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.

Classification:
1. Bilateral Ethmoidal polyps
2. Antrochoanal Polyps

Epidemiology

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 intrinsic asthma
8-26% have aspirin intolerance
50% have alcohol intolerance

 Pathogenesis (Various theories)

Bernstein theory
Vasomotor theory
Epithelia rupture theory
Chronic inflammation

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

 Pathogenesis
Epithelial damage
(barrier dysfunction))

Ig E

Cytokines

chronic microbial trigger

Superantigens

Eosinophils

Chemokines

 Pathogenesis
1. Chronic inflammation ...... Increase cytokines or Chemoines
like macrophag, e colony stimulating factor, IL-5, RANTES
and Eotaxin ..... Contribute Eosinophil mugration.
2. Increase IL-8 ...... Netrophil infiltration
3. Increase VEGF .... Upregulation and by transforming
growth factor contribute edema and increase angiogenesis at
nasal polyps
4. TGF modulate fibroblast function ..... Eosinophil infiltration
and stroma fibosis
5. others mediators like albumin, histamin, Ig E and IgG also
increase.

Pathology

Histologically, nasal polyps are characterized by a

pseudostratified ciliated columnar epithelium, thickening of
the epithelial basement membrane, and few nerve endings.
Edema or fibrosis
Reduce of vascularization
Reduce number of glands
The stroma of nasal polyps is edematous semi transluscent.
Increase of Eosinophil cells , occurring in 80-90% of polyps.
Increase of Mast cell an T cell
Neutrophils in 7% of polyps
Ethmoidal polyps arise from Middle meatus
Insensitive to touch
blood supply is poor.(Pale colour)

Clinical Presentation

Airway obstruction
Postnasal drip
Dull headaches
Snoring
Rhinorhoea
Hyposmia / Anosmia
Epistaxis (often other lesion)
Obstructive sleep apnoea

Antrochoanal Polyp;arise from

maxillary sinus.
3 parts channel,nasal, antrum.
end result of prolong sinus
infection
unilateral

DIAGNOSTIC :
1.
2.
3.
4.
5.

Waters photo
Coronal CT scan
MRI scan
Flexible nasendoscopy
Rigid nasendoscopy

Investigations
Sweat test.(Cystic fibrosis)
RAST(radioallergosorbent test/ skin
testing
Nasal smear
Microbiology
Eosinophils (allergic component)
Neutrophils (chronic sinusitis

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.