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Nasal Polyps

Sheraz Ahmed

Page 1

Topics

Nasal polyps can be described under following headings

A. Definition
B. Incidence

C. Classification

D. Ethmoidal Polyp

Definition – Etiology – Pathogenesis -Pathology – Site of origin – Symptoms – Signs – Differential Diagnosis – Staging of mucosal polyp – Investigations – Treatment – Complications of surgery

E. Antrocoanal Polyp – Definition -Etiology-Pathology -Symptoms -Signs -Differential diagnosis -Treatment

F. Prevention of Recurrence of Nasal Polyps

G. Complications of Nasal Polyps

H. Important Points to Remember in a Case of Nasal Polyps

A: Definition

Nasal polyps are non-neoplastic masses of edematous nasal or sinus mucosa

B: Incidence

Incidence in general population is unknown possibly between 1 % -2 % . There is higher incidence in asthmatics (20 -30 %) and even higher (49 %) in those asthmatics hypersensitive to aspirin. It is most common in middle aged men.

C: Classification

Nasal polyps are classified into 2 main categories.

  1. Ethmoidal polyps, or mucosal polyps.
  2. Antrocoanal polyps.

D: Ethmoidal Polypi

Definition

There is edematous hypertrophy of submucosa with loose fibrous stroma.

Etiology

Polyps are RED FLAGS indicating the presence of chronic inflammatory: chronic sinusitis (longstanding bacterial infection of facial sinuses ) is one explanation; as is allergy (eg allergy to pollen, dust mites, mold spore, cat dander etc).

Other possible causes are:

  1. Gravity
  2. Forceful nose
  3. Nasal defects eg D.N.S.
  4. Heredity
  5. Age
  6. Sex
  7. Narrow nose

Pathogenesis

Nasal mucosa becomes edematous due to collection of extracellular fluid causing polypoidal change. Polypi which are sessile in the beginning become pedunculated due to gravity and excessive sneezing which is associated with allergy.

Pathology

Due to metaplasia ,the normal ciliated lining is converted into squamous type over the polyp side(which is exposed to atmospheric air ).There is also infiltration with eosinophil and round cells.

Site of Origin

Multiple nasal polypi arises from the lateral wall of nose usually from middle meatus. Common sites are:

  • Uncinate process,
  • Bulla ethmoidalis,
  • Ostia of sinuses,
  • Medial surface, and
  • Edge of middle turbinate

Note

Allergic nasal polypi almost never arises from the septum or floor of nose.



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