Nasal Polyposis Overview
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Questions and Answers

What is the primary structure from which nasal polyps arise?

Nasal polyps primarily arise from the ethmoid sinuses.

Name two main conditions associated with nasal polyposis.

Asthma and aspirin hypersensitivity are two main conditions associated with nasal polyposis.

What histological feature is commonly present in nasal polyps?

Nasal polyps typically have respiratory epithelium containing ciliated columnar cells and goblet cells.

Describe the appearance of nasal polyps in terms of color and texture.

<p>Nasal polyps are pale, translucent, and white, due to poor blood supply and are insensitive to probing.</p> Signup and view all the answers

What phenomenon explains the pressure changes that can lead to nasal polyp development?

<p>The Bernoulli phenomenon explains that a pressure drop next to a constriction can draw mucosa into the nasal cavity.</p> Signup and view all the answers

At what age range are nasal polyps most commonly diagnosed?

<p>Nasal polyps most commonly affect adults aged 30 to 50 years.</p> Signup and view all the answers

What is the male to female ratio of nasal polyp occurrences?

<p>The male to female ratio for nasal polyps is approximately 2:1 to 4:1.</p> Signup and view all the answers

What histological change may occur in nasal polyps due to repeated trauma?

<p>Repeated trauma may lead to squamous metaplasia in nasal polyps.</p> Signup and view all the answers

What are the most common complications associated with extra nasal ethmoidectomy?

<p>The most common complications include adhesions inside the nose (synechiae formation) and hemorrhages.</p> Signup and view all the answers

What differentiates an antrochoanal polyp from a simple ethmoidal polyp?

<p>An antrochoanal polyp arises from the maxillary antrum and extends to the nasal cavity, while simple ethmoidal polyps do not have this origin.</p> Signup and view all the answers

What imaging technique is preferred for diagnosing antrochoanal polyps, and why?

<p>CT-scan is preferred because it provides a detailed view of the sinus structures and the polyp's extent.</p> Signup and view all the answers

Why might recurrence of polyps not be classified as a complication of surgery?

<p>Recurrence is a feature of the disease itself rather than a result of the surgical procedure.</p> Signup and view all the answers

What is the significance of cribriform plate injury during extra nasal ethmoidectomy?

<p>Injury to the cribriform plate can lead to entry into the anterior cranial fossa and potential CSF leakage.</p> Signup and view all the answers

What are the main surgical options for treating an antrochoanal polyp in adults?

<p>Main surgical options include radical removal through the Caldwell-Luc operation and FESS.</p> Signup and view all the answers

Describe the typical presentation of an antrochoanal polyp during nasopharyngeal examination.

<p>An antrochoanal polyp typically causes nasal obstruction and mucoid nasal discharge, visible during examination.</p> Signup and view all the answers

What demographic factors are associated with the occurrence of antrochoanal polyps?

<p>Antrochoanal polyps are more common in males, usually appearing unilaterally.</p> Signup and view all the answers

What are the main symptoms associated with nasal obstruction due to polyps?

<p>The main symptoms include nasal obstruction, sneezing, rhinorrhea, loss of sense of smell, facial pain, postnasal drip, and epistaxis.</p> Signup and view all the answers

What radiological findings are indicative of nasal polyps?

<p>Findings include loss of translucency in the nose, hypertrophy of turbinates, deviation of the nasal septum, opaque ethmoid sinuses, thickened maxillary sinus mucosa, and fluid levels in the sinuses.</p> Signup and view all the answers

What is the role of intranasal corticosteroids in the treatment of nasal polyps?

<p>Intranasal corticosteroids help reduce inflammation and size of the polyps, making them effective in early stages and for small polyps.</p> Signup and view all the answers

How does eosinophilia relate to the appearance of postnasal drip?

<p>Severe eosinophilia may cause the postnasal drip to appear yellow and be referred to as allergic pus.</p> Signup and view all the answers

What are the indications for surgical intervention in the case of nasal polyps?

<p>Surgery is indicated if there is no response to medical treatment after one month or if the patient requires more than two courses of systemic steroids per year.</p> Signup and view all the answers

What are common signs observed in patients with nasal polyps?

<p>Common signs include a hyponasal voice, observed nasal polyps, mouth breathing, flaring of the alar cartilages, and hypertelorism.</p> Signup and view all the answers

What types of medications can be used as adjunct therapy to open the airway for nasal obstruction?

<p>Nasal decongestants like xylomethazoline and antihistamines are used to open the airway but should not be used for longer than recommended durations.</p> Signup and view all the answers

What is the recommended dosage and duration for using oral steroids in the treatment of nasal polyps?

<p>Oral steroids like prednisolone are recommended at dosages of 5-30 mg daily for 10 days, and can be given in divided doses with tapering.</p> Signup and view all the answers

Which condition is commonly associated with nasal polyps, particularly in adults aged 30-50?

