Simple Nasal Polyps Research Articles

Целесообразность радикальных методов эндоскопических хирургических вмешательств на околоносовых пазухах при полипозном риносинусите

Treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex problem for physicians. There is basic therapy with topical glucocorticosteroids, in case of ineffectiveness of which a short course of systemic glucocorticosteroid therapy is carried out, or the question of using biological therapy with monoclonal antibodies is considered. Surgical approaches for CRSwNP have evolved over the years, ranging from simple nasal polyps to nasalization procedures. Since the introduction of functional endoscopic sinus surgery (FESS) into widespread practice, there has been a principle that surgery for CRSwNP should only be considered in patients who are refractory to pharmacological therapy. The analysis of surgical treatment of patients with CRSwNP in the departments of otorhinolaryngology of the Vladimirsky Moscow Regional Research Clinical Institute (MONIKI) and Clinical Hospital No. 1 of Department for Presidential Affairs of the Russian Federation (Volynsk Hospital) for the period 2015–2022 was carried out. In the department of the Volynsk Hospital, from 2017 to 2022, 595 people were treated with CRSwNP, of which 440 patients received surgical care, 36 patients in 2021 and 119 patients in 2022 were treated with dupilumab. The index of surgical activity in 2021 was 0.695 (30.51% of patients received conservative treatment, 69.49% of patients received surgical treatment) and 0.27 in 2022 (63% of patients received conservative treatment, 27% of patients were operated). In the department of otorhinolaryngology of MONIKI, in 2015, 144 surgeries were performed for PRS; in 2016, 94 surgeries; in 2017, 31 surgeries; in 2018, 28 surgeries; in 2019, 26 surgeries. All surgical interventions in both departments were performed in the scope of endoscopic polysinusotomy or maxillary ethmoidotomy. In parallel, since September 2015, on the basis of the surgical department with a day hospital, specialized care has been organized for patients with CRSwNP, where diagnostic measures are carried out jointly with an allergist-immunologist, treatment is carried out according to a stepwise therapy scheme for various CRSwNP phenotypes with an assessment of the dynamics of the course of the disease every 3 months. This made it possible to reduce the number of these operations in the department of otorhinolaryngology of MONIKI by almost 5 times. Surgical treatment for CRSwNP is not a panacea. Mechanical removal of pathologically altered tissue does not eliminate the etiological factors of this disease, nor does it affect any link in the development of pathogenesis. Any operation is associated with a surgical and anesthetic risk for the patient and costs. Therefore, reducing their number due to the complex treatment of patients, considering comorbid pathology, the use of biological therapy drugs along with economic efficiency and reducing the load on a round-the-clock hospital allows avoiding invasive interventions. Radical endoscopic surgery with a reboot approach, full-house functional endoscopic sinus surgery (FESS), and Draf III (frontal drillout) operations should always have strict indications since they are rather a «rescue operation» and can never become a routine surgical intervention for CRSwNP, especially since in 96.3% of patients with CRSwNP relapse occurs within 3 years after surgery. Schemes for the management of patients with CRSwNP in the departments of otorhinolaryngology of MONIKI and the Volynsk Hospital can improve the quality of life of these patients, achieve drug control of the disease, and reduce the number of surgical interventions while increasing the total number of patients with CRSwNP treated in these institutions.

Clinicopathological study of lesions of nasal cavity and paranasal sinuses- A two year study

Sinonasal masses are common in the ENT Outpatient Department. The incidence being 1-4% of population. The symptoms and signs frequently overlap, hence, a diagnostic dilemma exists. The aim of this study was to study the occurrence of various lesions, the age, site and sex wise distribution in a tertiary care hospital of Maharashtra over the period of two years. The study aims to examine the occurrence of various lesions in nasal cavity and paranasal sinuses, to determine the age, sex and site wise incidence of different benign and malignant lesions of nasal cavity and paranasal sinuses and to correlate the clinical and histopathological findings. Descriptive Study A descriptive study was carried out in the Department of Pathology at Tertiary Health Care among patients with clinically diagnosed nasal and paranasal sinus lesions attending the OPD of ENT during a period of 2 years. The specimens were grossly examined; fixed and routine microscopic staining was done. Interpretation was done using colour of the nuclei and the specimens were classified as neoplastic and non-neoplastic lesions. The data was statistical analysed. Mean, Median, Mode The most common clinical presentation was nasal obstruction 97 (93.26%), rhinorrhoea 73 (70.19%) and facial pain 24 (23%). 1: Mean age for the lesions to occur was years with the range 21-30 years (20.92%); 2: Non-neoplastic lesions 82 (79.6%) were more common than neoplastic lesions; 3: Simple nasal polyp 74 (90.23%), hemangiomas (50%) and squamous cell carcinoma (50%) were most common. The study concludes that complete clinical, radiological and histopathological correlation helps us to categorize these sino-nasal lesions into various non-neoplastic and neoplastic types. But final histopathological examination provides a confirmatory diagnosis, as a significant number of cases may be missed on clinical evaluation alone.The clinical features of non-neoplastic and neoplastic nasal and paranasal sinuses lesions may be indistinguishable from each other leading to delay in proper diagnosis and treatment. Histopathological examination is a reliable, cost effective diagnostic tool for accurate diagnosis and management of such lesions, as a significant number of cases may be missed on clinical evaluation alone.

