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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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