Nasal polyps are hypertrophied mucosal growths often stemming from allergic reactions and sinus infections, predominantly affecting children and young adults. They typically present with unilateral or bilateral nasal obstruction, nasal discharge, and may be discovered via nasal endoscopy or imaging. Treatment options include antihistamines and surgical procedures like endoscopic sinus surgery for persistent cases.

1. NASAL POLYPS

2. Definition
• Hypertrophied, edematous, pedunculated mucosa
prolapsing out of nose or paranasal sinuses

4. Pathology

6. Antrochoanal Polyp (Killian’s Polyp)
• It arises from mucosa of maxillary antrum near its accessory ostium,
comes out of it, and grows in the choana and nasal cavity.
• It consists of three parts:
i. Antral: A thin stalk
ii. Nasopharyngeal: Round and globular
iii. Nasal: Flat from side to side.

7. Etiology
• Nasal allergy along with sinus infection.
• Seen in children and young adults.
• Usually unilateral and single.

8. Symptoms
• Unilateral nasal obstruction
• Bilateral nasal obstruction
-when polyp grows into the nasopharynx
-starts obstructing the opposite choana
• Thick and dull voice – hyponasality
• Nasal discharge- mostly mucoid

9. Signs
• On anterior rhinoscopy – sometimes it may be missed as it grows
posteriorly
• Large, smooth, greyish mass
covered with nasal discharge.
• Soft and mobile
• May protrude from nostril
-pink and congested

10. • On posterior rhinoscopy
-globular mass filling the choana
or nasopharynx
-a large polyp may sometimes be also seen
hanging down in the oropharynx.

11. Investigations
• Nasal endoscopy
-may reveal choanal or antrochoanal polyp
hidden posteriorly in the nasal cavity

12. • X ray of PNS
-show opacity of the
involved antrum
• Lateral view xray
-column of air behind the polyp

13. Bilateral Ethmoidal Polyposis
• Common sites of origin are
-uncinate process,
-bulla ethmoidalis,
-ostia of sinuses and
-medial surface and edge middle turbinate.
• Nasal polyps usually never arise from the septum or the floor of nose.

14. Etiology
• Inflammatory conditions of nasal mucosa
-Rhinosinusitis
• Disorders of ciliary motility
- Kartagener’s syndrome
• Abnormal composition of nasal mucus
- Cystic fibrosis

15. • Various diseases associated are
- Chronic rhinosinusitis
- Kartagener syndrome: Bronchiectasis, sinusitis, situs inversus and ciliary
dyskinesis.
- Young’s syndrome: Sinopulmonary disease and azoospermia.
- Churg-Strauss syndrome: Asthma, fever, eosinophilia, vasculitis and
granuloma
- Samter’s triad: It is the triad of nasal polyps, asthma and aspirin
intolerance.
- Allergic fungal sinusitis.

16. Symptoms
• Mostly seen in adults
• Nasal stuffiness- leading to total nasal obstruction
• Partial/ Total loss of smell
• Headache
• Sneezing and watery nasal discharge
• Protruding mass

17. Signs
• On anterior rhinoscopy, polyp looks like:
-smooth glistening
-grape like masses
-pale in colour
-sessile or pedunculated
-insensitive to probe
-does not bleed on touch
-multiple and bilateral

18. Investigations
• On Nasal endoscopy

19. • On CT

20. Differential Diagnosis
a. Bleb of mucus:
-It disappears on blowing the nose.
b. Hypertrophied middle turbinate:
-It is pink in color
-hard like bone on probe testing.

21. c. Angiofibroma:
- It occurs in adolescent male
- profuse recurrent episodes of epistaxis.
- Easily bleeds on touch
d. Neoplasms:
-fleshy pink appearance
-friable nature
-tendency to bleed

22. Treatment
Conservative
• Antihistamines
-may revert early polypoidal changes with edematous mucosa to
normal
• Short course of steriods

23. Surgical
Currently almost all the polyps, which do not respond to medical
treatment, are managed by ESS.
• Snare
-Solitary pedunculated polyp can be removed with snare.
-Krause’s nasal snare is used for removal of nasal polyps and partial
turbinectomy. The polyp mass is engaged in the wire loop and avulsed
• FESS

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