Nasal polyp

[8] Various additional diseases associated with polyp formation include:[9] Chronic rhinosinusitis is a common medical condition characterized by symptoms of sinus inflammation lasting at least 12 weeks.

[7][10] Half of people with CF will experience extensive polyps leading to nasal obstruction and requiring aggressive management.

[7] The true cause of nasal polyps is unknown, but they are thought to be due to recurrent infection or inflammation.

Nasal mucosa, particularly in the region of middle meatus becomes swollen due to collection of extracellular fluid.

This extracellular fluid collection causes polyp formation and protrusion into the nasal cavity or sinuses.

In the airway, these inflammatory products lead to symptoms of asthma such as wheezing as well as nasal polyp formation.

[12] Nasal endoscopy involves passing a small, rigid camera with a light source into the nose.

An image is projected onto a screen in the office so the doctor can examine the nasal passages and sinuses in greater detail.

The procedure is not generally painful, but the person can be given a spray decongestant and local anesthetic to minimize discomfort.

Proposed staging systems take into account the extent of polyps seen on endoscopic exam and the number of sinuses affected on CT imaging.

[7] On a CT scan, a nasal polyp generally has an attenuation of 10–18 Hounsfield units, which is similar to that of mucus.

[14] On histologic examination, nasal polyps consist of hyperplastic edematous (excess fluid) connective tissue with some seromucous glands and cells representing inflammation (mostly neutrophils and eosinophils).

[10] Early biopsy is recommended for unilateral nasal polyps to rule out more serious conditions such as cancer, inverted papilloma, or fungal sinusitis.

Steroids by mouth often provide drastic symptom relief, but should not be taken for long periods of time due to their side effects.

[12] Endoscopic sinus surgery, advocated and popularized by Professor Stammberger, is often very effective for most people, providing rapid symptom relief.

[7] Surgery serves to remove the polyps as well as the surrounding inflamed mucosa, open obstructed nasal passages, and clear the sinuses.

Specially designed long nozzles had been developed to use postoperatively to deliver steroids into those areas after sinus surgery for polyps.

Therefore, continued follow up with a combination of medical and surgical management is preferred for the treatment of nasal polyps.

[6] Nasal polyps occur more frequently in men than women and are more common as people get older, increasing drastically after the age of 40.

Paranasal sinuses : 1. frontal sinuses, 2. ethmoid sinuses (ethmoidal air cells), 3. sphenoid sinuses, 4. maxillary sinuses
Nasal polyp in the middle meatus
Nasal polyp appearing in the middle meatus.
Histology of nasal polyp, magnification 25x ( H&E stain )
Professor Heinz Stammberger, known as the father of endoscopic sinus surgery, teaching the technique at Tarabichi Stammberger Ear and Sinus Institute.
CT scan images after application of radioactive laced nasal steroids using long nozzle. Note the reach of the medication into the area where nasal polyps originate