ETHMOIDAL POLYPI

By | 14th May 2012

Nasal Polyps>>Definition>>Classification>>Ethmoidal polyp>>Antrocoanal polyp>>Prevention>>Complication>>Differential diagnosis

Nasal Polyps

ETHMOIDAL POLYPI

 Definition

There is edematous hypertrophy of submucosa with loose fibrous stroma.

ETIOLOGY

Polyps are RED FLAGS indicating the presence of chronic inflammatory: chronic sinusitis (longstanding bacterial infection of facial sinuses) is one explanation; as is allergy (eg allergy to pollen, dust mites, mould spore, cat danden e.t.c.).

Other possible causes are

1.   Gravity

2.   Forceful nose

3.   Nasal defects e.g. D.N.S.

4.   Heredity

5.   Age

6 .  Sex

7.   Narrow nose

PATHOGENESIS.

Nasal mucosa becomes edematous due to collection of extracellular fluid causing polypoidal change. Polypi which are sessile in the beginning become pedunculated due to gravity and excessive sneezing which is associated with allergy.

PATHOLOGY

Due to metaplasia, the normal ciliated lining is converted into squamous type over the polyp side (which is exposed to atmospheric air). There is also infiltration with eosinophil and round cells.

SITE OF ORIGIN

Multiple nasal polypi arises from the lateral wall of nose usually from middle meatus.

Common sites are

·        Uncinate process

·        Bulla ethmoidalis

·        Ostia of sinuses

·        Medial surface and

·        Edge of middle turbinate

 NOTE

 Allergic nasal polypi almost never arises from the septum or floor of nose.

 SYMPTOMS

    Nasal obstruction

2.     Nasal discharge

3.     Impaired sense of smell

4.     Feeling of fullness in the face

5.     Headache

6.     Facial pain

 

SIGNS

 On anterior Rhinoscopy

 

1.     Polypi appears as smooth glistening grape like masses often pale in color.

2.     They may be sessile or pedunculated.

3.     Insensitive to probing.

4.     Don’t touch on bleeding.

5.     Nasal cavity may show purulent discharge due to associated sinusitis.

 On Posterior Rhinoscopy.

 Only to see the polyp are visible in posterior nares or not.

 DIFFERENTIAL DIAGNOSIS OF MUCOSAL POLYP.

   Antrocoanal polyp

2.     Neoplastic lesions of nose.

3.     Nasal obstruction

4.     Maggots

5.     D.N.S.

6.     Rhinoliths

7.     Hypertrophy of turbinates

8.     Cystic middle turbinate.

 STAGING OF MUCOSAL POLYP

 The advantages of nasal endoscopy and imaging of sinuses make it possible to create a new classification based on morphologic data.

 There is 4 stage grading system for nasal polyps of ethmoid based on endoscopic aspect supplemented by C.T scan and acoustic rhinometry.

 STAGE 0  =    Equivalent to normal mucosa .

 STAGE 1  =    Mucosal swelling in middle meatus

 STAGE 2  =    Polyps not extending the middle meatus.

 STAGE 3  =    Polyps may involve the middle turbinate.

 STAGE 4  =    All nasal  structures may be involved.

 

INVESTIGATIONS

 1 . Blood C.P (TLC, DLC ,ESR ,Hb % and platelets.)

 2.     Blood sugar (to exclude the diabetes)

3.     Blood urea (to access the renal function)

4.     Urine D.R

5.     X-Ray of sinuses

6.     Anterior rhinoscopy

7.     Posterior rhinoscopy

8.     C.T. Scan

9.     M.R.I

10. Acoustic rhinometry

11. Nasal  endoscopy

 

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 (e.g. prednisolone; 6 day course using 21 5 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

 

ANTROCOANAL  POLYPS