Nasal Polyps & FESS – Lecture Review

Flashcards covering definitions, types, etiology, associated conditions, clinical features, histopathology, diagnosis, treatment, differences between ethmoidal and antrochoanal polyps, and principles of FESS.

What is a nasal polyp?

A non-neoplastic mass of oedematous nasal or sinus mucosa characterized by gross extracellular sub-epithelial edema (fibro-edematous infiltration).

Name the two major types of nasal polyps.

Ethmoidal (multiple, bilateral) and Antrochoanal (single, unilateral).

From which structures do ethmoidal polyps commonly arise?

The lining of ethmoid sinus cells, uncinate process, bulla ethmoidalis, sinus ostia, or middle turbinate, prolapsing into the middle meatus.

What is the most common etiological factor implicated in nasal polyps?

Allergy (present in about 90 % of cases, often with eosinophilia, asthma, or other allergic symptoms).

List three other theories or factors proposed in the etiology of nasal polyps besides allergy.

Bernoulli effect, infections, and chronic inflammation.

State three systemic conditions frequently associated with nasal polyps.

Asthma, Cystic Fibrosis, Kartagener’s Syndrome (others include Aspirin hypersensitivity, Young’s syndrome, Churg-Strauss, nasal mastocytosis).

What combination of findings is called Samter’s triad?

Asthma, nasal polyps, and aspirin (NSAID) hypersensitivity.

Give four common symptoms of ethmoidal polyps.

Bilateral nasal obstruction/stuffiness, sneezing with watery nasal discharge, hyposmia/anosmia, post-nasal drip (hyponasal voice may also be present).

Describe two typical endoscopic signs of ethmoidal polyps.

Smooth, pale, glistening masses that are insensitive to probing and do not bleed; usually multiple and bilateral.

What age findings should raise suspicion for other diagnoses when nasal polyps are seen?

< 2 years – exclude meningocoele; < 10 years – exclude cystic fibrosis.

Outline the characteristic histopathology of ethmoidal polyps.

Respiratory epithelium lining (may show squamous metaplasia), grossly oedematous submucosa with striking eosinophilia.

What is the imaging investigation of choice for nasal polyps and why?

CT scan of nose and paranasal sinuses; it reveals full extent of disease, delineates sinus anatomy, and helps exclude malignancy.

List three components of medical management for nasal polyps.

Topical steroid sprays, oral steroids, antihistamines (decongestants or antibiotics as indicated).

Name four surgical options for ethmoidal polyps.

Simple polypectomy, intranasal ethmoidectomy, external ethmoidectomy, Functional Endoscopic Sinus Surgery (FESS).

Define an antrochoanal polyp.

A solitary polypoidal mass that originates in the maxillary sinus, passes through its ostium into the choana, and may extend into the oropharynx.

From which exact area in the maxillary sinus do antrochoanal polyps generally originate?

The floor and lateral wall of the maxillary antrum (through the natural or accessory ostium).

Which age group most commonly presents with antrochoanal polyps?

Younger children and adolescents.

State four classic symptoms of an antrochoanal polyp.

Unilateral nasal obstruction (may become bilateral if choana blocked), hyponasal voice, nasal discharge, globular mass felt in throat (if large).

How does the histology of an antrochoanal polyp differ from an ethmoidal polyp?

Histologically similar but lacks marked eosinophilia found in ethmoidal polyps.

Give two preferred surgical treatments for antrochoanal polyps.

Endoscopic polypectomy or avulsion (Caldwell-Luc for recurrences).

Compare recurrence tendencies of ethmoidal vs. antrochoanal polyps.

Ethmoidal polyps recur commonly even after surgery; antrochoanal polyps have uncommon recurrence if completely removed.

State three key differences between ethmoidal and antrochoanal polyps (besides recurrence).

Ethmoidal: adults, allergic origin, multiple/bilateral, grows anteriorly; Antrochoanal: children, infectious element, single/unilateral, grows posteriorly.

Who pioneered Functional Endoscopic Sinus Surgery (FESS) and where?

Dr. Messerklinger in Graz, Austria; later popularized by Dr. Stammberger.

What is the guiding principle of FESS?

Remove only diseased mucosa while retaining normal sinus physiology and anatomy.

List the rigid endoscopes commonly required for FESS.

0°, 30°, and 70° rigid nasal endoscopes.

Under which types of anesthesia can FESS be performed?

General anesthesia (GA) or local anesthesia (LA) with sedation.