Nasal polyps are non-cancerous growths that can develop in the nose or sinuses. They are most common in people over 50 years of age and affect males more than females. Histologically, nasal polyps contain edema fluid and high numbers of eosinophil inflammatory cells. The most common sites for nasal polyps are the ethmoid and maxillary sinuses. Nasal polyps can cause symptoms like nasal obstruction, loss of smell, sneezing and headaches. Treatment involves steroid nasal sprays, oral steroids or surgery to remove the polyps.

1. NASAL POLYPOSIS
Moderator -Dr.Jyothi Swarup
Presenter-Dr.Razal
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2. 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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3. 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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4. 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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5. Sites
Commonest sites in order of frequency are;
1. Ethmoids
2. Maxillary antrum
3. Sphenoids
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6. 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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7. The Aspirin triad
• A triad of nasal polyposis ,asthma and aspirin
intolerance.
• It is a non allergic entity.
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8. 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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9. Symptoms
• Nasal obstruction bilaterally.
• Partial or total loss of smell
• Headache
• Sneezing(Excessive) /watery nasal discharge
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10. 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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11. • Anterior Rhinoscopy • Nasal Endoscopy
Findings
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12. 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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13. 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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14. 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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15. • 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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16. Endoscopic View
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18. Symptoms
• Nasal obstruction
• Rhinorrhea
• Snoring
• Headache
• Mouth breathing
• Hyposmia
• Halitosis
• Dyspnea
• Nasal pruritis
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19. 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

20. 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

21. Differential Diagnosis
• Juvenile angiofibroma
• Meningoencephalocele
• Inverted papilloma
• Mucocele
• Mucus retention cyst
• Tornwalt's cyst
• Grossly enlarged adenoids
• Lymphoma
• Nasopharyngeal malignancies
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22. 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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