Polyp

1. NASAL POLYPOSIS
Dr. Wachuka G. Thuku

2. Objectives
◦ Introduction
◦ Types
◦ Pathophysiology
◦ Predisposing Factors
◦ Sign and Symptoms
◦ Examination
◦ Management

3. Introduction
◦Nasal polyps are bags of oedematous mucosa prolapsing into the
nose or paranasal sinuses
◦Oedematous lamina propria of the nasal mucosa surrounded by
hyperplastic secreting mucosa
◦Nasal polyps usually arise from the ethmoid sinus and the region
of the middle meatus

4. Types
1. Nasal polyps
2. Antrochoanal polyps
3. Neoplastic polyps
4. Miscellaneous polyps

5. Stammberger Classification
1. Antrochoanal polyp;
2. Large isolated polyps;
3. Polyps associated with chronic rhinosinusitis (CRS), non-eosinophil
dominated, non-related to hyper-reactive airway syndromes;
4. Polyps associated with CRS, eosinophil dominated;
5. Polyps associated with specific disease (Cystic fibrosis, non-
invasive/ non-allergic fungal sinusitis, malignancy).

7. Common Locations
◦Stammberger found that 80% of nasal polyps arise from
middle meatus mucosa, uncinate process and infundibulum
◦65% originated from ethmoid bulla and hiatus semilunaris
and from the frontal recess in 48%
◦Polyps were found inside the ethmoid bulla in 30%

11. Pathogenesis
◦Numerous pathogenic theories
◦Final manifestation of chronic inflammatory disease eg
rhinosinusitis
◦Autonomic nervous system dysfunction
◦Genetic predisposition- disorders of ciliary motility such
as Kartageners and abnormal composition of nasal
mucosa e.g. cystic fibrosis

12. Pathogenesis

13. Factors predisposing to Polyps
1. Chronic infection
◦ B-hemolytic streptococci
◦ Staphylococcus aureus
◦ Strep pneumoniae
◦ H. influenzae
◦ Mainly neutrophillic infiltration rather than eosinophillic
2. Allergy – mainly eosinophilic infiltration
3. Aspirin hypersensitivity – Samter’s triad
4. Cystic fibrosis
5. Nasal mastocytosis

14. Conditions are associated with multiple benign polyps
1. Allergic conditions
• Bronchial asthma - In 20-50% of patients with polyps
• Allergic rhinitis
• 8-26% have aspirin intolerance
• 50% have alcohol intolerance
2. Cystic fibrosis
3. Allergic Fungal Sinusitis - Polyps in 85% of patients with AFS
4. Chronic rhinosinusitis
5. Primary ciliary dyskinesia
6. Churg-Strauss syndrome
7. Young syndrome (ie, chronic sinusitis, nasal polyposis, azoospermia)
8. Non-allergic rhinitis with eosinophilia syndrome (NARES)

16. Signs and Symptoms
◦ Could be asymptomatic
◦ Airway obstruction and Obstructive sleep apnea
◦ Postnasal drip
◦ Dull headaches or facial pain
◦ Snoring
◦ Headache
◦ Rhinorrhoea and nasal stuffiness
◦ Hyposmia / Anosmia
◦ Craniofacial abnormalities
◦ Optic nerve compression
◦ Nasal mass

17. Examination
• Anterior rhinoscopy
• In small children, use a headlamp and rhinologic speculum
• Characteristics: Smooth, glistening grape like masses often pale in
colour. May be sessile or pedunculated, do not bleed on touch
• Otoscopy for any otological symptoms
• Examination of oral cavity- large polyps may prolapse into postnasal
space and be visible in the oral cavity

20. ◦ A single, unilateral polyp originating high in the nasal cavity or with a
stalk that is not clearly visible may represent an encephalocele or
meningocele.
◦ Visible pulsations on endoscopy and enlargement of the mass with
ipsilateral internal jugular vein compression (Furstenberg’s sign) help to
confirm the diagnosis.
◦ As a rule, if the intranasal mass does not have the characteristic
appearance of a polyp, is unilateral, bleeds easily, or has a stalk that is not
clearly identified, imaging studies are indicated before proceeding with
management

21. Laboratory Testing
1. RAST / skin testing. A thorough allergy evaluation in patients with history
of environmental allergies or a strong family history of allergies.
2. Nasal smear
 Microbiology
 Eosinophils (allergic component)
 Neutrophils (chronic sinusitis)
3. Nasal polyposis in children -test for cystic fibrosis with either a sweat chloride
test or with hematologic genetic testing.

22. Imaging Studies
• Coronal nasal sinuses CT
• Gold standard. Shows the primary pathology, extent of disease and
possible bony destruction.
• Also aids in the assessment of the anatomy of the paranasal sinuses in
the event of surgical intervention.
• MRI only appropriate if intracranial extension is suspected. Bony details of
the paranasal sinus anatomy are poorly visualized on MRI.
• Radiography with Waters views may show opacification of the sinuses.

27. Histological Findings
◦Pseudostratified ciliated columnar epithelium
◦Thickened epithelial basement membrane
◦Oedematous stroma

28. Differential Diagnosis
1. Encephaloceles
2. Gliomas
3. Dermoid tumours
4. Haemangiomas
5. Papillomas / transitional cell papillomas
6. Lymphomas
7. Neuroblastomas
8. Sarcomas
9. Chordomas
10.Nasopharyngeal carcinomas
11.Juvenile nasopharyngeal angiofibroma

29. Medical Management
• Medical management is aimed at nonspecific treatment of this
inflammatory disorder.
• No clinical evidence shows that the management of allergies in atopic
individuals reduces or eliminates polyps.
• Oral corticosteroids are the most effective medication for the short-
term treatment of nasal polyps
• Antihistamines
• Intranasal steroid sprays may reduce or retard the growth of small
nasal polyps

30. Surgical Management
◦ Endoscopic sinus surgery and polypectomy
◦ Recurrence is common in multiple small polyps but less in
large and antrochoanal polyps

31. Thank You