NASAL POLYPI

NASAL POLYPI

Non-neoplastic masses of oedematous nasal or sinus

mucosa
BILATERAL
ETHMOIDAL
POLYPI
ANTROCHOANAL

BILATERAL ETHMOIDAL POLYP

Multiple BILATERAL
Arise from the lateral wall of nose, usually
from the middle meatus.
Common sites

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.

ETIOLOGY

Chronic rhinosinusitis allergi & non-allergic

N.A.R.E.S
Asthma (atopic/nonatopic)
Samter`s triad nasal polyp, asthma & asprin intolerence.
Cystic fibrosis abnormal composition of mucus
Allergic fungal sinusitis.
Kartagener's syndrome.
Young's syndrome.
Churg-strauss syndrome
Nasal mastocytosis nasal mucosa is infiltrated by mast cells.

PATHOGENESIS

Nasal mucosa(oedematous due to collection of ECF)

polypoidal change.

Sessile in the beginning pedunculated due to gravity &

excessive sneezing.

Pathology
nasal polypi (ciliated columnar epithelium)

metaplastic change on exposure to atmospheric irritation

transitional and squamous type.

Submucosa shows large intercellular spaces filled with

serous fluid + infiltration with eosinophils and round cells.

Symptoms

Mostly seen in adults.

Nasal stuffiness leading to total nasal obstruction may
be the presenting symptom.
Anosmia (Partial or total)
Headache due to associated sinusitis.
Sneezing and watery nasal discharge due to associated
allergy.
Mass protruding from the nostril.

Signs

On anterior rhinoscopy,
Multiple and bilateral
Smooth, glistening, grape-like masses often
pale in colour.
Sessile or pedunculated,
Insensitive to probing and do not bleed on touch.
Long-standing cases present with broadening of nose and
increased intercanthal distance.
A polyp may protrude from the nostril and appear pink and
vascular simulating neoplasm
Purulent discharge due to associated sinusitis.

DIAGNOSIS

Clinical examination
CT paranasal sinuses

bone erosion & expansion neoplasia

TREATMENT
Conservative :

Antihistaminics & control of allergy

Edematous mucosa reverts to normal

Short course of steroids

Prevent recurrence after surgery
With intolerance to antihistamines/asthma
Contraindications : DM, HTN, peptic ulcer, pregnancy

Surgery :

Polypectomy:
1 or 2 & pedunculated polyp using snare.
multiple & sessile with special forceps.

Intranasal ethmoidectomy:
multiple & sessile polyps.
by uncapping of air cells by intranasal route.

Extranasal ethmoidectomy:
recur after intranasal procedure.
due to lack of surgical landmarks.
through medial wall of orbit.

Transantral ethmoidectomy :
Infn and polypoidal change also involves maxillary antrum.
Caldwell-Luc approach maxillary antrum through medial wall of antrumethmoidal
air cells.

Functional endoscopic sinus surgery (FESS)

Using endoscopes of 0 , 30 & 70 angulation
Polypi can be removed more accurately when ethmoid cells are
removed, and drainage and ventilation provided to the other
involved sinuses such as maxillary,sphenoidal or frontal

Antrochoanal Polyp
Single & unilateral
Children & young adults
It arises from mucous membrane of the
floor and
close to the

medial wall of maxillary sinus

accessory ostium,

Comes out of it andstarts growing towards

the

choana and nasal cavity.

It has 3 parts :

Etiology

Exact ?
Nasal allergy with sinus infection

SYMPTOMS

Unilateral nasal obstruction.

Polyp grows in to nasopharynx obstruct opposite

choana causing bilateral nasal obstruction.

Thick & dull voice due to hyponasality.

Muciod nasal discharge.

SIGNS

Missed on anterior rhinoscopy (antrochoanal polyp grows

posteriorly) When large, a smooth greyish mass covered
with nasal discharge may be seen.
It is soft and can be moved up and down with a probe.
A large polyp may protrude from the nostril and show a
pink congested look on its exposed part .
Posterior rhinoscopy may 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

Why polyp grows backwards

Air currents
Cilliary movement
Drinage of secretions
Post. More space
Gravitry
Brenouilli`s phenomenon

Diagnosis :

CT paranasal sinuses

Differential Diagnosis

ANGIOFIBROMA firm & bleeds on touch.H/O

recurrent epistaxis
BLEB OF MUCUS disappear on blowing nose
HYPERTROPHY OF CONCHAE (MIDDLE)
Colour
Consistency
Sensitivity
Bleeding
Movement

OTHER NEOPLASMS pink, friable, bleeds on touch

Ethmoidalpolyp

Antrochoanal
polyp

Age

Adults

Children

Etiology

Allergy

Infection

Number

Multiple

Solitary

Laterality

Bilateral

Unilateral

Origin

Middle turbinate &meatus

Accessoryostiumof
maxillary sinus

Growth

Anteriorly

Posteriorly

Size & shape

Small& grape like

Large& trilobed

Recurrence

Common

Uncommon

Treatment

Polypectomy

Polypectomy

FESS

FESS

Ethmoidectomy

Caldwell-Luc

Treatment

Avulsion either through the nasal or oral route.

Caldwell-Luc operation recurrence & maxillary
sinusitis.
Endoscopic sinus surgery

Clinical importance

Red and fleshy, friable and has granular surface, especially in older
patients Malignancy.
Epistaxis and orbital symptoms associated with a polyp
Malignancy.
Polyp subjected to histology Simple nasal polyp with a
malignancy underneath.
A simple polyp Glioma, Encephalocele or
Meningoencephalocele.
It should always be aspirated and fluid examined for CSF.
Careless removal of such polyp would result in CSF rhinorrhoea and
meningitis.
Multiple nasal polypi in children mucoviscidosis.

Causes of unilateral nasal

obstruction

Causes of bilateral nasal

obstruction