Nasal Polyps :An Etiological Analysis

Nasal polyps,the prolapsed linings of nasal mucosa are one of the commonly encountered conditions in theoutpatient department of otolaryngology, The aim of this study is to study the etiology of nasal polyps andalso to compare between the different methods used for diagnosis of nasal polyps.This study was submitted prospectively on 100 patients diagnosed with nasal polyps (diagnosed eitherclinically or radiologically) with evidence of nasal obstruction,rhinorrhae and headache. from April 2015till April 2017. All patients had been selected from the outpatient clinics of Al-Zahraa University Hospitaland Kobry El Koppa military hospital. The study was approved by the ethics committee of Al Azhar Facultyof Medicine.A total of 100 patients were analyzed, age range 18 to 56 yrs with a mean age of 38.5 yrs. There were 83 maleand 17 female. The main presenting symptoms are nasal obstruction and rhinorrhea. Most of the cases wasbilateral nasal polyps,. The commonest clinical diagnoses were non-neoplastic simple nasal polyps 84% andabout 13% were benign neoplastic, 3% were malignant . The commonest histological diagnosis among nonneoplastic nasal polyps was simple allergic nasal polyp, among benign neoplastic was inverted papilloma.most of neoplastic lesions were presented by unilateral nasal polyps,where epistaxis was noticed mostlywith vascular tumour and malignant ones. The results show that most of nasal polyps were simple nonneoplastic lesions especailly bilateral ones,also for proper evaluation of nasal polyps clinical, radiologicaland histopathological evaluation should be done in all patients.

Indication and outcome of endoscopic sinus surgery among patients with chronic rhinosinusitis with or without nasal polyps in the national ear care centre, Kaduna

Context: Endoscopic sinus surgery is a minimally invasive and currently the treatment of choice for acute/intermittent and chronic/persistent rhinosinusitis (RS) unresponsive to conservative medical treatment. Aims: To evaluate the indications and outcomes of treatment of RS with or without nasal polyps. Methods and Material: This was a retrospective review of all cases of endoscopic sinus surgery done at the National Ear Care Centre. The information extracted from the case notes of patients included the demographic profile, clinical radiologic and endoscopic findings, the surgery offered and outcome of surgery. Statistical analysis used: All information was entered into SPSS version 20.0. Results: Out of 116 patients had endoscopic sinus surgery, only 107 (92%) had complete information for the analysis. Their age ranged from 9 to 72 years with a mean age of 35.9 ± 1.9 years. Up to 105 of the patients presented nasal discharge alternating with nasal obstruction while 65% (70) of them had bilateral disease. Computed tomography scan revealed abnormalities in 66.4% (71) patients. The preoperative diagnosis of chronic RS (CRS) with simple nasal polyp was made in 66 patients, had functional endoscopic sinus surgery with polypectomy in 64.5% (69) patients and intraoperative findings revealed a mixture of mucosal diseases with sinonasal polyps in 73.8% and fungal sinus diseases in 18 (16.8). Majority of the patients (53.3%) were discharged home on the 2nd postoperative day. About 71% of the patients had resolution of their disease after months of followup. Conclusion: Endoscopic sinus surgery is higher among young adult in third and fourth decades of life. There is female preponderance and preoperative radiology assessment and the intraoperative findings revealed strong relationship. The outcome of treatment revealed recurrent disease in 10.5% with nasal adhesion, epistaxis and excessive nasal crust formation.

Granular cell tumor that originated in a posterior ethmoid sinus

<p class="abstract"><span lang="EN-US">A granular cell tumor (GCT) is a rare neoplasm. It grows slowly, presumably originates from a Schwann cell, and is typically benign. Histopathologically, GCTs are composed of loosely infiltrating sheets of large, pale, polyhedral cells with abundant granular eosinophilic cytoplasm and a pale, centrally situated nucleus. Immunohistochemically, GCTs express the S-100 protein and neuron-specific enolase. A GCT can occur anywhere in the body. Half of all GCTs occur in the head and neck regions, especially on the tongue, but they are rarely found in the nasal cavity. A GCT usually arises as a solitary tumor and can be confirmed only by a histologic examination. The appropriate treatment is excision of the lesion. </span>Here, we present a rare case of a GCT originating in the right posterior ethmoid sinus in the nasal cavity. A GCT originating in a posterior ethmoid sinus has not been reported thus far. In our case, a simple nasal polyp was found in the left ethmoid sinus of the patient. Thus, we initially misjudged the GCT in the right nasal cavity as a simple nasal polyp.</p>

