NASAL POLYPOSIS

1
 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.
• A polyp presents with grape like appearance having a
body and a stalk.

2
 Epidemiology

• Prevalence rate is about 1-4%

• Increase with the age--peak at the age of 50
• Male: Female ratio is about 2:1

3
PATHOGENESIS

Nasal mucosa(oedematous due to collection of ECF)

↓
polypoidal change.
sessile in the beginning pedunculated due to gravity & excessive
sneezing.
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.
 SITES

Commonest sites in order of frequency are;

1. Ethmoids
2. Maxillary antrum
3. Sphenoids

6
Types of Nasal Polyps

BILATERAL
ETHMOIDAL
POLYPS

ANTROCHOANAL
 Bilateral Ethmoidal Polyps

• 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

8
Symptoms

• Nasal obstruction bilaterally.

• Partial or total loss of smell
• Headache
• Sneezing(Excessive) /watery nasal
discharge

9
 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.

10
 Aetiology

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.

11
 The Aspirin triad
• A triad of nasal polyposis ,asthma and aspirin
intolerance.
• It is a non allergic entity.

12
Findings

• Anterior Rhinoscopy • Nasal Endoscopy

13
 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.

14
TREATMENT

•ANTIHISTAMINICS & CONTROLOFALLERGY

•Revert to normal withedematous mucosa
•SHORT COURSE OF STEROIDS
• Prevent recurrence after surgery
•With intolerance to antihistamine o have asthma
• Contraindication --dm,htn,pepticulcer,pergnancy
Surgical
1. Polypectomy

2. Intranasal ethmoidectomy

3. Extranasal ethmoidectomy

4. Transantral ethmoidectomy

• In more severe cases surgery is required, FESS

 ANTROCHOANAL POLYP
• 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.

17
 ANTROCHOANAL POLYP

• 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
30 to 50 year old
• They are slightly more common in males compared to
females.

18
Endoscopic View

19
Symptoms
• Nasal obstruction
• Rhinorrhea
• Snoring
• Headache
• Mouth breathing
• Hyposmia
• Halitosis
• Dyspnea
• Nasal pruritis

21
Investigations
Plain X-ray film
• Waters View
• Unilateral opacification
of the maxillary sinus
• Nasopharyngeal mass is
occasionally seen
• Frequently bilateral sinus
involvement

22
Investigations
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

23
Differential Diagnosis
• Juvenile angiofibroma
• Meningoencephalocele
• Inverted papilloma
• Mucocele
• Mucus retention cyst
• Tornwalt's cyst
• Grossly enlarged adenoids
• Lymphoma
• Nasopharyngeal malignancies

24
 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.

25