Nasal Polypi

Definitionnon neoplastic edematous nasal or

sinus mucosa.Nasal polyps are abnormal lesions that originate from any portion of the nasal mucosa or paranasal sinuses.Polyps are an end result of varying disease processes in the nasal cavities.

malignant tumours.

IntroductionNasal polyps are abnormal lesions that originate from

any portion of the nasal mucosa or paranasal sinuses.Polyps are an end result of varying disease processes

in the nasal cavities.Benign polyps.Other benign or malignant tumours.

Classification:

1/ Bilateral Ethmoidal polyps

2/ Antrochoanal Polyps

3/ Neoplastic

Pathology: Histologically, nasal polyps are characterized by a pseudostratified ciliated columnar epithelium, thickening of the epithelial basement membrane, and few nerve endings. The stroma of nasal polyps is edematous.

Eosinophil cells are the most commonly identified inflammatory cell, occurring in 80-90% of polyps.

Neutrophils in 7% of polyps

Multiple polyps can occur in children with chronic sinusitis, allergic rhinitis, cystic fibrosis (CF), or allergic fungal sinusitis (AFS). An individual polyp could be an antral-choanal polyp, a benign massive polyp, or any benign or malignant tumor (eg, encephaloceles, gliomas, hemangiomas, papillomas, juvenile nasopharyngeal angiofibromas, rhabdomyosarcoma, lymphoma, neuroblastoma, sarcoma, chordoma, nasopharyngeal carcinoma, inverting papilloma). Evaluate all children with benign multiple nasal polyposis for CF and asthma.

Next Section: Pathophysiology

Ethmoidal polyps arise from Middle meatus

•Insensitive to touch

•blood supply is poor.(Pale colour)

•When unilateral Exclude malignancy.

CausesAs described in Pathophysiology, chronic

inflammation (from whatever source) apparently has an initial role in the pathogenesis of nasal polyps. Multiple polyps occur in children with chronic sinusitis, allergic rhinitis, CF, and AFS. An isolated polyp could be an antral-choanal polyp , a benign massive polyp, a nasolacrimal duct cyst or any congenital lesion or benign or malignant tumor .

Simple polyps can arise any time after age 2yrs, before this suspect meningocele,encephalocoel.(do ct. scan)

Before age 10 yrs. rare if found suspect cystic fibrosis,(do sweat test

FrequencyAdults 1-4%Children 0.1%All races and social classesM/F 2-4:1 in adultsIncreasing incidence with age

Associated with allergic conditions20-50% have asthmaAllergic rhinitis8-26% have aspirin intolerance50% have alcohol intolerance

Various theoriesBernstein theoryVasomotor theoryEpithelia rupture theory

Bernstein theoryInflammatory changes in lateral nasal wall or

sinus mucosaPolyps originate from contact areaUlceration, reepithelialisation and new gland

formationInflammatory processes from epithelial cells,

endothelium and fibroblastsIntegrity of sodium channels affected

Clinical Presentation

Airway obstructionPostnasal dripDull headachesSnoringRhinorhoeaHyposmia / AnosmiaEpistaxis (often other lesion)Obstructive sleep apnoea

Coronal CT scanMRI scanFlexible nasendoscopyRigid nasendoscopy

Coronal CT scan through anterior sinuses. Opacification of left maxillary sinus, opacification of inferior half of nasal cavity. Due to antro coanal polyp.

Antrochoanal Polyp;arise from maxillary sinus.

3 parts channel,nasal, antrum.

end result of prolong sinus infection

unilateral

differential diagnosis, 1/ hypertrophied middle turbinate, probe test,

2/ Angiofibroma

other neoplasm, fleshy appearance.fiable tissue and bleed easily. e.g. squamous cell carcinoma, adenocarcinoma

Fiber optic Nasophyrangoscopy.Coronal CT scanMRI scan

2020

InvestigationsSweat test.(Cystic fibrosis)RAST(radioallergosorbent test/ skin testingNasal smear

MicrobiologyEosinophils (allergic component)Neutrophils (chronic sinusitis)

Clinical Presentation

Airway obstructionPostnasal dripDull headachesSnoringRhinorhoeaHyposmia / AnosmiaEpistaxis (often other lesion)Obstructive sleep apnoea

Management:

Conservative : Oral steroid. Prednisolon 30mg for 3 days,20mg for 3 days,10mg for 3 days.

Surgery 1/ simple polypctomy

2/ Nasal polytectomy (With debrider and FESS.

Endoscopic sinus surgery (ESS) is a better technique that not only removes the polyps but also opens the clefts in the middle meatus, where they most often form, which helps decrease the recurrence rate.

Nasal Polypectomy

Microdebrider entering left middle meatus

SummaryCommon condition in adultsAetiology not fully understoodMajority are not allergic in natureMedical treatment can be effectiveEven with surgery, recurrence is common

Thank You

Questions: 10 yrs. old boy with nasal polyps, the child suffers from recurrent lung infections with thick, sticky sputum and his skin tastes salty.

whats your diagnosis

Name one test to confirm your diagnosis.

Question 2: A 40yrs male suffer from unilateral Nasal obstruction,and symptoms of sinusitis.Anterior rhinoscopy reveals nasal Polyp.

1/ what radiological investigation you will request.explain why.

2/ treatment option 3/ would you send specimen for histology ,explain why.