Nasal polyp

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Nasal polyps
Polype nasal.jpg
A nasal polyp
Classification and external resources
Specialty Otorhinolaryngology
ICD-10 J33
ICD-9-CM 471
MedlinePlus 001641
eMedicine ent/334 ent/335
MeSH C09.603.557

Nasal polyps are polypoidal masses arising mainly from the mucous membranes of the nose and paranasal sinuses.[1] They are overgrowths of the mucosa that frequently accompany allergic rhinitis, and are freely movable and nontender.[2]

Signs and symptoms[edit]

Nasal polyps are usually classified into antrochoanal polyps and ethmoidal polyps. Antrochoanal polyps arise from the maxillary sinuses and are the much less common,[3] ethmoidal polyps arise from the ethmoidal sinuses.[4]

Symptoms of polyps include nasal congestion, sinusitis, anosmia (loss of smell), and secondary infection leading to headache. They may be removed by surgery, but are found to recur in about 70% of cases. Sinus surgery requires a great amount of precision as this involves risk of damage to orbit matter.[5]

Types[edit]

Human nasal polyp, magnification 25x, (H&E stain)

There are 2 major types of nasal polyps.

  1. Antrochoanal
    1. Single, Unilateral
    2. Can originate from maxillary sinus
    3. Usually found in children
  2. Ethmoidal
    1. Bilateral
    2. Usually found in adults

Nasal polyps consist of hyperplastic oedematous connective tissue with some seromucous glands and inflammatory cells (mostly neutrophils and eosinophils) with respiratory epithelium, sometimes with metaplastic squamous epithelium on the surface.

Nasal polyps should be distinguished from nasal papillomas, which are benign epithelial tumors and have more serious consequences.

Causes[edit]

The pathogenesis of nasal polyps is unknown. Nasal polyps are most commonly thought to be caused by allergy and rarely by cystic fibrosis although a significant number are associated with non-allergic adult asthma or no respiratory or allergic trigger that can be demonstrated. Nasal mucosa, particularly in the region of middle meatus becomes oedematous due to collection of extracellular fluid causing polypoidal change. Polyps which are sessile in the beginning become pedunculated due to gravity and excessive sneezing.[6]

Micrograph of a sinonasal papilloma (H&E stain), which may have serious consequences and should be distinguished from nasal polyps

In early stages, surface of nasal polyp is covered by ciliated columnar epithelium, but later it undergoes metaplastic change to squamous type on atmospheric irritation. Submucosa shows large intercellular spaces filled with serous fluid.[7]

There are various diseases associated with polyp formation:[8]

  1. Chronic rhinosinusitis
  2. Asthma
  3. Aspirin-induced asthma, or aspirin-exacerbated respiratory disease (AERD)
  4. Cystic fibrosis
  5. Kartagener's syndrome
  6. Young's syndrome
  7. Churg-Strauss syndrome
  8. Nasal mastocytosis

Exposure to some forms of chromium can cause nasal polyps and associated diseases.[citation needed]

Chronic rhinosinusitis is a common chronic medical condition that can be classified into two groups presenting either with nasal polyposis or without.[9] Chronic rhinosinusitis with nasal polyposis can be divided into eosinophilic chronic rhinosinusitis, which include allergic fungal rhinosinusitis and aspirin-exacerbated respiratory disease, or nasal polyps associated with neutrophilic inflammation, which is primarily characterized by cystic fibrosis.[10]

Diagnosis[edit]

There are two criteria (major and minor) that must be met. The former in the form of facial pressure, nasal blockage, hyposmia and the latter in the form of fever, headache, cough and dental pain.[11]

Treatment[edit]

Nasal polyps are most often treated with steroids or topical, but can also be treated with surgical methods.[12] Before and after surgery, sinus rinses with warm water mixed with a small amount of salts (sodium chloride and sodium bicarbonate) can be helpful to clear the sinuses.[13]

The removal of nasal polyps via surgery lasts approximately 45 minutes to 1 hour. The surgery can be done under general or local anaesthesia, and the polyps are removed using endoscopic surgery. Recovery from this type of surgery is anywhere from 1 to 3 weeks. Mometasone furoate, commonly available as a nasal spray for treating common allergy symptoms, has been indicated in the United States by the FDA for the treatment of nasal polyps since December 2005.[14][15]

References[edit]

  1. ^ "Nasal polyps: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-05-18. 
  2. ^ Frazier, Margaret Schell; Drzymkowski, Jeanette (2014-03-12). Essentials of Human Diseases and Conditions. Elsevier Health Sciences. ISBN 9780323292283. 
  3. ^ Pilch, Ben Z. (2001). Head and Neck Surgical Pathology. Lippincott Williams & Wilkins. ISBN 9780397517275. 
  4. ^ Maqbool, Mohammad; Maqbool, Suhail (2013). Textbook of Ear, Nose and Throat Diseases. JP Medical Ltd. ISBN 9789350904954. 
  5. ^ Önerci, T. Metin; Ferguson, Berrylin J. (2010-08-13). Nasal Polyposis: Pathogenesis, Medical and Surgical Treatment. Springer Science & Business Media. ISBN 9783642114120. 
  6. ^ Wilkins, Lippincott Williams & (2009). Professional Guide to Diseases. Lippincott Williams & Wilkins. ISBN 9780781778992. 
  7. ^ Michaels, Leslie (2012-12-06). Ear, Nose and Throat Histopathology. Springer Science & Business Media. ISBN 9781447133322. 
  8. ^ Behrbohm, Hans; Kaschke, Oliver (2011-01-01). Ear, Nose, and Throat Diseases: With Head and Neck Surgery. Thieme. ISBN 9783131702135. 
  9. ^ Chaaban, Mohamad; Walsh, Erika M.; Woodworth, Bradford A. (Nov–Dec 2013). "Epidemiology and differential diagnosis of nasal polyps". American Journal of Rhinology and Allergy 27 (6): 473–478. doi:10.2500/ajra.2013.27.3981. PMC 3899526. PMID 24274222. 
  10. ^ Kang, Suzie Hyeona; Dalcin, Paulo de Tarso Roth; Piltcher, Otavio Bejzman; Migliavacca, Raphaella de Oliveira (2015). "Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment *". Jornal Brasileiro de Pneumologia 41 (1): 65–76. doi:10.1590/S1806-37132015000100009. ISSN 1806-3713. PMC 4350827. PMID 25750676. 
  11. ^ Chaaban, Mohamad R.; Walsh, Erika M.; Woodworth, Bradford A. (2013). "Epidemiology and differential diagnosis of nasal polyps". American Journal of Rhinology & Allergy 27 (6): 473–478. doi:10.2500/ajra.2013.27.3981. ISSN 1945-8924. PMC 3899526. PMID 24274222. 
  12. ^ Önerci, T. Metin; Ferguson, Berrylin J. (2010-08-13). Nasal Polyposis: Pathogenesis, Medical and Surgical Treatment. Springer Science & Business Media. ISBN 9783642114120. 
  13. ^ Bansal, Mohan (2012-10-01). Diseases of Ear, Nose and Throat. JP Medical Ltd. ISBN 9789350259436. 
  14. ^ Vedanthan, Pudupakkam K.; Nelson, Harold S.; Agashe, Shripad N.; A, Mahesh P.; Katial, Rohit (2014-02-21). Textbook of Allergy for the Clinician. CRC Press. ISBN 9781466598331. 
  15. ^ "Dulera (Mometasone Furoate and Formoterol Fumarate Dihydrate) Inhalation Aerosol". www.fda.gov. Retrieved 2015-05-18. 

External links[edit]