1. Nasal polyp

3. 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.

4. Types:
Antrochoanal polyp
Ethmoidal polyp

5. Antrochoanal polyp

6. Aetiology
Mainly infection

7. 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

8. Histopathology

9. Age:
Common in children and young adult

10. Clinical features Symptoms: Nasal obstruction Nasal discharge Headache
Hyposmia

12. 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

13. 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.

16. 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

17. Ethmoidal polyp

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

20. Aetiology
Mainly allergic

21. 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

22. Age: Common in middle age and elderly

23. Clinical features Symptoms: Nasal obstruction Nasal discharge Sneezing
Anosmia
Headache

24. 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

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

30. Treatment Conservative Antihistamine Local decongestant
Topical steroid

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

32. 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

33. Thanks to all