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

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

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

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

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

8. 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

9. 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 )

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

11. 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

12. Differential Diagnosis
Enlarged turbinates
Nasopharyngeal Angiofibroma
Malignant growth
Antochoanal polyp
Foreign body
Rhinolith

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

14. Treatment Conservative: Treatment of underlying cause ? Antihistamines
Topical steroids / ? Short course of oral steroids
Surgical:
Intranasal polypectomy
Ethmoidectomy (Intranasal / external)
FESS

16. ..

17. .

18. 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

21. 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

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