Definition of Nasal polyps :

• Nasal polyps are non-neoplastic in nature.
• Moreover they are the masses of odematous nasal or Sinus mucosa.

Types of Nasal polyps :

• Antrochoanal polyp or Killians polyp.
• Bilateral ethmoidal polyp

Antrochoanal nasal polyp :

• It is also called Killian’s polyp.
• Moreover this polyp arises from the mucosa of the maxillary antrum near its accessory ostium.
• It comes out of the ostium and grows in the Choana and Nasal cavity.
• The antrochoanal polyp has three parts.
  • Antral – A thin stalk
  • Choanal – Roumd and globular
  • Nasal – Flat from side to side

Aetiology / Causes of Nasal polyps :

• Exact cause is unknown till now.
• But most probable cause may be nasal allergy coupled with sinus infection.
• The most common age group affected are children and young adults.
• Usually they are single and unilateral.

Symptoms :

• Patients usually present with unilateral nasal obstruction.
• Obstruction progresses and become unilateral when polyp grows into the nasopharynx – Obstructing the opposite choana.
• Moreover voice may become thick and dull due to hyponasality.
• Nasal discharge is usually mucoid.
• It is also present on one or on both sides.

Signs :

• Antrochoanal polyp may go missed on the anterior rhinoscopy.
• This is because it often grows posteriorly.
• When it is large; a smooth greyish mass covered up with nasal discharge can be seen.
• And also it is usually soft.
• It is also movable up and down by a probe.
• Appearance – A large polyp protruding from the nostril.
• It often shows a pink congested look on its exposed part.
• Posterior rhinoscopy often reveals a globular mass filling the choana or the nasopharynx.
• A large polyp may hang behind the soft palate and present in the Oropharynx.
• Moreover examination of the nose with endoscopy may reveal a mass/polyp hidden posteriorly.

Differential diagnosis :

• Mucous plug or blob may look like polyp but it would dissappear on blowing the nose.
• On probe test, the hypertrophied middle turbinate can be differentiated by its pink appearance and hard feel on the bone.
• Angiofibroma profusely bleeds and also has recurrent epistaxis.
• Moreover it is firm in consistency and easily bleeds when probed.
• Neoplasms often appear pink, fleshy, friable and bleeds on probe test.
• X-Rays of the involved paranasal sinuses shows opacity of the involved antrum.
• Above all, noncontrast CT scan of the paranasal sinuses in coronal axis and sagittal planes is the Gold standard method.
• Moreover it reveals the details of polyps and its extent.

Treatment :

• Treatment of choice for antrochoanal polyp is endoscopic sinus surgery.
• Earlier method was simple Polypectomy and also Caldwell-Luc operations performed for the recurrent cases.
• Usually removed by avulsion either through the nasal or oral route.
• Recurrence is usually uncommon in antrochoanal polyp after the complete removal.
• And also in cases where the polyp recurrs, Caldwell-luc operation may be required to remove the polyp completely but avoided nowadays.
• But nowadays endoscopic sinus surgery has superseded over other modes of polyp removal.

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