includes intranasal or systemic steroids and Leukotrine
inhibitors.
• A short course of systemic steroids can serve as
‘medical polypectomy’.
• In more severe cases surgery is required, FESS.
13
ANTROCHOANAL POLYP
• Syn Killian’s polyp
• They are benign polypoid lesions arising
from the maxillary antrum and they
extend into the choana.
• A-C Polyps usually have three
components
o Antral Part
o Nasal Part
o Choanal Part
• A-C Polyps are almost always unilateral,
although bilateral A-C Polyps have been
reported.
14
• Arises from maxillary and passes through the maxillary
ostium into the middle meatus, and then extends
towards the nasopharynx / oropharynx.
• mostly originates from the posterior, inferior, lateral or
medial walls of the maxillary antrum.
• They are most commonly seen in young adults and in
3rd to 5th decades.
• They are slightly more common in males compared to
females.
ANTROCHOANAL POLYP
15
Endoscopic View
16
Symptoms
• Nasal obstruction
• Rhinorrhea
• Snoring
• Headache
• Mouth breathing
• Hyposmia
• Halitosis
• Dyspnea
• Nasal pruritis
18
Plain X-ray film
• Waters View
• Unilateral opacification
of the maxillary sinus
• Nasopharyngeal mass is
occasionally seen
• Frequently bilateral sinus
involvement
19
Investigations
Computed Tomography
• Defined mass with mucin
density is seen arising
within the maxillary sinus
• Widening of maxillary
ostium and extending in
to nasopharynx
• No associated bony
destruction but rather
smooth enlargement of
sinus
20
Investigations
Differential Diagnosis
• Juvenile angiofibroma
• Meningoencephalocele
• Inverted papilloma
• Mucocele
• Mucus retention cyst
• Tornwalt's cyst
• Grossly enlarged adenoids
• Lymphoma
• Nasopharyngeal malignancies
21
Treatment
• The treatment of A-C Polyp is always surgical.
• Simple polypectomy and for recurrent polyps Caldwell
Luc procedure were the previously preferred methods for
surgical treatment.
• In recent years, functional endoscopic sinus surgery
(FESS) became the more preferred surgical technique.
22
23

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Nasal polyposis

  • 1. NASAL POLYPOSIS Moderator -Dr.Jyothi Swarup Presenter-Dr.Razal 1
  • 2. Definition • Nasal polyp are non-neoplastic mass of edematous nasal or sinus mucosa. • An inflammatory reaction involving the mucous membrane of nose ,the paranasal sinus ,often lower airways. • Presents with grape like appearance having a body and a stalk. 2
  • 3. Epidemiology • Prevalence rate is about 1-4% • Increase with the age(peak at the age of 50s • Male: Female ratio is about 2:1 3
  • 4. Histo-pathology • Histologically, nasal polyps are characterized by a pseudostratified ciliated columnar epithelium and few nerve endings. The stroma of nasal polyps is edematous. • Eosinophil cells are the most commonly identified inflammatory cell, occurring in 80-90% of polyps. • Neutrophils in 7% of polyps 4
  • 5. Sites Commonest sites in order of frequency are; 1. Ethmoids 2. Maxillary antrum 3. Sphenoids 5
  • 6. Causes 1. Allergic rhinitis, Allergic fungal sinusitis 2. Asthma-7% of patient shows polyp 3. Cystic fibrosis(disease of Exocrine glands) 4. Kartagener syndrome(Bronchiectasis,Chronic Sinusitis situs inversus,ciliary dyskinesia) 5. Nickel exposure 6. Young’s Syndrome- It consists of chronic rhiniosinusitis, nasal polyposis, bronchiectasis and azoospermia. 7. Churg-Strauss Syndrome-Affects small to medium-sized arteries and veins. 6
  • 7. The Aspirin triad • A triad of nasal polyposis ,asthma and aspirin intolerance. • It is a non allergic entity. 7
  • 8. ETHMOIDAL POLYP • Multiple polyps always arise from lateral wall of nose, usually from middle meatus. • Common sites are uncinate process, bulla ethmoidalis, medial surface of middle turbinate 8
  • 9. Symptoms • Nasal obstruction bilaterally. • Partial or total loss of smell • Headache • Sneezing(Excessive) /watery nasal discharge 9
  • 10. Signs • Smooth, glistening, grapelike masses, Multiple and bilateral. • Often greyish-pale in color, long standing polyps may appear pinkish. • May be sessile or pedunculated, insensitive to touch, does not bleed on touch and probe can be passed all around the mass. • Long standing cases may present with broadening of nose and increase in inter-canthal distance. 10
  • 11. • Anterior Rhinoscopy • Nasal Endoscopy Findings 11
  • 12. Differential Diagnosis • Hypertrophied turbinates (pink in colour,sensitive to touch, probe cannot be passed laterally) • Inverted papilloma-Irregular surface, pink in color, common in middle aged female and arises from lateral wall. • Malignant tumors-Blood tinged nasal discharge, irregular proliferative growth. 12
  • 13. Treatment • Includes intranasal or systemic steroids and Leukotrine inhibitors. • A short course of systemic steroids can serve as ‘medical polypectomy’. • In more severe cases surgery is required, FESS. 13
  • 14. ANTROCHOANAL POLYP • Syn Killian’s polyp • They are benign polypoid lesions arising from the maxillary antrum and they extend into the choana. • A-C Polyps usually have three components o Antral Part o Nasal Part o Choanal Part • A-C Polyps are almost always unilateral, although bilateral A-C Polyps have been reported. 14
  • 15. • Arises from maxillary and passes through the maxillary ostium into the middle meatus, and then extends towards the nasopharynx / oropharynx. • mostly originates from the posterior, inferior, lateral or medial walls of the maxillary antrum. • They are most commonly seen in young adults and in 3rd to 5th decades. • They are slightly more common in males compared to females. ANTROCHOANAL POLYP 15
  • 17.
  • 18. Symptoms • Nasal obstruction • Rhinorrhea • Snoring • Headache • Mouth breathing • Hyposmia • Halitosis • Dyspnea • Nasal pruritis 18
  • 19. Plain X-ray film • Waters View • Unilateral opacification of the maxillary sinus • Nasopharyngeal mass is occasionally seen • Frequently bilateral sinus involvement 19 Investigations
  • 20. Computed Tomography • Defined mass with mucin density is seen arising within the maxillary sinus • Widening of maxillary ostium and extending in to nasopharynx • No associated bony destruction but rather smooth enlargement of sinus 20 Investigations
  • 21. Differential Diagnosis • Juvenile angiofibroma • Meningoencephalocele • Inverted papilloma • Mucocele • Mucus retention cyst • Tornwalt's cyst • Grossly enlarged adenoids • Lymphoma • Nasopharyngeal malignancies 21
  • 22. Treatment • The treatment of A-C Polyp is always surgical. • Simple polypectomy and for recurrent polyps Caldwell Luc procedure were the previously preferred methods for surgical treatment. • In recent years, functional endoscopic sinus surgery (FESS) became the more preferred surgical technique. 22
  • 23. 23