History of nasal polyp


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History of nasal polyp

  1. 1. History of Nasal polyposis Dr T Balasubramanian
  2. 2. Introduction <ul><li>Nasal polypi first reported 4000 years ago
  3. 3. Egyptians were pioneers in diagnosis & trt of nasal polypi
  4. 4. Egyptians were familiar with nasal anatomy as they used this route to suck out the brain contents during mummification procedures
  5. 5. Samuel of Egypt described a large polyp hanging in the throat strangulating a patient </li></ul>
  6. 6. Contribution of Hippocrates <ul><li>Father of Rhinology
  7. 7. Coined the term polyp
  8. 8. This term was used because they resembled sea polyp
  9. 9. First described the surgical procedure to remove nasal polypi </li></ul>” Nasal polyps are sacs of phlegm that cause nasal obstruction and deranges the sense of smell” Hippocrates
  10. 10. Etiopathology <ul><li>1 st Century AD – Celsus documented nasal polypi enlarged in size during moist weather
  11. 11. Celsus hypothesized nasal polypi to be local manifestation of systemic disorder
  12. 12. Boerhaave hypothesized nasal polyp to be elongated nasal mucosa - 17 th century
  13. 13. Mann & Heister – Nasal polypi are formed due to obstruction of mucosal glands </li></ul>“ A Nasal polyp shows itself by bad smell of the nose” Samuel
  14. 14. Billroth hypothesis <ul><li>Billroth demonstrated that nasal polypi microscopically resembled nasal mucosa
  15. 15. He also postulated nasal infections somehow could play a role in the genesis of polypi
  16. 16. In his classic treatise published in1843 he concluded that nasal polypi could be nothing but hypertrophic nasal mucosa </li></ul>
  17. 17. Virchow's hypothesis <ul><li>Considered nasal polyp to be primary tumors like fibroma / myxoma
  18. 18. Stressed on the relationship between the age of occurence and nasal deformity </li></ul>
  19. 19. Eggston's theory <ul><li>Nasal polypi are formed due to vascular changes in the submucosal blood vessels
  20. 20. These changes are caused by inflammation and periphlebitis
  21. 21. The passive oedema of nasal mucous membrane is caused by venous stasis </li></ul>
  22. 22. Burn's theory <ul><li>Also known as mucopolysaccharide theory
  23. 23. Mucopolysaccharides present in the stroma could somehow play a role in the pathogenesis of nasal polypi
  24. 24. Stromal mucopolysaccharides under go changes in response to allergy and nasal mucosal inflammation causing the mucosa to swell </li></ul>
  25. 25. Berden's theory <ul><li>Nasal polypi could be caused due to allergic inflammation of nasal mucosa
  26. 26. He was able to demonstrate the reagin responsible for inflammation of nasal mucosa
  27. 27. Allergic reactions involving the nasal mucosa caused mucosal oedema </li></ul>
  28. 28. Syndromes associated with nasal polyp <ul><li>Lurie described the association between nasal polypi and cystic fibrosis in 1959
  29. 29. Samter & Beer described the classic samter's triad in 1969.
  30. 30. Components of samter's triad include – nasal polypi, aspirin hypersensitivity and bronchial asthma </li></ul>
  31. 31. Instruments used to examine the nasal cavity <ul><li>Hippocrates designed a tubular nasal speculum inspired by the speculum designed by Hindu surgeons of yesteryears
  32. 32. Hildanus designed the currently available nasal speculum. Hildanus speculum underwent different modifications to evolve into its present form
  33. 33. Morrel Mecenzie used mirrors to reflect sunlight to examine the nasal cavity </li></ul>
  34. 34. Medical Management <ul><li>Hippocrates used tampoons dipped in honey and pepper
  35. 35. Celsus used caustic agents to treat nasal polypi
  36. 36. Galen used oil of turpentine to treat nasal polyp
  37. 37. Daniel Bovet used antihistamines in the treatment of nasal polypi for the first time </li></ul>
  38. 38. Surgical management <ul><li>Rolando of Italy used strings with knots to remove nasal polypi
  39. 39. Hippocrates described a method of removing the nasal polypi and delivering it via the post nasal space by using a large tampoon which can be pushed into the nasal cavity there by dislodging the polypi </li></ul>
  40. 40. Thank you