Nasal pol

• Bilateral Ethmoidal Polypi


  Polyps arising from the ethmoid sinuses on both sides of the nose
• Aetiology (causes)


  • Chronic rhinosinusitis (allergic and nonallergic)
  • Asthma
  • Aspirin intolerance (Samter's triad)
  • Cystic fibrosis
  • Allergic fungal sinusitis
  • Kartagener syndrome
  • Young syndrome
  • Churg–Strauss syndrome
  • Nasal mastocytosis
• Pathogenesis

  1. Nasal mucosa in middle meatus and turbinate becomes oedematous

  2. Sessile polypi become pedunculated due to gravity and sneezing
• Site of Origin

  • Arise from lateral wall of nose, mainly from middle meatus
  • Common sites: uncinate process, bulla ethmoidalis, sinuses' ostia, medial surface/edge of middle turbinate
  • Allergic nasal polypi almost never arise from septum or floor of nose
• Symptoms

  • Nasal stuffiness, total nasal obstruction
  • Partial or total loss of sense of smell
  • Headache due to associated sinusitis
  • Sneezing, watery nasal discharge due to allergy
  • Mass protruding from nostril
• Signs

  • Smooth, glistening, grape-like masses on anterior rhinoscopy
  • May be sessile or pedunculated, insensitive to probing, do not bleed on touch
  • Often multiple and bilateral
  • Long-standing cases may present with broadening of nose
  • Nasal cavity may show purulent discharge due to associated sinusitis
• Diagnosis


  • Clinical examination
  • CT scan of paranasal sinuses
  • Histological examination if malignancy is suspected
• Surgical Treatment

  • Polypectomy
  • Intranasal ethmoidectomy
  • Extranasal ethmoidectomy
  • Transantral ethmoidectomy
  • Endoscopic sinus surgery (FESS) for accurate removal of polypi and associated sinus drainage
• Antrochoanal Polyp (Syn. Killian's Polyp)

  Polyp arising from the maxillary sinus and extending into the nasal cavity and nasopharynx
• Aetiology (causes)


  • Nasal allergy
  • Sinus infection
• Signs


  • Smooth greyish mass covered with nasal discharge, soft and movable
  • May protrude from nostril, pink and congested
  • Posterior rhinoscopy reveals globular mass filling choana or nasopharynx
  • Endoscopic examination may reveal hidden polyp in nasal cavity
• Differential Diagnosis


  • Blob of mucus, disappears on blowing nose
  • Hypertrophied middle turbinate, pink appearance and hard feel of bone
  • Angiofibroma, history of recurrent epistaxis, firm consistency, easily bleeds
  • Other neoplasms, fleshy pink appearance, friable, tendency to bleed
• Treatment

  • Easily removed by avulsion through nasal or oral route
  • Recurrence uncommon after complete removal
  • Endoscopic sinus surgery preferred over other methods, avoids Caldwell–Luc operation