Uncommon and Atypical Sinonasal Masses: Diagnostic and Therapeutic Challenges

ABSTRACT Introduction Sinonasal masses are a wide range of pathologies ranging from simple nasal polyps to rare tumors like esthesioneuroblastomas. Early symptoms of all of them are similar to common nasal and sinus problems, hence, producing a delay in diagnosis. Materials and methods All the patients presenting with sinonasal masses in the Department of ENT and Head/Neck Surgery, SRMS Institute of Medical Sciences, Bareilly, were included in the study. The study was carried out between January 2007 and December 2011. Detailed history and ENT examination were recorded. Radiological investigation was carried out in the form of computed tomographic (CT) scan of nose and paranasal sinuses. Final diagnosis was made by histopathological examination either before instituting any form of treatment or by a postsurgical biopsy where surgery was carried out. Immunohistochemistry was done in some cases as deemed necessary by the pathologist. Thus, their modes of presentation, radiological and histopathological profiles were studied along with dilemmas in diagnosis and management. Results A total of 189 nasal masses were observed during this period. Out of which 126 were diagnosed as nasal polyps and were excluded from the study. Thus, 63 uncommon nasal masses were seen in the study period. A large number of uncommon sinonasal masses had atypical presentation and/or presented in an advanced stage to pose a diagnostic and surgical challenge. Endoscopic techniques are becoming a gold standard in surgical resection in most of them. Interdepartmental cooperation is highly essential. How to cite this article Sharma R, Sharma VK, Madhok R, Agarwal T, Mehrotra A, Kochhar A. Uncommon and Atypical Sinonasal Masses: Diagnostic and Therapeutic Challenges. Clin Rhinol An Int J 2012;5(3):114-117.

Clinico-pathological profile of sinonasal masses: an experience in national ear care center Kaduna, Nigeria

BackgroundThe presence of a mass in the nose and paranasal sinuses may seem to be a simple problem; however it raises many questions about the differential diagnosis. The aim of this study is to evaluate the clinico-pathological profile of sinonasal masses in our environmentThis is a retrospective analytical review of all the patients with sinonasal masses that presented to the national ear care center, Kaduna over a six year (2003-2008) period. Their biodata, clinical profile and histological diagnoses were analyzed.FindingsA total of 76 patients were analyzed, age range 5 to 64 yrs with a mean age of 33.3 yr median and modal age of 35.00 (SD = 13.1 ± 1.5). Majority of the patients were in the age groups 21-50 yrs. There were 34 male and 42 female with M: F ratio of 1:1.2. The main presenting symptoms are nasal blockage 97.4% and rhinorrhea 94.7%. It was bilateral in 34 (44.7%), left side in 24(31.6%) and right side in 18(23.7%) patients. The commonest clinical diagnoses were simple nasal polyp 47(61.8%) and antrochoanal polyp 10(13.2%). About 59 (77.6%) were benign, 2 (2.6%) were malignant and 15 (19.7%) were lost to follow up. The commonest histological diagnosis is simple inflammatory nasal polyp in 28 (36.8%) patients and the least was nasal capillary hemangioma 2 (2.6%). About 55(72.4%) patients had surgical treatment.ConclusionsNasal obstruction and rhinorrhea are the commonest symptoms of presentation, simple inflammatory nasal polyp is still the commonest histological pattern seen in our environment, and surgery is still the best modality of treatment for benign tumor thus the need for advocacy for early recognition and referral to the ENT surgeon.

Endothelial L-selectin ligand expression in nasal polyps

L-selectins on leukocytes and their counter-receptors on endothelial cells have been shown to be involved in leukocyte recruitment in chronic rhinosinusitis without nasal polyps (NP). The purpose of this study was to evaluate the expression level of functionally active endothelial L-selectin ligands in NP obtained from patients with NP of different etiology [simple NP, antro-choanal polyps (ACP) and cystic fibrosis (CF) NP] and inferior turbinate specimens of healthy controls and to compare these levels to the presence of various leukocyte subsets. Nasal polyp specimens and healthy nasal mucosa specimens were obtained from patients undergoing surgery and were immunohistochemically stained with monoclonal antibodies detecting CD34, sialyl Lewis x (sLe(x)) of sulfated extended core 1 lactosamines and various leukocyte subsets. All NP are characterized by a decrease in the number of CD34+ vessels. The number of eosinophils and the percentage of vessels expressing endothelial sulfated sLe(x) epitopes is upregulated in all groups of simple NP. Tissue eosinophilia is increased in those patients with increased disease severity (acetyl salicylic acid intolerance), but the percentage of endothelial sulfated sLe(x) epitopes is not. Results on CF NP are similar to those observed for simple NP. Antro-choanal polyps, on the contrary, are characterized by low numbers of tissue eosinophils and relatively few vessels expressing endothelial sulfated sLe(x) epitopes. Our results suggest that functionally active L-selectin ligands might play a role in guiding leukocyte traffic into NP in patients with simple NP and CF NP but not ACP.

