Nasal polyp

Def: Sagging down of oedematous and hypertrophied mucosa of the nose and PNS. It is composed of loose fibro-oedematous tissue and surface is usually lined by ciliated columnar epithelium.

Types: Antrochoanal polyp Ethmoidal polyp

Antrochoanal polyp

Aetiology Mainly infection

Pathology Due to prolonged infection in the maxillary antrum Accumulation of the exudate in the submucosa Antral mucosal swelling is aggravated by the traction of exudate Mucosal swelling interfere with lymphatic flow. Ultimately formation of antral polyp It goes through the ostium to nose and nasopharynx

Histopathology

Age: Common in children and young adult

Clinical features Symptoms: Nasal obstruction Nasal discharge Headache Hyposmia

Signs Purulent or mucopurulent discharge Anterior rhinoscopy: Pale, smooth surface, insensitive to touch, soft, arising from the lateral wall of the nose and directed posteriorly Posterior rhinoscopy: Polyp in the posterior choana

Investigation X-ray PNS OM view X-ray nasopharynx L/V Haziness in affected maxillary antrum and nasal cavity. X-ray nasopharynx L/V Soft tissue mass in nasopharynx, above and behind- air column present.

Treatment If facility available: ESS (Endoscopic sinus surgery) If facility of ESS is not available: Before 15 years of age: Polypectomy+ AWO under GA After 15 years of age: Cald well-Luc operation under GA

Ethmoidal polyp

It arises from the ethmoidal air cells and directed downwards and forwards to the anterior nares

Aetiology Mainly allergic

Pathology Allergy- prolonged oedema of mucosa and submucosa Accumulation of intracellular serous fluid and shows oedematous hypertrophy Mucosal swelling aggravated by the traction of discharge Interference of lymphatic flow Gravity and narrowness of the meatus promote downward extension and formation of polyp

Age: Common in middle age and elderly

Clinical features Symptoms: Nasal obstruction Nasal discharge Sneezing Anosmia Headache

Signs Clear or Purulent/ mucopurulent discharge Anterior rhinoscopy: Multiple pale, pedunculated, movable soft tissue mass, usually bilateral, insensitive to touch, soft in consistency, coming from ethmoidal region 3. Broadening of nasal bridge ( frog-face deformity)- Long standing case

Investigations Pus for CS X-ray PNS OM view: Haziness maxillary antrum (bilateral), Ethmoidal region hazy Nasal endoscopy CT scan

Treatment Conservative Antihistamine Local decongestant Topical steroid

Surgical: 1. FESS 2. Polypectomy 3. Ethmoidectomy Intranasal External

Antrochoanal polyp Ethmoidal polyp Age Children & young adult Middle age & elderly Origin Maxillary antrum Ethmoidal air cell Aetiology Mainly infection Manly allergic Number Usually single Usually multiple Direction Downward & backward to posterior choana Downward &forward toanterior nares Usually unilateral Usually bilateral Nasal obstruction During expiratory phase During inspiratory phase

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