<p>Asthma</p> Signup and view all the answers

What is the appearance of nasal polyps due to their poor blood supply?

<p>Pale, translucent, and white</p> Signup and view all the answers

What phenomenon is described as the pressure drop next to a constriction that can lead to nasal polyp formation?

<p>Bernoulli phenomenon</p> Signup and view all the answers

What histological feature occurs in nasal polyps alongside respiratory epithelium due to trauma?

<p>Squamous metaplasia</p> Signup and view all the answers

What is the male to female ratio of nasal polyps?

<p>2:1 to 4:1</p> Signup and view all the answers

What type of hypersensitivity is associated with aspirin and nasal polyposis?

<p>Aspirin hypersensitivity</p> Signup and view all the answers

At what age do nasal polyps most commonly affect individuals?

<p>30-50 years</p> Signup and view all the answers

Which mucosal changes can result from infections leading to nasal polyps?

<p>Hypersecretion and herniation</p> Signup and view all the answers

What are common nasal symptoms associated with nasal polyps?

<p>Common symptoms include nasal obstruction, sneezing, rhinorrhea, and loss of sense of smell.</p> Signup and view all the answers

What are the typical signs to observe in patients with nasal polyps?

<p>Signs include a hyponasal voice, mouth breathing, and possible polyps visible at the nose.</p> Signup and view all the answers

What is the role of intranasal corticosteroids in managing nasal polyps?

<p>Intranasal corticosteroids are used to reduce inflammation and can be effective for small polyps.</p> Signup and view all the answers

What is the indication for surgical intervention in the treatment of nasal polyps?

<p>Surgical intervention is indicated if there is no response to medical treatment after one month.</p> Signup and view all the answers

What are some potential complications of nasal polypectomy?

<p>Potential complications include recurrence of polyps and localized bleeding.</p> Signup and view all the answers

How does eosinophilia affect postnasal drip in patients with nasal polyps?

<p>Severe eosinophilia can change the color of postnasal drip to yellow, termed 'allergic pus.'</p> Signup and view all the answers

What non-surgical treatments can aid in relieving nasal obstruction caused by polyps?

<p>Medications such as nasal decongestants and antihistamines can provide relief.</p> Signup and view all the answers

What radiological findings might suggest the presence of nasal polyps?

<p>Findings include loss of translucency in the nose and thickened maxillary sinus mucosa.</p> Signup and view all the answers

What is the most common complication associated with extra nasal ethmoidectomy?

<p>Adhesions inside the nose (synechiae formation) are the most common complication.</p> Signup and view all the answers

What condition arises from the maxillary antrum and can cause nasal obstruction?

<p>Antrochoanal polyp arises from the maxillary antrum and can cause nasal obstruction.</p> Signup and view all the answers

Which imaging technique shows mucosal thickening or complete opacity of the maxillary antrum?

<p>An X-ray of the sinuses shows mucosal thickening or complete opacity of the maxillary antrum.</p> Signup and view all the answers

What surgical technique is suggested for radical removal of an antrochoanal polyp in adults?

<p>The Cald–weil–Luc operation is suggested for radical removal in adults.</p> Signup and view all the answers

What is the primary reason why recurrence of polyps is not considered a complication of surgery?

<p>Recurrence of polyps is a feature of the disease, not a complication of the surgery.</p> Signup and view all the answers

What are the common symptoms of an antrochoanal polyp present in the nasal cavity?

<p>Common symptoms include nasal obstruction and mucoid nasal discharge.</p> Signup and view all the answers

What anatomical damage can occur due to trauma during extra nasal ethmoidectomy?

<p>Trauma can lead to damage to the cribriform plate and the orbit.</p> Signup and view all the answers

What demographic factors influence the occurrence of antrochoanal polyps?

<p>Antrochoanal polyps are more common in males and can occur unilaterally or bilaterally.</p> Signup and view all the answers

