Nasal Polypi
Definition
non neoplastic edematous nasal or sinus
mucosa.
Nasal polyps are abnormal lesions that originate from any
portion of the nasal mucosa or paranasal sinuses.
Polyps are an end result of varying disease processes in the
nasal cavities.
malignant tumours.
Introduction
 Nasal polyps are abnormal lesions that originate from
any portion of the nasal mucosa or paranasal sinuses.
 Polyps are an end result of varying disease processes
in the nasal cavities.
 Benign polyps.
 Other benign or malignant tumours.
Classification:
1/ Bilateral Ethmoidal polyps
2/ Antrochoanal Polyps
3/ Neoplastic
Pathology: Histologically, nasal polyps are
characterized by a pseudostratified ciliated
columnar epithelium, thickening of the
epithelial basement membrane, and few nerve
endings. The stroma of nasal polyps is
edematous.
 Eosinophil cells are the most commonly
identified inflammatory cell, occurring in 8090% of polyps.
 Neutrophils in 7% of polyps
Multiple polyps can occur in children with chronic
sinusitis, allergic rhinitis, cystic fibrosis (CF), or allergic
fungal sinusitis (AFS). An individual polyp could be an
antral-choanal polyp, a benign massive polyp, or any
benign or malignant tumor (eg, encephaloceles, gliomas,
hemangiomas, papillomas, juvenile nasopharyngeal
angiofibromas, rhabdomyosarcoma, lymphoma,
neuroblastoma, sarcoma, chordoma, nasopharyngeal
carcinoma, inverting papilloma). Evaluate all children with
benign multiple nasal polyposis for CF and asthma.
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Next Section: Pathophysiology
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Ethmoidal polyps arise from Middle
meatus
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Insensitive to touch
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blood supply is poor.(Pale colour)
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When unilateral Exclude
malignancy.
Causes
 As described in Pathophysiology, chronic inflammation
(from whatever source) apparently has an initial role in
the pathogenesis of nasal polyps. Multiple polyps
occur in children with chronic sinusitis, allergic rhinitis,
CF, and AFS. An isolated polyp could be an antralchoanal polyp , a benign massive polyp, a
nasolacrimal duct cyst or any congenital lesion or
benign or malignant tumor .
Simple polyps can arise any time
after age 2yrs, before this suspect
meningocele,encephalocoel.(do ct.
scan)
Before age 10 yrs. rare if found
suspect cystic fibrosis,(do sweat test
Frequency
 Adults 1-4%
 Children 0.1%
 All races and social classes
 M/F 2-4:1 in adults
 Increasing incidence with age
 Associated with allergic conditions
 20-50% have asthma
 Allergic rhinitis
 8-26% have aspirin intolerance
 50% have alcohol intolerance
 Various theories
 Bernstein theory
 Vasomotor theory
 Epithelia rupture theory
 Bernstein theory
 Inflammatory changes in lateral nasal wall or
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


sinus mucosa
Polyps originate from contact area
Ulceration, reepithelialisation and new gland
formation
Inflammatory processes from epithelial cells,
endothelium and fibroblasts
Integrity of sodium channels affected
Clinical Presentation
Airway obstruction
Postnasal drip
Dull headaches
Snoring
Rhinorhoea
Hyposmia / Anosmia
Epistaxis (often other lesion)
Obstructive sleep apnoea
 Coronal CT scan
 MRI scan
 Flexible nasendoscopy
 Rigid nasendoscopy
 Coronal CT scan
through anterior
sinuses.
Opacification of left
maxillary sinus,
opacification of
inferior half of nasal
cavity. Due to antro
coanal polyp.
Antrochoanal Polyp;arise from
maxillary sinus.
3 parts channel,nasal, antrum.
end result of prolong sinus infection
unilateral
differential diagnosis, 1/
hypertrophied middle turbinate,
probe test,
2/ Angiofibroma
other neoplasm, fleshy
appearance.fiable tissue and bleed
easily. e.g. squamous cell
carcinoma, adenocarcinoma
 Fiber optic Nasophyrangoscopy.
 Coronal CT scan
 MRI scan
20
Investigations
 Sweat test.(Cystic fibrosis)
 RAST(radioallergosorbent test/ skin testing
 Nasal smear
Microbiology
Eosinophils (allergic component)
Neutrophils (chronic sinusitis)
Clinical Presentation
Airway obstruction
Postnasal drip
Dull headaches
Snoring
Rhinorhoea
Hyposmia / Anosmia
Epistaxis (often other lesion)
Obstructive sleep apnoea
Management:
Conservative : Oral steroid.
Prednisolon 30mg for 3 days,20mg
for 3 days,10mg for 3 days.
Surgery 1/ simple polypctomy
2/ Nasal polytectomy (With debrider
and FESS.
 Endoscopic sinus surgery (ESS) is a better
technique that not only removes the polyps but
also opens the clefts in the middle meatus, where
they most often form, which helps decrease the
recurrence rate.
Nasal Polypectomy
 Microdebrider
entering left
middle meatus
Summary
 Common condition in adults
 Aetiology not fully understood
 Majority are not allergic in nature
 Medical treatment can be effective
 Even with surgery, recurrence is common
Thank You
Questions: 10 yrs. old boy with
nasal polyps, the child suffers from
recurrent lung infections with thick,
sticky sputum and his skin tastes
salty.
whats your diagnosis
Name one test to confirm your
diagnosis.
Question 2: A 40yrs male suffer from
unilateral Nasal obstruction,and
symptoms of sinusitis.Anterior
rhinoscopy reveals nasal Polyp.
1/ what radiological investigation
you will request.explain why.
2/ treatment option 3/ would you
send specimen for histology ,explain
why.