NASAL POLYPS
-
Upload
christen-burton -
Category
Documents
-
view
33 -
download
5
description
Transcript of NASAL POLYPS
NASAL POLYPSNASAL POLYPS
MAJ ZEESHAN AYUBMAJ ZEESHAN AYUB
MBBS, MCPS, FCPSMBBS, MCPS, FCPS
CLASSIFIED ENT SPECIALISTCLASSIFIED ENT SPECIALIST
NASAL POLYPSNASAL POLYPS
An edematous , pedunculated mass An edematous , pedunculated mass arising from mucous membrane of arising from mucous membrane of nose or paranasal sinuses nose or paranasal sinuses
TYPESTYPES
Two main typesTwo main types
1.1. Simple / mucosal / Ethmoidal nasal Simple / mucosal / Ethmoidal nasal polypipolypi
1.1. Antrochoanal nasal polypAntrochoanal nasal polyp
Other nasal polyps / Resembling Other nasal polyps / Resembling polypipolypi
1.1. Bleeding polypus Bleeding polypus hemangioma / hemangioma / fibroangioma / granulomafibroangioma / granuloma
2.2. Malignant growths Malignant growths CA , Lymphoma CA , Lymphoma , Melanoma & sarcoma, Melanoma & sarcoma
3.3. Nasopharyngeal angiofibromaNasopharyngeal angiofibroma
4.4. RhinosporidiosisRhinosporidiosis
EtiologyEtiology
AllergicAllergic InfectionInfection Vasomotor imbalanceVasomotor imbalance Mucopolysaccharide changesMucopolysaccharide changes Bernoulli's phenomenonBernoulli's phenomenon Genetics : Monozygotic twinsGenetics : Monozygotic twins Aspirin allergyAspirin allergy
PathologyPathology
Collection of edema fluid in submucosa Collection of edema fluid in submucosa with collection of cells e.g. eosinophils , with collection of cells e.g. eosinophils , plasma cells & macrophagesplasma cells & macrophages
Covered with ciliated columnar epithelium, Covered with ciliated columnar epithelium, long standing exposure long standing exposure squamous squamous metaplasiametaplasia
Edematous swelling hangs down due to Edematous swelling hangs down due to gravity / Bernoulli’s phenomenon & gravity / Bernoulli’s phenomenon & assumes polypoidal shapeassumes polypoidal shape
Scanty blood supplyScanty blood supply InsensativeInsensative
Clinical FeaturesClinical Features
Common in adults , incidence Common in adults , incidence increases with age increases with age
A/C polyp common in teensA/C polyp common in teens If polyps in young children If polyps in young children Cystic Cystic
fibrosis to be excludedfibrosis to be excluded Male predominance ( 3 : 1 )Male predominance ( 3 : 1 )
Nasal obstruction , unilateral / bilateralNasal obstruction , unilateral / bilateral Hyposmia / AnosmiaHyposmia / Anosmia PNDPND SnoringSnoring Speech changesSpeech changes Nasal discharge , Watery / Nasal discharge , Watery /
mucopurulentmucopurulent HeadacheHeadache
EpiphoraEpiphora Blockage earsBlockage ears Broad nose / Frog noseBroad nose / Frog nose ProptosisProptosis Grayish white ( grape like ) pedunculated Grayish white ( grape like ) pedunculated
masses , soft , smooth , freely mobile & masses , soft , smooth , freely mobile & insensitive to touchinsensitive to touch
Probe can be passed around themProbe can be passed around them If metaplasia If metaplasia pink / red color pink / red color
Differential DiagnosisDifferential Diagnosis
1.1. Enlarged turbinatesEnlarged turbinates
2.2. Nasopharyngeal AngiofibromaNasopharyngeal Angiofibroma
3.3. Malignant growthMalignant growth
4.4. Antochoanal polypAntochoanal polyp
5.5. Foreign bodyForeign body
6.6. RhinolithRhinolith
InvestigationsInvestigations
Blood CP,ESRBlood CP,ESR Blood sugarBlood sugar X-RAY PNSX-RAY PNS X-RAY Chest PAX-RAY Chest PA BiopsyBiopsy Nasal secretions for Cytology & C/SNasal secretions for Cytology & C/S Tests for AllergyTests for Allergy
TreatmentTreatment
Conservative:Conservative:1.1. Treatment of underlying causeTreatment of underlying cause2.2. ? Antihistamines? Antihistamines3.3. Topical steroids / ? Short course of oral Topical steroids / ? Short course of oral
steroidssteroids Surgical:Surgical:1.1. Intranasal polypectomyIntranasal polypectomy2.2. Ethmoidectomy (Intranasal / external)Ethmoidectomy (Intranasal / external)3.3. FESSFESS
ANTROCHOANAL POLYPANTROCHOANAL POLYP
Arises in the Max. sinus , enters the Arises in the Max. sinus , enters the nose through it’s osteum , traverse nose through it’s osteum , traverse to choana & may hang into to choana & may hang into nasopharynxnasopharynx
CAUSESCAUSES: :
1.1. InfectionInfection
2.2. AllergyAllergy
3.3. Retention cystRetention cyst
Clinical FeaturesClinical Features
Teen age--- Young adultsTeen age--- Young adults Nasal obstructionNasal obstruction RhinorrheaRhinorrhea Hyposmia / AnosmiaHyposmia / Anosmia SnoringSnoring Impaired hearingImpaired hearing Post nasal dripPost nasal drip May be seen on ant. Rhinoscopy but May be seen on ant. Rhinoscopy but
commonly visible on Posterior rhinoscopycommonly visible on Posterior rhinoscopy