Investigation of association of Helicobacter pylori and simple nasal polyps

Objective: To investigate a possible contribution of Helicobacter pylori (H. Pylori) in the etiopathogenesis of simple nasal polyps. Study Design: Prospective clinical trial. Methods: Twenty five patients with simple nasal polyps underwent nasal polypectomy were studied. Helicobacter pylori DNA was investigated for specimens removed from those patients by using polymerase chain reaction (PCR). Results: Helicobacter pylori DNA was detected in 2 (8%) of total 25 specimens. Conclusion: We could not find strong indicator that H. pylori played a role at the tissue level in the pathogenesis of nasal polyp. Keywords: Nasal polyp - Helicobacter pylori –Polymerase chain reaction.Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 95-98

Traditional open surgery for advanced benign nasal tumours in an era of endoscopy: review of 38 cases.

During the past decade open nasal surgery has been overtaken by endoscopic resection in the management of benign sinonasal tumours in the advanced countries. However, due to limited availability of endoscopic surgical facilities and training in most parts of sub-Saharan Africa, open surgery still seems popular. This report determines the indications and outcome of open nasal surgery for benign tumours in a resource – poor tertiary centre in sub-Saharan Africa and compares with endoscopic resection. This is retrospective study of 38 open surgeries done by the authors for cases of benign sinonasal tumours. Seventeen (45%) caldwel-luc procedures, 12 (31%) external (lynch-howarth) fronto-ethmoidectomy and 9(24%) lateral rhinotomy were carried out. The indications were simple nasal polyps 17(45%), mucocoele 10(26%), inverted paplloma 8(21%), invasive fungal sinusitis 2(5%) and ossifying fibroma 1(2%). Postoperatively, recurrence was 1/17(6%) caldwel-Luc surgery and 1/9 (11%) lateral rhinotomy for inverted papilloma. Facial scar was seen in 21/38(55%) but the cosmetic effect of the scars was acceptable to our patients. Postoperative stay was between 5 to 17 days. We conclude that open nasal surgery met the therapeutic expectations of our patients. The recurrence rate compared with that of endoscopic resection reported in the literature and cosmetic effect of facial scar was acceptable to the patients, however, postoperative stay in the hospital is longer. It is our hope that this will serve as a baseline to compare the result of endoscopic nasal surgery in future when it becomes a widespread procedure in the developing countries. African Journal of Health Sciences Vol. 14 (1-2) 2007: pp. 44-48

Malignant transformation in inverted papilloma.

The detection of markers associated with malignancy will help in the early identification of tumors and assessment of the success of treatment in patients suffering from carcinoma. Three characteristics investigated in this study were found to differentiate a premalignant inverted papilloma from a benign simple nasal polyp.

Allergy and immunology: an annotated bibliography of recent literature. Allergy and Immunology Committee, American College of Physicians.

Allergy and immunology: an annotated bibliography of recent literature. Allergy and Immunology Committee, American College of Physicians.

Simple nasal polyps and allergic manifestations

A series of 74 consecutive patients with simple nasal polyps were interviewed with regards to features of allergy. Skin testing with a variety of antigenic extracts and estimations of peripheral blood immunoglobulins including total serum IgE were also carried out. The simple tests performed in this study have not been able to delineate a specific subgroup of atopic patients with nasal polyps. Positive skin testing with house dust mite extract may form the basis of a clinical evaluation of hyposensitization.

Ultrastructure of the Stroma of Nasal Polyps: Cilia in Stromal Fibroblasts

Ultrastructural examination of the stroma of simple nasal polyps was shown that there is an edematous framework of fibroblasts with abundant interdigitating cytoplasmic processes, a plexus of inflamed blood vessels, and a mixed infiltrate of active inflammatory cells. Solitary cilia were seen to arise from the stromal mesenchymal cells; no mycoplasma or viral inclusions were present. These features may have a relationship to the pathogenesis of nasal polyps. An immunologically induced liberation of vasoactive amines from mast cells results in increased capillary permeability and a consequent excess of intracellular fluid; the stromal cells attempt to check this expansion by an increase in collagen synthesis.

An unusual case of adenocarcinoma of the nose.

An unusual case of adenocarcinoma of the nose is described which began as a simple nasal polyp. Although clinically invasive, microscopic investigations did not show any definite malignant changes until after 5 years. Despite vigorous attempts it did not respond to surgery or irradiation treatment. It showed progressive locally malignant changes but did not metastasise.