Transcript Nasal-polyps-1

NASAL POLYPS
MAJ ZEESHAN AYUB
MBBS, MCPS, FCPS
CLASSIFIED ENT SPECIALIST
NASAL POLYPS
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An edematous , pedunculated mass
arising from mucous membrane of nose
or paranasal sinuses
TYPES
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Two main types
Simple / mucosal / Ethmoidal nasal
polypi
Antrochoanal nasal polyp
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Other nasal polyps / Resembling polypi
Bleeding polypus  hemangioma /
fibroangioma / granuloma
Malignant growths  CA , Lymphoma ,
Melanoma & sarcoma
Nasopharyngeal angiofibroma
Rhinosporidiosis
Etiology
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Allergic
Infection
Vasomotor imbalance
Mucopolysaccharide changes
Bernoulli's phenomenon
Genetics : Monozygotic twins
Aspirin allergy
Pathology
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Collection of edema fluid in submucosa with
collection of cells e.g. eosinophils , plasma cells
& macrophages
Covered with ciliated columnar epithelium, long
standing exposure  squamous metaplasia
Edematous swelling hangs down due to gravity /
Bernoulli’s phenomenon & assumes polypoidal
shape
Scanty blood supply
Insensative
Clinical Features
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Common in adults , incidence increases
with age
A/C polyp common in teens
If polyps in young children  Cystic
fibrosis to be excluded
Male predominance ( 3 : 1 )
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Nasal obstruction , unilateral / bilateral
Hyposmia / Anosmia
PND
Snoring
Speech changes
Nasal discharge , Watery / mucopurulent
Headache
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Epiphora
Blockage ears
Broad nose / Frog nose
Proptosis
Grayish white ( grape like ) pedunculated
masses , soft , smooth , freely mobile &
insensitive to touch
Probe can be passed around them
If metaplasia  pink / red color
Differential Diagnosis
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Enlarged turbinates
Nasopharyngeal Angiofibroma
Malignant growth
Antochoanal polyp
Foreign body
Rhinolith
Investigations
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Blood CP,ESR
Blood sugar
X-RAY PNS
X-RAY Chest PA
Biopsy
Nasal secretions for Cytology & C/S
Tests for Allergy
Treatment
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Conservative:
Treatment of underlying cause
? Antihistamines
Topical steroids / ? Short course of oral
steroids
Surgical:
Intranasal polypectomy
Ethmoidectomy (Intranasal / external)
FESS
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ANTROCHOANAL POLYP
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Arises in the Max. sinus , enters the nose
through it’s osteum , traverse to choana
& may hang into nasopharynx
CAUSES:
Infection
Allergy
Retention cyst
Clinical Features
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Teen age--- Young adults
Nasal obstruction
Rhinorrhea
Hyposmia / Anosmia
Snoring
Impaired hearing
Post nasal drip
May be seen on ant. Rhinoscopy but commonly
visible on Posterior rhinoscopy
Treatment
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Pre-op. investigations: Same as for
mucosal polyps.
SURGERY
Polypectomy  Intranasal / Oral route
Cald Wel Luc’s operation