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    Nasal Polyp DR Eva 2018

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    huda
    Nasal polyps are benign lesions that protrude from the nasal cavity or paranasal sinuses. While the exact cause is unknown, they are associated with chronic inflammation and genetic factors. Common symptoms include nasal obstruction, congestion, and loss of smell. Diagnosis involves endoscopy and CT imaging, while treatment options include steroids, immunotherapy, and surgery although recurrence is common.

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    Nasal Polyp DR Eva 2018

    Uploaded by

    huda
    104 views37 pages
    Nasal polyps are benign lesions that protrude from the nasal cavity or paranasal sinuses. While the exact cause is unknown, they are associated with chronic inflammation and genetic factors. Common symptoms include nasal obstruction, congestion, and loss of smell. Diagnosis involves endoscopy and CT imaging, while treatment options include steroids, immunotherapy, and surgery although recurrence is common.

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    Nasal polyps are benign lesions that protrude from the nasal cavity or paranasal sinuses. While the exact cause is unknown, they are associated with chronic inflammation and genetic factors. Common symptoms include nasal obstruction, congestion, and loss of smell. Diagnosis involves endoscopy and CT imaging, while treatment options include steroids, immunotherapy, and surgery although recurrence is common.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    104 views37 pages

    Nasal Polyp DR Eva 2018

    Uploaded by

    huda
    Nasal polyps are benign lesions that protrude from the nasal cavity or paranasal sinuses. While the exact cause is unknown, they are associated with chronic inflammation and genetic factors. Common symptoms include nasal obstruction, congestion, and loss of smell. Diagnosis involves endoscopy and CT imaging, while treatment options include steroids, immunotherapy, and surgery although recurrence is common.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 37

    Nasal Polyps

    Eva Pravitasari Nefertiti


    Introduction
    • Abnormal lesions
    that emanate from
    portion of nasal
    mucosa or
    paranasal sinuses
    • Benign polyps
    • Other benign or
    malignant tumours
    Nasal polyps
    • Endoscopic view
    of left nasal
    cavity. Polyp
    protruding from
    uncinate process
    Nasal polyps
    • Left anterior nasal
    cavity showing an
    antro-coanal polyp.
    Sucker is pushing
    inferior turbinate to
    one side
    Pathophysiology
    • Unknown
    • Chronic inflammation
    • Autonomic nervous system dysfunction
    • Genetic predisposition
    • Allergic verses non-allergic
    Pathophysiology
    Associated with allergic conditions
    • 20-50% have asthma
    • Allergic rhinitis
    • 8-26% have aspirin intolerance
    • 50% have alcohol intolerance
    Pathophysiology
    Non allergic conditions
    • Cystic Fibrosis 6-48% have polyps
    • AFS 85% have polyps
    • Young syndrome
    • Churg-Strauss syndrome
    Pathophysiology
    • Coronal CT scan of
    sinuses of patient
    with cystic fibrosis
    Pathophysiology
    • Allergic fungal
    sinusitis
    Pathophysiology
    • Polyps are more common in patients
    with non-allergic asthma (13%) than
    allergic asthma (5%)
    • 3000 atopic patients 0.5% have polyps

    Norlander et al (1999)
    Pathophysiology
    Various theories
    • Bernstein theory
    • Vasomotor theory
    • Epithelia rupture theory
    Pathophysiology
    Bernstein theory
    • Inflammatory changes in lateral nasal
    wall or 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
    Frequency
    • Adults 1-4%
    • Children 0.1%
    • All races and social classes
    • M/F 2-4:1 in adults
    • Increasing incidence with age
    Presentation
    – Asymptomatic
    – Airway obstruction
    – Postnasal drip
    – Dull headaches
    – Snoring
    – Rhinorhoea
    – Hyposmia / Anosmia
    – Epistaxis (often other lesion)
    – Obstructive sleep apnoea
    – Craniofacial abnormalities
    – Optic nerve compression
    Differential
    – Encephalocoeles
    – Gliomas
    – Dermoid tumours
    – Haemangiomas
    – Papillomas / transitional cell papillomas
    – Nasopharyngeal angiofibromas
    – Rhabdomyosarcomas
    – Lymphomas
    – Neuroblastomas
    – Sarcomas
    – Chordomas
    – Nasopharyngeal carcinomas
    Differential
    • Intranasal gioma
    in a 5 year old
    Differential
    • Nasal papilloma
    arising from septum
    Differential
    • Rhabdomyosarcoma
    affecting posterior
    ethomids, orbit, left
    middle fossa and skull
    base of cavernous
    sinuses
    Investigations
    • Sweat test
    • RAST / skin testing
    • Nasal smear
    – Microbiology
    – Eosinophils (allergic component)
    – Neutrophils (chronic sinusitis)
    Investigations
    • Coronal CT scan
    • MRI scan
    • Flexible nasendoscopy
    • Rigid nasendoscopy
    Investigations
    • Coronal CT scan
    through anterior
    sinuses.
    Opacification of left
    maxillary sinus,
    opacification of
    inferior half of nasal
    cavity. Due to antro
    coanal polyp.
    Gross appearance of Nasal polyp
    Histological findings
    • Pseudostratified
    ciliated columnar
    epithelium
    • Thickened
    epithelial basement
    membrane
    • Oedematous
    stroma
    POLYP NASI
    • Polyps consist of edematous mucosa
    • Loose stroma
    • Hyperplastic or cystic mucous glands
    • Infiltrated with a variety of inflammatory
    cells --- neutrophils, eosinophils, plasma
    cells, lymphocytes
    POLYP NASI
    Microscopic picture of nasal polyp
    Nasal polyp
    Histological findings
    • Eosinophils in 80-90% of polyps
    • Eosinic granules - LTs, ECP, PAF,
    peroxidases, etc
    • Epithelial damage, ciliostasis
    • LT-A4 mucosal swelling and
    hyperresponsiveness
    • Increased lifespan (12 days vs 3 days)
    • ?due to IL5 blockage of Fas receptors
    Histological findings
    • Neutrophils in 7% of polyps
    • CF, primary ciliary dyskinesia, Youngs
    syndrome
    • Poor response to standard treatment
    • Non IgE mediated degranulation
    Histological findings
    • Histamine - level in polyps 10-1000
    times higher than serum levels
    • Immunoglobulins normally unaffected.
    IgA2 and IgE higher in middle and
    inferior turbinate polyps
    Treatment
    • Oral and nasal steroids
    – High dose prednisolone and nasal steroid
    for 20 days will eliminate 50% of polyps
    – Lower bioavailability in modern nasal
    steroids
    – Poor response in certain groups
    – Intranasal injection not effective
    • Immunotherapy
    • Diet (no effect)
    Treatment
    • Traditional polypectomy
    • Microdebrider
    • Endoscopic sinus surgery
    • Recurrence
    – Multiple small polyps common
    – Large and antro-coanal less so
    Nasal polypectomy
    • Nasal polyp.
    Stalk attached
    to medial
    maxillary wall
    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

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