1. Nasal Polyps
Dr. Vishal Sharma

2. Nasal Polyp
Hypertrophied, oedematous, prolapsed mucosa of nose & paranasal sinus.
Properties of nasal polyp:
 Gray in colour  Glistening  Smooth surface
 Pedunculated  Insensitive to pain  Mobile
 Does not bleed on probing

3. Antro-choanal Polyp

4. Clinical Presentation
 Adolescent / child
 Unilateral nasal obstruction
 Unilateral nasal discharge

5. Differential diagnosis
Hypertrophied inferior turbinate
Blob of mucous
Inverted papilloma
Rhinosporiosis & rhinoscleroma
Angiofibroma
Meningocoele
Malignancy

6. Nasal mass

7. Oropharynx examination

8. Oropharynx examination

9. Posterior rhinoscopy

10. Examination of nasal mass
Inspection = side, size, number, color, surface, pedunculated or sessile, origin, attachment
Probing = consistency, sensitivity to touch, bleeding on touch, can be passed all around
Shrinkage with decongestant drops

11. Hypertrophied turbinate Probe can be passed all around
Probe test
Antrochoanal polyp
Hypertrophied turbinate
Insensitive to pain
Sensitive
Probe can be passed all around
Cannot be passed
Mobile
Not mobile

12. Etiology & origin Etiology: Infective maxillary sinusitis
Anomaly of maxillary sinus ostium
Origin:
Arises from maxillary sinus mucosa & exits via its natural or accessory ostium

13. Why AC polyp goes back? 1. Maxillary ostium is directed posteriorly
2. Cilia beat posteriorly
3. Air current flows posteriorly
4. Nasal floor slopes posteriorly
5. Posterior nasal cavity is larger
6. Negative oropharynx pressure while swallowing

14. Investigations Diagnostic Nasal Endoscopy X-ray PNS (Waters view)
X-ray nasopharynx lateral view:
presence of air b/w skull base & polyp
CT scan PNS (coronal cuts)

15. Diagnostic Nasal Endoscopy

16. Diagnostic Nasal Endoscopy

17. X-ray Paranasal Sinus

18. C.T. scan Paranasal Sinus

19. C.T. scan Paranasal Sinus

20. Treatment Antibiotics (pre & post operatively)
F.E.S.S. (avulsion polypectomy with middle meatal antrostomy)
Caldwell – Luc operation (for recurrence)

21. How to prevent recurrence
Complete removal of all parts
Wide middle meatal antrostomy (widening of maxillary sinus ostium)
Post-operative antibiotics

22. Parts of Killian’s A.C. polyp
Antral: globular
Nasal: flattened transversely
Choanal: globular
Neck: present at maxillary ostium

23. Middle meatal antrostomy

24. Caldwell – Luc Operation

25. Ethmoid Polyp

26. Clinical Presentation
Adult patient
Bilateral nasal obstruction
Bilateral watery nasal discharge
Excessive, paroxysmal sneezing
H/o previous nasal surgery

27. B/l nasal mass

28. Anterior rhinoscopy

29. Broadening of nasal bridge

30. Etiology of ethmoid polyp
1. Allergy
2. Allergy + Infection
3. Vasomotor imbalance
4. Bernoulli phenomenon
5. Poly-saccharide changes

31. Associated diseases
1. Aspirin intolerance + Bronchial asthma + Ethmoid polypi = Samter’s triad
2. Cystic fibrosis Allergic fungal sinusitis
4. Kartagener’s syndrome (ciliary dyskinesia +
situs invertus)
5. Young’s syndrome (hyperviscous mucous +
azoospermia)

32. Investigations Diagnostic Nasal Endoscopy (D.N.E.)
X-ray PNS (Rhese lateral oblique view)
C.T. scan P.N.S. (coronal cuts)
Tests for allergy

33. Diagnostic Nasal Endoscopy

34. Diagnostic Nasal Endoscopy

35. Diagnostic Nasal Endoscopy

36. CT scan Paranasal Sinus

37. Non-surgical Treatment
Given for very small polyps
Avoid allergens
Oral antihistamines (1-3 months)
Corticosteroid nasal sprays (3-6 months)
Oral prednisolone (1 mg/kg/day for 2 weeks)

38. Pre-steroid vs. Post-steroid

39. Surgical Treatment Intra-nasal avulsion polypectomy
Extra-nasal external ethmoidectomy
Trans-antral ethmoidectomy
Functional Endoscopic Sinus Surgery
 Conventional  Micro-debrider  Laser

40. F.E.S.S.

41. F.E.S.S. instruments

42. F.E.S.S. with navigation

43. Micro-debrider

44. Micro-debrider

45. How to prevent recurrence
1. Complete removal of all polyps
2. Avoid allergens
3. Post-operative course of:
Oral antihistamines (1-3 months)
Corticosteroid nasal sprays (3-6 months)

46. Bilateral FESS cavities

47. Post FESS CT scan

48. Antrochoanal polyp Ethmoid polyp Seen in adolescents & children Adult
Etiology is infection
Allergic
Single
Multiple
Unilateral
Bilateral
Shape is tri-lobed (dumbbell)
Grape like
Grows backward
Forward
Treatment is surgical
Medical + Surgical
Recurrence is uncommon
Common

49. Thank You