Nasal polypi otorhinolaryngology types etiology management ent ppt antrochoanal ethmoidal polyp etiology diagram management treatment medical ent ppt

1. NASAL POLYPI

2. NASAL POLYPI
• non-neoplastic masses of oedematous nasal or sinus mucosa
POLYPI
BILATERAL
ETHMOIDAL
ANTROCHOANAL

3. BILATERAL ETHMOIDAL POLYP
• Multiple BILATERAL
• arise from the lateral wall of nose, usually from the middle meatus.
• Common sites
• uncinate process,
• bulla ethmoidalis
• ostia of sinuses,
• medial surface and edge of middle turbinate.
• Allergic nasal polypi almost never arise from the septum or the floor
of nose.

4. ETIOLOGY
• inflammatory conditions of nasal mucosa (rhinosinusitis),
• disorders of ciliary motility or
KARTAGENER’S SYNDROME
• abnormal composition of nasal mucus (cystic fibrosis)

5. ETIOLOGY
• CHRONIC RHINOSINUSUTITS esp N.A.R.E.S
• ASTHMA (atopic/nonatopic)
• ASPIRIN INTOLERANCE
• CYSTIC FIBROSIS.
• ALLERGIC FUNGAL SINUSITIS.
• KARTAGENER'S SYNDROME.
• YOUNG'S SYNDROME.
• CHURG-STRAUSS SYNDROME
• NASAL MASTOCYTOSIS.
Asthma
Aspirin intolerance SAMTERS TRIAD
Polyp

6. PATHOGENESIS
Nasal mucosa(oedematous due to collection of ECF)
↓
polypoidal change.
sessile in the beginning pedunculated due to gravity & excessive
sneezing.

7. Pathology
nasal polypi (ciliated columnar epithelium)
↓
metaplastic change on exposure to atmospheric irritation
↓
transitional and squamous type.
↓
Submucosa shows large intercellular spaces filled with serous fluid +
infiltration with eosinophils and round cells.

8. Symptoms
• 1. mostly seen in adults.
• 2. Nasal stuffiness leading to total nasal obstruction may be the
presenting symptom.
• 3. anosmia (Partial or total)
• 4. Headache due to associated sinusitis.
• 5. Sneezing and watery nasal discharge due to associated allergy.
• 6. Mass protruding from the nostril.

9. Signs
• On anterior rhinoscopy,
• multiple and bilateral
• smooth, glistening, grape-like masses often pale in colour.
• sessile or pedunculated,
• insensitive to probing and do not bleed on touch.
• Long-standing cases present with broadening of nose and increased
intercanthal distance.
• A polyp may protrude from the nostril and appear pink and vascular
simulating neoplasm
• purulent discharge due to associated sinusitis.

10. DIAGNOSIS
• CLINICAL EXAMINATION
• CT  PARANASAL SINUSES } BONE EROSION &EXPANSION
NEOPLASIA

11. TREATMENT
• ANTIHISTAMINICS & CONTROL OF ALLERGY
• Revert to normal with edematous mucosa
• SHORT COURSE OF STEROIDS }
• Prevent recurrence after sx
• With intolerance to antihistamines/asthma
• c/I : dm,htn,peptic ulcer,pergnancy

12. Surgical
• Polypectomy:
• 1 or 2 & pedunculated polyp }using snare ….
• multiple & sessile } with special forceps
• Intranasal ethmoidectomy:
• multiple & sessile polyps
• by uncapping of air cells by intranasal route
• Extranasal ethmoidectomy:
• recur after intranasal procedure due to lack of surgical landmarks ….
• through medial wall of orbit
• Transantral ethmoidectomy :
• Infn and polypoidal change also involves maxillary antrum
• Cald well luc approach  maxillary antrum through medial wall of
antrumethmoidal air cells

13. Endoscopic sinus surgery
• Functional endoscopic sinus surgery (FESS)
• Using endoscopes of 0’ , 30’ & 70’ angulation
• Polypi can be removed more accurately when ethmoid cells are
removed, and drainage and ventilation provided to the other involved
sinuses such as maxillary,sphenoidal or frontal

14. Antrochoanal type

15. Antrochoanal
• Single & unilateral
• Children & young adults

16. Antrochoanal polyp
It arises from mucous membrane of the floor
and medial wall of maxillary sinus close to
the accessory ostium,
comes out of it and
starts growing towards the choana and nasal
cavity.
That
is the reason it has 3 parts, i.e. antral, choanal & nasal

17. Parts of antrochoanal type
• Antral  thin stalk
• Choanal round & globular
• Nasal  flat from side to side

18. etiology
• Exact ?
• Nasal allergy with sinus infn?

19. SYMPTOMS
• U/L NASAL OBSTN  polyp grows in to nasopharynxobstruct
opposite choana B/L NASAL OBSTN
• THICK & DULL VOICE(HYPONASALITY)
• NASAL DISCHARGE (MUCOID)

20. SIGNS
• missed on anterior rhinoscopy (antrochoanal polyp grows posteriorly)
When large, a smooth greyish mass covered with nasal discharge may
be seen.
• It is soft and can be moved up and down with a probe.
• A large polyp may protrude from the nostril and show a pink
congested look on its exposed part .
• Posterior rhinoscopy may reveal a globular mass filling the choana or
the nasopharynx. A large polyp may hang down behind the soft
palate and present in the oropharynx

21. DDs
• ANGIOFIBROMA } firm & bleeds on touch….H/O recurrent epistaxis
• BLEB OF MUCUS } disappear on blowing nose
• HYPERTROPHY OF CONCHAE (MIDDLE) } PINK & hard feel of bone
• OTHER NEOPLASMS } pink ,friable,bleeds on touch

23. Treatment
• avulsion either through the nasal or oral route.
• Caldwell-Luc operation } RECURRENCE +maxillary sinusitis.
• endoscopic sinus surgery

24. • 1. red and fleshy, friable and has granular surface, especially in older
patientsmalignancy.
• Epistaxis and orbital symptoms associated with a polyp } malignancy.
• 2. histology } Simple nasal polyp with a malignancy underneath.
• 3. A simple polyp } glioma, an encephalocele or a
meningoencephalocele. It should always be aspirated and fluid
• examined for CSF. Careless removal of such polyp would result in CSF
rhinorrhoea and meningitis.
• 4. Multiple nasal polypi in children } mucoviscidosis.

25. Causes of unilateral nasal obstruction

26. Causes of bilateral nasal obstruction