Study Notes

Nasal Polyposis

  • Definition: Nasal polyp is a prolapsed lining from the nasal sinuses, primarily the ethmoid sinuses, into the nasal cavity, causing airway obstruction.
  • Etiology:
    • Allergy: 90% of polyps have eosinophilia, associated with asthma and allergy symptoms.
    • Infection: Sinusitis can lead to polypoid changes in the sinus mucosa, causing hypersecretion and herniation into the nasal cavity.
    • Bernoulli phenomenon: Pressure drop from nasal constriction can "suck" sinus mucosa into the nose.
    • Vaso-motor imbalance: In some cases without obvious allergens or eosinophilia.
    • Polysaccharide changes in ground substance
  • Conditions associated with polyps:
    • Asthma: 20-40% of patients with polyps have asthma, particularly late-onset asthma.
    • Aspirin Hypersensitivity: About 8% of cases.
    • Age: Most common in adults 30-50 years old.
    • Sex: Male to female ratio is 2:1 to 4:1.
    • Samters triad: Asthma, nasal polyposis, and aspirin hypersensitivity.
  • Macroscopic Features:
    • Commonly arise from the ethmoid sinuses and prolapse from the middle meatus.
    • Pale, translucent, and white due to poor blood supply.
    • Insensitive to probe, differentiating them from polypoid middle turbinate mucosa.
    • Redness possible with trauma or infection, and may prolapse out of the nose.
  • Histology:
    • Respiratory epithelium (ciliated columnar cells with goblet cells).
    • Squamous metaplasia may occur with repeated trauma.
  • Nasal Symptoms:
    • Nasal obstruction: Varies in degree, depending on size.
    • Sneezing: Present in 50% of patients.
    • Rhinorrhea: Present in 50% of patients.
    • Loss of sense of smell.
    • Pain: Over bridge of nose, forehead, and cheeks.
    • Postnasal drip: Typically white, but can become green or yellow, with severe eosinophilia causing yellow "allergic pus."
    • Epistaxis: Due to frequent nose cleaning.
  • Signs
    • Hyponasal voice.
    • Visible polyps out of the nose.
    • Mouth breathing.
    • Flaring of alar cartilages.
    • Hypertelorism.
    • Intranasal signs (mentioned before).
  • Investigations:
    • Anterior rhinoscopy is sufficient to diagnose nasal polyp.
  • Radiology:
    • X-ray: Loss of translucency, turbinate hypertrophy, nasal septum deviation, opaque ethmoid sinuses, thickened maxillary sinus mucosa, sinus fluid levels.
    • CT-scan: Preferred imaging technique.
  • Treatment:
    • Medical Treatment: (Smaller polyps, early stages)
      • Intranasal corticosteroids
      • Nasal steroid sprays
      • Oral steroids
      • Other drugs: Nasal decongestants (short-term), antihistamines.
      • 50% of cases may respond to medical treatment without surgery.
      • If no improvement after 1 month, or if 2+ courses of systemic steroids/year are needed, surgery is considered.
    • Surgical Treatment:
      • Simple polypectomy.
      • Intranasal ethmoidectomy (with or without endoscopy - FESS).
      • Extra nasal ethmoidectomy (EEE).
  • Complications of Surgery:
    • Hemorrhage.
    • Trauma to cribriform plate (CSF leakage).
    • Trauma to orbit (orbital fat herniation).
    • Damage to medial rectus muscle.
    • Nasal adhesions (synichiae formation)
    • Damage to turbinate and nasal septum.
  • Note: Polyp recurrence is a feature of the disease, not necessarily a complication of surgery.

Antrochoanal Polyp

  • Definition: A polyp originating from the maxillary antrum (sinus), extending through the middle meatus into the nasal cavity and nasopharynx, sometimes extending to the anterior nasal cavity
  • Epidemiology:
    • More common in males.
    • Typically unilateral, but can be bilateral.
    • Most often around the age of 40.
  • Features:
    • Covered by respiratory epithelium, but no eosinophilia.
    • Similar in color to ethmoidal polyps.
  • Symptoms:
    • Nasal obstruction.
    • Mucoid nasal discharge.
  • Signs:
    • Anterior rhinoscopy.
    • Nasopharyngeal mirror examination.
  • Etiology: Unknown.
  • Radiology:
    • X-ray of sinuses: Mucosal thickening or complete maxillary antrum opacity.
    • Lateral sinus X-ray: Mass at the nasopharynx.
    • CT-scan: Preferred imaging technique.
  • Treatment:
    • No medical treatment is effective.
    • Surgery:
      • Simple polypectomy: Used in children (dentition not complete), but recurrence is possible.
      • Radical removal (Cald-Weil-Luc operation): Used in adults with complete dentition, lower recurrence rate. Performed through the gingiva.
      • FESS: Functional endoscopic sinus surgery.

Nasal Polyposis

  • Definition: Nasal polyps are prolapsed linings of nasal sinuses, mainly the ethmoid sinuses, into the nasal cavity. Their size can obstruct airflow.
  • Etiology:
    • Allergy: Associated with eosinophilia, asthma, and allergic signs and symptoms.
    • Infection: Sinus infections can cause polypoidal mucosa with hypersecretion and herniation into the nasal cavity.
    • Bernoulli Phenomenon: A pressure drop near a constriction can suck sinus mucosa into the nose.
    • Vaso-Motor Imbalance: Some polyps occur without obvious allergens or eosinophilia.
    • Polysaccharide Changes: Changes in the ground substance may contribute to polyp formation.

