Dr. Sofyan, Sp.

THT

Definition
Nasal polyp: inflammatory

mucosal protrusion from the

nasal and/or sinus cavities

Aetiological
factors
- Aspirin intolerance
- Cystic fibrosis
- etc.

Nerve damage
Vasomotor denervation
Gland denervation

Predisposing
factors
- Allergic reaction
(Type I -Ig E mediated)

Mast cell degranulation

Mediator release
Histamine release
Chronic inflammation of nasal mucosa
Hypersensitivity of mucosal vascular bed
Increased vascular permeability
Repeated vasomotor reaction
Repeated edema
Accumulation of inflammatory exudate
Collagen fibrils lose stability
New blood vessels formation
Young connective tissue formation
Increased thickness of mucosal edema
Polyps formation

Unknown
causes

Classification of nasal
Clinical presentation
Histological findings
polyp
1. Simple polyps

1. Allergic polyp

2. Nasochoanal or

(Eosinophilic)
2. Fibroinflammatory polyp
(Neutrophilic)
3. Polyp with glandular
hyperplasia
4. Polyp with atypia

antrochoanal polyps
3. Nasal polyps with asthma
and aspirin intolerance
(ASA triad)
4. Nasal polyps associated
with systemic diseases
5. Allergic fungal sinusitis

Grading system for nasal

polyp
Grade I Confine in middle meatus
GradeII Prolapse into nasal cavity,

Not reaching the lower end of inf.

turbinate
GradeIII Reaching the floor of nasal
cavity

Characteristic of nasal
polyp

Typical nasal polyps: bilateral

Polypoidal, soft, semi-translucent
Whitish grey or yellow in color
Smooth glistening surface
Mobile, Non-painful
Unresponsive to topical
decongestants

Endoscopy

Differential diagnosis of
nasal
polyp
Unilateral nasal mass
1. Hypertrophic/polypoid turbinate
2. Antrochoanal polyps
3. Mucocele
4. Benign tumors: Inverted papilloma,

Angiofibroma
5. Malignant tumors: SCC, Adenocarcinoma

ANTROCHOANAL POLYPS

Frontal Mucocele

Medical polypectomy
1. For polyps grade I-II
2. Prednisolone 20-40 mg/day 1-2 weeks
3. Topical nasal steroid spray for 3 months
4. Treatment of sinusitis
5. Treatment of allergic rhinitis

ENT Siriraj

Surgical treatment
For polyps grade III or

failure of medical treatment

1. Snaring and inferior antrostomy
2. Intranasal ethmoidectomy
3. Caldwell-Luc operation
4. Functional Endoscopic Sinus Surgery (FESS)

CALDWELL-LUC OPERATIO

CWL

ENDOSCOPIC SINUS SU

ESS

ESS :

1.Use the endoscope for magnificati

2. Clear the OM complex
3. Preserve the sinus mucosa as mu