Nasal Polyposis 2022-2023 PDF

NASAL POLYPOSIS Dr. Luqman A. Mustafa M.B.Ch.B, FKBMS (ORL-HNS) UOD/SCHOOL OF MEDICINE 2022-2023 Nasal Polyposis Definition: Nasal polyp is the prolapsed lining of the nasal sinuses (mainly the ethmoid sinuses) to the nasal cavity to a variable degree with causing of obstructio...

NASAL POLYPOSIS Dr. Luqman A. Mustafa M.B.Ch.B, FKBMS (ORL-HNS) UOD/SCHOOL OF MEDICINE 2022-2023 Nasal Polyposis Definition: Nasal polyp is the prolapsed lining of the nasal sinuses (mainly the ethmoid sinuses) to the nasal cavity to a variable degree with causing of obstruction of air passage in the nose to a degree depend on its size. prolapsed lining of nasal sinuses tonasal cality Ethmoid obstructionof air passages Etiology: 1.Allergy: because 90% of nasal polyps have an eosinophilia, and 8 associated with asthma, and has signs and symptoms of allergy. 2.Infection: infection of nose may extend to sinuses and make the sinus mucosa to be polypoidal with hypersecretion and herniation to nasal cavity. E 3.Bernoulli phenomenon, which said that there is a pressure drop next a constriction. This pressure drop sucks the mucosa of sinus into the nose. 4.Vaso – motor imbalance because some cases of polyps has no obvious allergen or eosinophilia. 5. polysaccride changes in ground substance  Conditions associated with polyps: 1.Asthma: 20-40% of patients with polyps associated with presence of asthma and vice versa, especially late onset asthma is more associated with polyps mainly during 5 years of each other. 2.Aspirin hypersensitivity: about 8%. Age: mainly affect adults at age of 30-50 years. Sex: male to female ratio is 2:1 to 4:1. Aspirin exacerbated respiratory disease ”AERD” (Samters triad): asthma, nasal polyposis, aspirin hypersensitivity. AND U  And Macroscopic features: o Nasal polyps mainly arise from ethmoid sinuses then maxillary sinuses and prolapses from middle meatus. It is pale, translucent, and white due to poor blood supply. It is insensitive to probe and this differentiates it from mucosa of middle turbinate which may also be polypoidal in some times. Polyps may become red in color with repeated trauma or infection and may prolapse out of nose. HE cent Histology: Polyps have respiratory epithelium (ciliated columnar cells with goblet cells). With repeated trauma, squamous metaplasia may occur. ciliated soluble  nasal obstruction Nasal symptoms: 585Th 1) Nasal obstruction to a variable degree depends on its size. 2) Sneezing: 50% of patients have sneezing. 3) Rhinorrhea: in 50%. 4) Loss of sense of smell. 5) Pain may occur especially over bridge of the nose, forehead and cheeks. 6) Postnasal drip: it is manly white but may become green or yellow. Severe eosinophilia may change the color of drip to yellow so it is named allergic pus. 7) Epistaxis may occur due to extensive cleaning of the nose.  nasalObstruction ineering Signs: im 1. Patients have hyponasal voice. 2. Polyps may be seen out of the nose. 3. Mouth breather. 4. Flaring of the alar cartilages. 5. Hypertelorism. 6. Intranasal signs (mentioned previously).  Investigations: These are same of nasal allergic rhinitis. Aneroir rhinoscopy is enough to diagnose nasal polyp Radiology: Ant Rv x-ray? CT-scan 8 Loss of translucency in the nose, hypertrophy of turbinate’s and deviation of nasal septum, ethmoid sinuses are opaque, thickened maxillary sinus mucosa, fluid level in the sinuses. T Treatment: I- Medical treatment: this is mainly used in earlier cases and when polyps are small and not cases complete obstruction of the nose. 1) Intranasal corticosteroid like betamethasone (methadin) 2 drops each side twice daily for 1 month. Ie 2) Steroid like nasal sprays like beclomethasone (beconase) or budesonide (cortinase) 2 puffs each side twice daily for 1 month. 3) Oral steroids like prednisolone 5-30 mg (1 mg/kg) daily for 10 days which can be given in divided doses (tapering).  All these steroid therapies can also be used after surgery to prevent recurrence. 50% of cases with polyps may respond to medical treatment and do not need surgery. If no response after 1 month, or if needed 2 courses of a systemic steroids/year then we can remove polyps by surgery. We can also use other drugs to open the airway like nasal decongestants (xylomethazoline) but not for more than 5-7 days, antihistamine.  II- Surgical treatment: 1. Simple polypectomy. Em Intra 2. Intranasal ethmoidectomy with or without endoscopy (functional endoscopioc sinus surgery “FESS”). 3. Extra nasal ethmoidectomy EEE t  Complications of surgery: 1. Hemorrhages. 2. Trauma to cribriform plate more medially with entering of anterior cranial fossa and CSF leakage. 3. Trauma to orbit laterally with damage to thin lamina papracia and then herniation of orbital fat. 4. Damage to medial rectus E muscle of the eye. 5. Adhesions inside the nose (synichiae formation) “most common complication”. 6. Damage to turbinate and nasal septum Note: Recurrence of polyps is not a complication of the disease Surgery since it is a feature of the disease.  Antrochoanal polyp This polyp arises from the maxillary antrum (sinus) and prolapses through ostium of the middle meatus to nasal cavity and goes back to nasopharynx with other head to anterior nasal cavity. r at age of 40 years and it is These polyps are more common in male, o g mainly unilateral but may be bilateral, and mainly similar in color to simple ethmoidal polyp. These polyps are covered by respiratory epithelium but there is no eosinophilia. It can cause nasal obstruction, mucoid nasal discharge, seen in anterior rhinoscopy and also seen by nasopharyngeal mirror examination of the nasopharynx. I Etiology is unknown mainly. Radiology: X- ray of sinuses shows mucosal thickening or complete opacity of maxillary antrum. I Lateral sinus X-ray shows mass at nasopharynx. CT-scan: Preferred  Treatment: There is no medical treatment; it can be treated only by surgical removal. 1. Simple polypectomy especially in children because dentition is not complete. Recurrence may occur by this method. 2. Radical removal by Cald –weil –Luc operation which is more radical surgery and done only in adults when dentition is complete and recurrence rate is less. Through gingiva 3. FESS ANY QUESTION