Understanding Nasal Polyps and Deviated Nasal Septum

1. Dr.Varun.SDept.of. Surgery skhmc

2. There are two types of nasalpolyp • Antrochoanal • Ethmoidal

4. Antrochoanaltype  It arises from the maxillary antrum and grows backwards in to nosetowardsthechoanaandnasalcavityrichesthenasopharynx .

5. Ethmoidal • They are multiple bilateral and arises from numerous ethmoidal sinuses. • It is very commonlyfound

6. Etiology • ANTROCHOANALPOLYP- • Exact cause is notknown. • AGE: usually it occurs in children and youngadults. • NUMBER: usually it issingle. • INFECTION and ALLERGY may result in ANTROCHOANAl POLYP.

7. ETHMOIDALPOLYP • AGE; ethmoidal polyps occurs at anyage • SEX: both sexes are equallyaffected • PREDISPOSINGFACTOTRS: • Allergy • Vasomotor • Infection • Mixedinfection

8. Polysaccharidechanges Bernouillis phenomenon: when air passes through a narrow area in the nose negativre pressure develops in the viscinity in the paranasal sinuses leading to increased formation of tissue fluids this may encourage polyp formation.

9. Asthma can be associated with ethmoidalpolyp. Aspirinsensitivity

10. Pathology • Antrochoanal polyp • Macroscopic :antral part : arise from maxillaryantrum. • Mucosa:oedamatous • Nasal part: arise from hiatus semilunaris in nose and reaches thechoana

11. Pharyngeal part :enters the naso pharynx throughchoana. • ETHMOIDALPOLYP: • Arised from mucosa ethmoidal sinuses and hang down in the nasal cavity.

12. antrochoanal polyp showing choanal (c)nasal (n) antral (a)parts A N C

13. Microscopic • Mucous membrane: metaplastivchanges. • Polyp: ulcerated orprotruded • Submucoasaltissue:oedamtoius. • Cellular infiltrationoccurs • Polyp is avascular and painless • Blood vessels and nerves supplyscanty

14. DIAGRAM OF NASALPOLYPI

15. Clinicalfeatures • Blocking ofnose • Sneezing • Dischargerclear • Expansion ofnose • Anosmia • Snoring and mouthbreathing • headache

16. Epiphora • Postnasaldischarge • Speech:hyponasal

18. Signs • External nose: Frog like appearance “BROADNOSE” • Anterior rhinoscopy: • antrochonal :rarelyvisible • Ethmoidal:multiple like n bunch ofgrapes • Posteriorrhinoscopty • Antrochoanal :large visible like pearshaped • Ethmoidal :fairly visible and growslowly

20. Investigation • Nasal secretion : culture and sensitivitytest • Radiography test of nose andsinuses. • Ct scan of nose and par nasal sinuses. • Biopsy ofpolyp

21. DIFFERENTIALDIAGNOSIS • Hypertrophicturbinate's • Rhinospordiosis • Malignancy • Angioma • Adenods • Nasopharangealangiofibroma • Nasophrangealmalignancy • Glioma • menegiocle

22. Treatment • antrochoanal polyp:conservative • nasaldecongestant • anrttibiotics • surgical:polypectomy • sinoscopy • cold weellluc-operation

23. ETHOMOIDALPOLYP • conservative:antihistamine • steroids • antibioticsxecongesatant • surgical:polypectomy • ethmoidectomy • sinoscopy

24. HOMOEOPATHICTREATMENT • calc.carb • kreosotum • phosphorus • hamamelis

25. DNS • deviated nasalseptum: • defination:deviation of the septum occurs very frquentlybut it requires treatment only if it producessymptoms

26. ETIOLOGY • AGE:puberty • upto 20yrs • sex :bothsexes • hereditoyry • developmentalcause • high archedpalate • congenital

27. trauma secondary :tumor mass polyp

28. PATHOLOGY • deviation • spurs • thickening • dislocation • c-shaped or s shapeddeviation • hypertrophy ofturbinates

30. SYMPTOMS • asypmtomatic • blocking ofnose • vacuumheadache • neuralgicheadche • recurrentcold • epistaxis • anosmia • deformity

31. INVESTIGATION • examination ofnose • anteriorrhinoscopy • posteriorrhinoscopy • radiography of face ornose

32. COMPLICATION • recurrent sinusitis • middle earinfection • mouthbreathing • asthma • atrophicrhinitis

33. DIFFERENTIALDIAGNOSIS hypertrophicturbinates polyp septalhaematoma

34. HAEMATOMA

35. TREATMENT SMR(submucosal resection of nasalseptum) septoplasty

36. HOMOEOPATHICTREATMENT • ars.alb • aconite • thuja