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NASAL POLYPOSIS
Moderator -Dr.Jyothi Swarup
Presenter-Dr.Razal
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Definition
• Nasal polyp are non-neoplastic mass of edematous
nasal or sinus mucosa.
• An inflammatory reaction involving the mucous
membrane of nose ,the paranasal sinus ,often lower
airways.
• Presents with grape like appearance having a body and
a stalk.
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Epidemiology
• Prevalence rate is about 1-4%
• Increase with the age(peak at the age of 50s
• Male: Female ratio is about 2:1
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Histo-pathology
• Histologically, nasal polyps are characterized by a
pseudostratified ciliated columnar epithelium 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
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Sites
Commonest sites in order of frequency are;
1. Ethmoids
2. Maxillary antrum
3. Sphenoids
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Causes
1. Allergic rhinitis, Allergic fungal sinusitis
2. Asthma-7% of patient shows polyp
3. Cystic fibrosis(disease of Exocrine glands)
4. Kartagener syndrome(Bronchiectasis,Chronic Sinusitis situs
inversus,ciliary dyskinesia)
5. Nickel exposure
6. Young’s Syndrome- It consists of chronic rhiniosinusitis, nasal
polyposis, bronchiectasis and azoospermia.
7. Churg-Strauss Syndrome-Affects small to medium-sized
arteries and veins.
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The Aspirin triad
• A triad of nasal polyposis ,asthma and aspirin
intolerance.
• It is a non allergic entity.
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ETHMOIDAL POLYP
• Multiple polyps always arise from lateral wall of nose,
usually from middle meatus.
• Common sites are uncinate process, bulla ethmoidalis,
medial surface of middle turbinate
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Symptoms
• Nasal obstruction bilaterally.
• Partial or total loss of smell
• Headache
• Sneezing(Excessive) /watery nasal discharge
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Signs
• Smooth, glistening, grapelike masses, Multiple and
bilateral.
• Often greyish-pale in color, long standing polyps may
appear pinkish.
• May be sessile or pedunculated, insensitive to touch,
does not bleed on touch and probe can be passed all
around the mass.
• Long standing cases may present with broadening of
nose and increase in inter-canthal distance.
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• Anterior Rhinoscopy • Nasal Endoscopy
Findings
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Differential Diagnosis
• Hypertrophied turbinates (pink in colour,sensitive to
touch, probe cannot be passed laterally)
• Inverted papilloma-Irregular surface, pink in color,
common in middle aged female and arises from lateral
wall.
• Malignant tumors-Blood tinged nasal discharge,
irregular proliferative growth.
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Treatment
• Includes intranasal or systemic steroids and Leukotrine
inhibitors.
• A short course of systemic steroids can serve as
‘medical polypectomy’.
• In more severe cases surgery is required, FESS.
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ANTROCHOANAL POLYP
• Syn Killian’s polyp
• They are benign polypoid lesions arising
from the maxillary antrum and they
extend into the choana.
• A-C Polyps usually have three
components
o Antral Part
o Nasal Part
o Choanal Part
• A-C Polyps are almost always unilateral,
although bilateral A-C Polyps have been
reported.
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• Arises from maxillary and passes through the maxillary
ostium into the middle meatus, and then extends
towards the nasopharynx / oropharynx.
• mostly originates from the posterior, inferior, lateral or
medial walls of the maxillary antrum.
• They are most commonly seen in young adults and in
3rd to 5th decades.
• They are slightly more common in males compared to
females.
ANTROCHOANAL POLYP
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Endoscopic View
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Symptoms
• Nasal obstruction
• Rhinorrhea
• Snoring
• Headache
• Mouth breathing
• Hyposmia
• Halitosis
• Dyspnea
• Nasal pruritis
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Plain X-ray film
• Waters View
• Unilateral opacification
of the maxillary sinus
• Nasopharyngeal mass is
occasionally seen
• Frequently bilateral sinus
involvement
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Investigations

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Computed Tomography
• Defined mass with mucin
density is seen arising
within the maxillary sinus
• Widening of maxillary
ostium and extending in
to nasopharynx
• No associated bony
destruction but rather
smooth enlargement of
sinus
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Investigations

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Differential Diagnosis
• Juvenile angiofibroma
• Meningoencephalocele
• Inverted papilloma
• Mucocele
• Mucus retention cyst
• Tornwalt's cyst
• Grossly enlarged adenoids
• Lymphoma
• Nasopharyngeal malignancies
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Treatment
• The treatment of A-C Polyp is always surgical.
• Simple polypectomy and for recurrent polyps Caldwell
Luc procedure were the previously preferred methods for
surgical treatment.
• In recent years, functional endoscopic sinus surgery
(FESS) became the more preferred surgical technique.
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