Indmedica - India's Premier Medical Portal - Cyber Lectures

 

Nasal Polyps

Sheraz Ahmed

Page 3

Topics

Treatment of Mucosal Polyps

Conservative

  1. Use of antihistamines and control of allergy if polyps are small and without symptoms.
  2. Medical treatment with topical nasal steroids (beclomethasone dipropionate aqueous nasal spray; 200 micro gram twice a day) for 1-3 months initially is useful successful for small polyps

A short course of oral corticosteroids (eg prednisolone; 6 day course using 215 milligram tablets)may be benefit.

Contraindications to use of steroids are:

Hypertension,Peptic ulcer, Diabetes, Pregnancy and Tuberculosis.

Surgical Treatment

When medical management is unsuccessful, polyps should be removed surgically.

When frequent recurrence is likely or surgery itself is associated with increased risk a more complete procedure (etmoidectomy) may be advisable.

In recurrent polyposis, it may be necessary to remove polyps from ethmoid , sphenoid and maxillary sinuses to provide long lasting relief.

This may be done by intranasaly ,endoscopically ,via an anterior transantral route through the gingivolabial sulcus (Caldwell Luc)or through an external skin incision depending on the extent of disease.

Complications of Surgery.

Adhesions, Anosmia, Damage to orbital contents, Meningitis, Asthma

E: Antrocoanal Polyps

Definition

This polyp arises from the mucosa of maxillary antrum near its accessory ostium, comes out and grows in choana and nasal cavity . Thus it has 3 parts

Antral, Choanal, Nasal

Etiology

Nasal allergy coupled with sinus infection is important cause. These polyps are seen in children and young adults .usually they are single and unilateral.

Pathology – Two views about it

  1. It is mucous cyst.
  2. It is due to catarrhal protrusion of mucosa through accessory ostium.

Symptoms

  1. Unilateral nasal obstruction.
  2. Voice may become thick and dull due to hyponasality.
  3. Mucoid nasal discharge.
  4. Difficulty in chewing and swallowing.
  5. Nasal deformity (late cases).

Signs

On Anterior Rhinoscopy

  1. When small, may be missed.
  2. When large, smooth grayish mass covered with nasal discharge may be seen.
  3. It is soft and can be moved up and down with a probe.

On Posterior Rhinoscopy

  1. May reveal globular mass filling the choana.
  2. A large polyp may hang down behind the soft palate and present in the oropharynx.

1 2 3 4 Previous page Next page Back