Nasal polyps are non-cancerous masses of swollen nasal or sinus mucosa that can develop due to conditions like chronic rhinosinusitis or cystic fibrosis. There are two main types: bilateral ethmoidal polyps which originate in the ethmoid sinuses, and antrochoanal polyps which arise from the maxillary sinus near its opening and extend into the nasal cavity and nasopharynx. Symptoms include nasal congestion, loss of smell, headache and sneezing. Diagnosis involves clinical examination, CT scan and biopsy. Treatment options range from medical management with steroids or antihistamines to surgical polypectomy or functional endoscopic sinus surgery.

2. SINONASAL
POLYPS
BY
DR. TAHIR
PGR

3. “Polyps are Non-neoplastic
masses of oedematous nasal or sinus
mucosa”

4. TYPES
1. BILATERAL ETHMOIDAL POLYPS
2. ANTROCHOANAL POLYPS

5. BILATERAL ETHMOIDAL POLYPS
1. Inflammatory condition of nasal mucosa
- Rhinosinusitis
2 . Disorders of ciliary motility
- Kartagener’s syndrome
3 . Abnormal composition of nasal mucus
- Cystic fibrosis
AETIOLOGY

6. Various diseases associated with the formation of nasal
polyps are:
• Chronic rhinosinusitis (Alleregic & Nonallergic) NARES
• Kartagener syndrome
• Cystic fibrosis 20%
• Asthma 7%
• Aspirin tolerance 36% (Samter’s triad)
• Allergic fungal Sinusitis 100%
• Young Syndrome (sinopulmonary disease + Azoospermia)
• Churg-Strauss Syndrome
• Nasal mastocytosis (nasal mucosa infiltrate with mast cells but few eosinophils)

7. PATHOGENESIS
Nasal mucosa (middle meatus and turbinate)
Becomes edematous due to collection of ECF
Polypoidal Changes
Sessile/Pedunculated (due to gravity and excessive sneezing)

8.  Epithelium: Nasal polyp (surface covered by ciliated
columnar epithelium)
 Metaplastic changes in exposure to atmospheric irritation
-Transitional & Squamous epithelium
Submucosa: Large ICS filled with serous fluid + infiltration
with eosinophils and round cells

9. SITE OF ORIGION
Multiple nasal polyps always arise from the lateral wall of nose,
usually from the middle meatus.
Common sites:
• Uncinate process
• Bulla ethmoidalis
• Ostia of sinuses
• Medial surface & edge of middle turbinate
Never arise from septum and floor of nose.

10. SYMPTOMS
• Mostly seen in adults
• Nasal stuffiness leading to total nasal obstruction
• Partial/total loss of smell
• Headache (associated sinusitis)
• Sneezing and watery nasal discharge (associated allergy)
• Protruding mass from the nostril

11. SINGS
• On anterior rhinoscopy, polyps appear as:
- Smooth, glistening
- Grapelike masses
- Often pale in color
- May be sessile or pedunculated
- Insensitive to probing
- Do not bleed on touch
- Often multiple and bilateral
• Broadening of nose
• Increase intercanthal distance
• May protrude from nostril and appear pink and vascular,
simulating neoplasm
• Purulent discharge (associated sinusitis)

12. DIAGNOSIS
• Clinical examination
• CT scan of paranasal sinuses
- exclude neoplasia & bony erosion
- to plan surgery
• Histological Examination
- especially in people >40 years

13. TREATMENT
CONSERVATIVE
• Antihistaminics & Control of allergy
- may revert early polypoidal changes with oedematous
mucosa to normal
• Short Course of Steroids (Medical polypectomy)
- in people who cannot tolerate antihistaminics or with
asthma and polypoidal nasal mucosa

14. TREATMENT
SURGICAL
• Polypectomy
• Intranasal ethmoidectomy
• Extranasal ethmoidectomy
• Transantral ethmoidectomy
• FESS ( Functional endoscopic sinus surgery)

15. ANTROCHOANAL POLYP
SITE OF ORIGIN
Arise from the mucosa of maxillary antrum near its accessory
ostium, comes out of it, and grow in the choana and nasal
cavity
Thus, it has 3 parts
1. Antral
2. Choanal
3. Nasal

16. SYMPTOMS
Unilateral nasal obstruction
Bilateral nasal obstruction
- when polyp grows into nasopharynx and starts
obstructing the opposite choana
Thick and dull voice due to hyponasality
 Nasal discharge

17. SIGNS
Anterior rhinoscopy • Large, smooth, greyish mass covered with nasal discharge
• Soft, can be moved up and down with probe
• May protrude from the nostril and shows pink
(congested)
• May be missed as it grows posteriorly
Posterior rhinoscopy
• Globular mass filling the choana or the nasopharynx
• A large polyp may hang down behind soft palate and
present in oropharynx

18. INVESTIGATIONS
Nasal endoscopy
- May reveal choanal or antrochonal polyp
hidden posteriorly in the nasal cavity
Xrays of paranasal sinuses
- May show opacity of the involved antrum
Lateral view xray
- Globular swelling in postnasal space
- Column of air behind the polyp

19. DIFFERENTIAL DIAGNOSIS
1. A blob of mucus
- disappear on blowing nose
2. Hypertrophied middle turbinate
- Pink appearance
3. Angiofibroma
- History of profuse recurrent epistaxis
- firm in consistency
- easily bleed on touch
4. Neoplasms
- fleshy pink appearance
- friable nature
- tendency to bleed

20. TREATMENT
Avulsion
Recurrence is uncommon after complete removal
In case of recurrence, Cladwell-Luc operation
- complete removal of polyp from site of origion
Endoscopic sinus surgery is now preferred

23. Thank You !