Conditions Associated with Polyps

  • Asthma: 20-40% of polyp patients have asthma, and vice versa. Late-onset asthma is more commonly associated with polyps, with a 5-year association between the conditions.
  • Aspirin Hypersensitivity: About 8% of patients with polyps experience aspirin hypersensitivity.
  • Aspirin-Exacerbated Respiratory Disease (AERD) (Samters Triad): This includes asthma, nasal polyposis, and aspirin hypersensitivity.
  • Age: Mainly affects adults aged 30-50.
  • Sex: Male to female ratio is 2:1 to 4:1.

Macroscopic Features

  • Nasal polyps primarily originate in the ethmoid sinuses, sometimes in the maxillary sinuses, then prolapse from the middle meatus.
  • They are pale, translucent, and white due to poor blood supply.
  • Insensitive to probe, differentiating them from the sometimes polypoidal middle turbinate mucosa.
  • Polyps may turn red with repeated trauma or infection and may prolapse out of the nose.

Histology

  • Respiratory epithelium (ciliated columnar cells with goblet cells) is present.
  • Repeated trauma can lead to squamous metaplasia.

Nasal Symptoms

  • Nasal obstruction: Varies depending on polyp size.
  • Sneezing: Present in 50% of patients.
  • Rhinorrhea: Present in 50% of patients.
  • Loss of sense of smell: A common symptom.
  • Pain: May occur over the bridge of the nose, forehead, and cheeks.
  • Postnasal drip: Usually white, but can be green or yellow. Severe eosinophilia can turn the drip yellow, known as "allergic pus."
  • Epistaxis: May occur due to excessive nasal cleaning.

Signs

  • Hyponasal voice
  • Polyps visible outside the nose
  • Mouth breather
  • Flaring of the alar cartilages
  • Hypertelorism
  • Intranasal signs

Investigations

  • Anterior Rhinoscopy: Usually sufficient to diagnose nasal polyps.
  • Radiology: Similar to nasal allergic rhinitis.
    • X-ray: Can show loss of translucency in the nose, turbinate hypertrophy, nasal septum deviation, opaque ethmoid sinuses, thickened maxillary sinus mucosa, and fluid levels in the sinuses.
    • CT Scan: Preferred method for imaging.

Treatment:

  • Medical Treatment: Used for smaller polyps and early cases, especially when nasal obstruction is not complete.

    • Intranasal Corticosteroids: Betamethasone (methadin) 2 drops each side twice daily for 1 month.
    • Steroid Nasal Sprays: Beclomethasone (beconase) or budesonide (cortinase) 2 puffs each side twice daily for 1 month.
    • Oral Steroids: Prednisolone 5-30 mg (1 mg/kg) daily for 10 days, administered in divided doses, and often tapered.
    • Post-surgery treatment: Steroids are used to prevent polyp recurrence.
    • Response: 50% of patients with polyps may respond to medical treatment and avoid surgery.
    • Surgery: If no response is seen after 1 month or if multiple courses (2 or more) of systemic steroids are needed per year.

  • Surgical Treatment:

    • Simple Polypectomy: Removal of polyps.
    • Intranasal Ethmoidectomy: With or without endoscopy (Functional Endoscopic Sinus Surgery - FESS).
    • Extra-Nasal Ethmoidectomy (EEE)

Complications of Surgery:

  • Hemorrhage

  • Trauma to Cribriform Plate: May lead to anterior cranial fossa entry and CSF leakage.

  • Trauma to Orbit: Damage to the lamina papyracea can result in orbital fat herniation.

  • Damage to Medial Rectus Muscle of the Eye

  • Adhesions Inside the Nose (Synechiae Formation): Most common complication.

  • Damage to Turbinate and Nasal Septum

  • Note: Polyp recurrence is not a surgical complication but a feature of the disease.

Antrochoanal Polyp

  • Definition: A polyp arising from the maxillary antrum that prolapses through the middle meatus ostium into the nasal cavity and then into the nasopharynx.

  • Characteristics:

    • More common in males.
    • Typically unilateral but may be bilateral.
    • Similar in color to simple ethmoidal polyps.
    • Covered by respiratory epithelium without eosinophilia.

  • Symptoms:

    • Nasal obstruction
    • Mucoid nasal discharge

  • Diagnosis:

    • Anterior rhinoscopy
    • Nasopharyngeal mirror examination

  • Etiology: Unknown.

  • Radiology:

    • X-Ray: Shows mucosal thickening or complete opacity of the maxillary antrum. Lateral sinus X-ray shows a mass in the nasopharynx.
    • CT Scan: Preferred method.

Treatment:

  • No medical treatment; surgically removed.
    • Simple Polypectomy: Especially in children with incomplete dentition. Recurrence may occur.
    • Radical Removal (Caldwell-Luc Operation): More radical surgery done only in adults with complete dentition and lower recurrence rates. Performed through the gingiva.
    • FESS: Functional Endoscopic Sinus Surgery: A minimally invasive option for the removal of polyps.

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