On anterior
Rhinoscopy
1. Polypi appears as smooth glistening grape like
masses often pale in color.
2. They may be sessile or pedunculated.
3. Insensitive to probing.
4. Don’t touch on bleeding.
5. Nasal cavity may show purulent discharge due to
associated sinusitis.
On
Posterior Rhinoscopy.
Only to
see the polyp are visible in posterior nares or not.
DIFFERENTIAL
DIAGNOSIS OF MUCOSAL POLYP.
Antrocoanal polyp
2. Neoplastic lesions of nose.
3. Nasal obstruction
4. Maggots
5. D.N.S.
6. Rhinoliths
7. Hypertrophy of turbinates
8. Cystic middle turbinate.
STAGING OF
MUCOSAL POLYP
The
advantages of nasal endoscopy and imaging of sinuses make it possible to
create a new classification based on morphologic data.
There is 4
stage grading system for nasal polyps of ethmoid based on endoscopic
aspect supplemented by C.T scan and acoustic rhinometry.
STAGE 0
= Equivalent to normal mucosa .
STAGE 1
= Mucosal swelling in middle meatus
STAGE 2
= Polyps not extending the middle meatus.
STAGE 3
= Polyps may involve the middle turbinate.
STAGE 4
= All nasal structures may be involved.
1 . Blood
C.P (TLC, DLC ,ESR ,Hb % and platelets.)
2.
Blood sugar (to exclude the diabetes)
3. Blood urea (to access the renal function)
4. Urine D.R
5. X-Ray of sinuses
6. Anterior rhinoscopy
7. Posterior rhinoscopy
8. C.T. Scan
9. M.R.I
10. Acoustic rhinometry
11. Nasal endoscopy
CONSERVATIVE
1. Use of
antihistamines and control of allergy if polyps are small and without
symptoms.
2. Medical
treatment with topical nasal steroids (beclomethasone dipropionate
aqueous nasal spray; 200 micro gram twice a day) for 1-3 months
initially is useful successful for small polyps.
A short
course of oral corticosteroids (e.g. prednisolone; 6 day course using
21 5 milligram tablets) may be benefit.
Contraindications to use of steroids are