MAJ ZEESHAN AYUB MBBS, MCPS, FCPS CLASSIFIED ENT SPECIALIST NASAL POLYPS MAJ ZEESHAN AYUB MBBS, MCPS, FCPS CLASSIFIED ENT SPECIALIST

NASAL POLYPS An edematous , pedunculated mass arising from mucous membrane of nose or paranasal sinuses

TYPES Two main types Simple / mucosal / Ethmoidal nasal polypi Antrochoanal nasal polyp

Other nasal polyps / Resembling polypi Bleeding polypus  hemangioma / fibroangioma / granuloma Malignant growths  CA , Lymphoma , Melanoma & sarcoma Nasopharyngeal angiofibroma Rhinosporidiosis

Etiology Allergic Infection Vasomotor imbalance Mucopolysaccharide changes Bernoulli's phenomenon Genetics : Monozygotic twins Aspirin allergy

Pathology 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 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 )

Nasal obstruction , unilateral / bilateral Hyposmia / Anosmia PND Snoring Speech changes Nasal discharge , Watery / mucopurulent Headache

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 Enlarged turbinates Nasopharyngeal Angiofibroma Malignant growth Antochoanal polyp Foreign body Rhinolith

Investigations Blood CP,ESR Blood sugar X-RAY PNS X-RAY Chest PA Biopsy Nasal secretions for Cytology & C/S Tests for Allergy

Treatment 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 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 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 Pre-op. investigations: Same as for mucosal polyps. SURGERY Polypectomy  Intranasal / Oral route Cald Wel Luc’s operation