NOSE - Ethmoidal Polyps

What are ethmoidal polyps?

Ethmoidal polyps are multiple, bilateral, painless, pearly white, grape like masses arising from the ethmoidal air cells.Ethmoidal air cells are multiple air cells present on medial to the eyes.

What is the incidence and causes of ethmoidal polyps?

Incidence:

  • Age: Common in adults.
  • Sex: Both sexes are affected.

Causes:

  • Allergy: Usually allergic origin

What is the pathology of ethmoidal polyps?

These polyps are multiple, bilateral and have a grape like appearance. They have a strong allergic co-relation.

What are the symptoms of ethmoidal polyps?

  • Nasal obstruction: This is usually bilateral.
  • Anosmia(Loss of sensation of smell)
  • Watery nasal discharge
  • Headache also called "Vacuum Headache"
  • Watering of the eyes-Epiphora due to blockage of nasolacrimal duct
  • Sneezing is common as these polyps are allergic in origin.

What are the clinical signs of ethmoidal polyps?

  • Hyponasal voice (Rhinolalia Clausa) is present due to bilateral nasal obstruction.
  • Broadening of nasal bridge.

What investigations are required to confirm the diagnosis of ethmoidal polyps?

  • X-ray paranasal sinuses: They help in detecting the extent of the disease in the sinuses.
  • CT Scan of paranasal Sinuses: This is the investigation of choice. A CT Scan reveals the extent of the disease, the condition of lamina papyracea and also the posterior ethmoidal air cells and
    the cribriform plate.

What is the treatment for ethmoidal polyps?

Medical Treatment:

  • Antihistaminics, low dose steroids, local steroid sprays, help to regress the ethmoidal polyps to a certain extent. However, the above treatment rarely eliminates well formed polyps and is often combined with surgery.

Surgical Treatment:

  • Functional Endoscopic Sinus Surgery (FESS): Ethmoidectomy and polypectomy using FESS and microdebrider has considerably reduced the incidence of recurrence.
  • Ethmoidectomy: It can be done, external or transantral. However, it is not commonly done.
  • Polypectomy using nasal snare was used. However it is not commonly done these days due to higher chances of recurrence, and residual disease left behind.


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