Nasal polyps are abnormal lesions that originate from the nasal mucosa or paranasal sinuses. They are most commonly caused by chronic inflammation from various sources. Nasal polyps present with symptoms like nasal obstruction, postnasal drip, and headaches. Investigations include CT scans, nasal endoscopy, and tests for conditions like cystic fibrosis. Treatment options include oral steroids, sinus surgery to remove polyps, and addressing underlying causes of inflammation. While surgery provides relief, nasal polyps often recur due to the chronic inflammatory nature of the condition.

1. Nasal Polyps

2. Landmarks Of Lateral Wall Of
Nasal Cavity
 Lateral wall is marked by three bony
projections called turbinates or conchae
superior ,middle ,inferior
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3.  nasolacrimal duct opens in the anterior part of
Inferior meatus .
 Middle meatus- consists of bulla ethmoidalis,
hiatus semilunaris, infundibulum. Frontal,
maxillary and anterior ethmoidal sinuses open
into middle meatus.
 Superior meatus- posterior ethmoidal sinuses
open into it.
 Sphenoethmoidal recess- triangular fossa
above the superior meatus. Sphenoidal sinus
opens into it.
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5. Nasal Polyps
• abnormal lesions that originate from
any portion of the nasal mucosa or
paranasal sinuses.

6.  Polyps are an end result of varying disease
processes in the nasal cavities.
 The most commonly discussed polyps
are benign semitransparent nasal lesions

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9. Classification:
1/ Bilateral Ethmoidal polyps
2/ Antrochoanal Polyps
3/ Neoplastic

10. Ethmoidal polyps
. arise from Middle meatus
• Insensitive to touch
• blood supply is poor.(Pale colour)
• When unilateral, exclude malignancy.

11. Antrochoanal Polyp
arise from maxillary sinus.
3 parts channel,nasal, antrum.
end result of prolong sinus infection
unilateral

12. Differential diagnosis:
1/ hypertrophied middle turbinate, probe test,
2/ Angiofibroma
3/other neoplasm, fleshy appearance. and
bleed easily. e.g. squamous cell carcinoma,
adenocarcinoma

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14. Histopathology
 Nasal polyps are characterized by a pseudostratified
ciliated columnar epithelium, thickening of the
epithelial basement membrane, 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

15. Multiple Vs Solitary
 Multiple polyps can occur in children with chronic
sinusitis, allergic rhinitis, CF, and AFS
 An isolated polyp could be an antral-choanal
polyp , a benign massive polyp, a nasolacrimal duct
cyst or any congenital lesion or benign or malignant
tumor .
 Evaluate all children with benign multiple nasal
polyposis for CF and asthma.

16. chronic inflammation (from whatever
source) apparently has an initial
role in the pathogenesis of nasal
polyps.

17. Simple polyps can arise any time after age
2yrs, before this suspect
meningocele,encephalocoel.(do CT scan)
Before age 10 yrs. Rare…..
if found suspect cystic fibrosis,(do sweat
test)

18. Frequency
 Adults 1-4%
 Children 0.1%
 All races and social classes
 M/F 3:1 in adults
 Increasing incidence with age

19. Theories
 Bernstein theory
 Vasomotor theory
 Epithelia rupture theory

20. Bernstein theory
 Inflammatory changes in lateral nasal wall or sinus
mucosa
 Polyps originate from contact area
 Ulceration, reepithelialisation and new gland
formation
 Inflammatory processes from epithelial cells,
endothelium and fibroblasts
 Integrity of sodium channels affected

21.  the heightened inflammatory process from
epithelial cells, vascular endothelial cells, and
fibroblasts affects the bioelectric integrity of
the sodium channels
 This response increases sodium absorption,
leading to water retention and polyp
formation.

22. The vasomotor imbalance theory
 postulates that increased vascular permeability
and impaired vascular regulation cause
detoxification of mast-cell products (eg,
histamine).
 The prolonged effects of these products within the
polyp stroma result in marked edema (especially
in the polyp pedicle) that is worsened by venous
drainage obstruction.

23. The epithelial rupture theory
 suggests that rupture of the epithelium of the nasal
mucosa is caused by increased tissue turgor in
illness (eg, allergies, infections). This rupture
leads to prolapse of the lamina propria mucosa,
forming polyps.
 The defects are possibly enlarged by gravitational
effects or venous drainage obstruction, causing
the polyps.

24. Clinical Presentation
 Airway obstruction
 Postnasal drip
 Dull headaches
 Snoring
 Rhinorhoea
 Hyposmia / Anosmia
 Epistaxis (often other lesion)
 Obstructive sleep apnoea

25. Investigations
 Sweat test.(Cystic fibrosis)
 RAST(radioallergosorbent test/ skin testing)
 Nasal smear
 Microbiology
 Eosinophils (allergic component)
 Neutrophils (chronic sinusitis)

26. Imaging
 Coronal CT scan
 MRI scan
 Flexible nasendoscopy
 Rigid nasendoscopy

27. Fiber optic Nasophyrangoscopy.

28.  Coronal CT scan
through anterior
sinuses. Opacification
of left maxillary sinus,
opacification of
inferior half of nasal
cavity. Due to antro
coanal polyp.

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30. Management
Conservative : Oral steroid. Prednisolon
30mg for 3 days,20mg for 3 days,10mg for 3
days.
Surgery
1/ simple polypctomy
2/ Nasal polytectomy (With debrider and
FESS.)

31.  Endoscopic sinus surgery (ESS) is a better
technique that not only removes the polyps but
also opens the clefts in the middle meatus, where
they most often form, which helps decrease the
recurrence rate.

32. Nasal Polypectomy
 Microdebrider
entering left
middle meatus

33. Summary
 Common condition in adults
 Aetiology not fully understood
 Majority are not allergic in nature
 Medical treatment can be effective
 Even with surgery, recurrence is common

34. جزاكم الله خير ا