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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.