Nasal Polyps Causes and Treatments
Nasal polyps can occur in association with more general diseases such as adult-onset asthma an uncommon association is with aspirin intolerance, and very occasionally they occur in children with cystic fibrosis. Adult-onset asthma rather than childhood asthma is associated with nasal polyps. 20-40 of patients with polyps will have asthma as well. Eight in every 100 patients with polyps also have asthma and aspirin sensitivity, and in these patients the polyps tend to recur more than in other people.
Nasal polyps come from the lining of the nose and often originate from the ethmoid sinuses (in the face, either side of the nose), which drain into the nasal cavity. Nasal polyps contain inflammatory fluid and while they can be associated with allergy and infection, the exact reason why some people get them and not others is unknown. Allergy is no more commonin people with nasal polyps than in people who do not have polyps.
Several studies have attempted to ascertain the site and state of infection in the nasopharynx of normal populations and those at high risk to develop NPC. In patients with infectious mononucleosis, EBV DNA and viral antigens were detected in sloughed epithelial cells (98,99). This suggested that the nasopharyngeal epithelial cells were the source of infectious virus that is detected in saliva during infectious mononucleosis. Evidence of EBV replication has been detected in epithelial cells in parotid tissue in which high copy numbers of EBV genomes were detected by in situ hybridization (100). A recent study also showed evidence of EBV replication in epithelial cells adjacent to an EBV positive T-cell lymphoma (101). The epithelial cells had high copy numbers of EBV DNA and were ZEBRA positive but EBER negative, while the malignant lymphocytes were positive for EBER and LMP-1 expression. Studies of normal nasopharyngeal mucosa have detected evidence of EBV only in lymphocytes in...
Fig. 1.1 Nasal polyps a before and b after medical treatment. Fig. 1.10 a Nasal polyps in the olfactory area medial to the middle turbinate, deliberately not removed at surgery. b The Fig. 1.10 a Nasal polyps in the olfactory area medial to the middle turbinate, deliberately not removed at surgery. b The
Although not a classic fungal infection, brief mention will be made of the use of fungal antigens to treat allergic fungal sinusitis. Allergic fungal sinusitis has histologic features resembling those of allergic bronchopulmonary aspergillosis and is characterized by association with asthma, nasal polyps, and allergic mucin, a viscous secretion that contains degenerating eosinophils and Charcot-Leyden crystals (67,68). Aspergillus species are frequently cultured from mucin, but a variety of other fungal species have been cultured from patients with allergic fungal sinusitis including Bipolaris, Curve-laria, Alternaria, and Cladosporium (69). The standard therapy for allergic fungal sinusitis is surgical drainage and corticosteroid administration, but relapses are common (67). Because of the immunologic nature of this disease, immunotherapy has been suggested to be potentially beneficial (69). Immunotherapy for allergic fungal sinusitis involves the injection of fungal antigens to...
Most inflammatory nasal polyps are known to shrink when nasal sprays or drops containing topical nasal steroids are used. New local nasal steroid drops or sprays can be taken to control symptoms for many years as very little is absorbed into the body they can work well, but it may take up to six weeks of treatment before their full benefit is felt. Steroids in tablet form can provide good relief, but the effects are short-lived and they are used sparingly because of concerns about side effects. If medicines don't work, then surgery can usually help.
It is said that to be a good surgeon you also have to be a good physician. Surgical maneuvers cannot cure the majority of patients with noninfective nasal polyps, any more than they can cure allergic rhinitis. Advances in instrumentation, computer-aided surgery, and optics may refine surgical techniques, but it seems likely that the main advances will come through research into the etiology and pathological mechanisms of allergic and idiopathic rhinitis and nasal polyposis, and the development of new medical therapies.
If the lamina papyracea is cracked or a segment is removed during the procedure, this may cause a minor ecchymosis (Fig. 12.7) this will settle spontaneously in 3-4 days. If the orbital periosteum is traversed, then orbital fat prolapses into the nasal airway. Although fat has a yellow hue, it can look remarkably like nasal polyps. Palpation of the closed eye by the assistant, or you, will tell whether it is orbital fat as it will move abruptly with this maneuver. If it is fat, do not panic there is a temptation to push it back into the orbit (this will fail), to pull it out (this will make the damage to the orbit worse), or to cauterize it. None of these is necessary and they may cause more harm.
Be aware that only 6 of patients with allergic rhinitis have hypertrophic or polypoidal mucosa, and that the majority of patients with nasal polyps do not have atopic disease. Patients with polyps and coexisting atopy usually respond well to the same treatment as those with rhinitis. If a patient has severe nasal polyps, particularly medial to the middle turbinate, it is worth giving them a preoperative course of oral steroids to reduce the Fig. 3.33 Nasal polyps a before and b after oral steroids, just prior to surgery. Fig. 3.33 Nasal polyps a before and b after oral steroids, just prior to surgery.
It is important that all tissue, whether it looks harmless or not, is sent for histological examination. We found that 1 of 2021 nasal polyps had pathology that differed significantly from the clinician's diagnosis, and this then altered management (Diamantopo-polous and Jones, 2000). Endoscopic biopsy can reduce morbidity (Trimas and Stringer, 1994) as well as preserving oncological barriers so that an en bloc resection can potentially be carried out without compromising oncological resection as well as increasing the rate of histological diagnosis. Biopsy should ideally be done after imaging so that the artifacts that occur after surgery do not complicate image interpretation (Myers and Carrau, 1993).
Bachert C, Gevaert P, Holtappels G, Johansson SG, van Cauwenberge P (2001) Total and specific IgE in nasal polyps is related to local eosinophilic inflammation. Journal of Allergy and Clinical Immunology 107(4) 607-614. Diamantopopolous I, Jones NS (2000) All nasal polyps need his-tological examination an audit based appraisal of clinical practice. Journal of Laryngology and Otology 114 755-759. Drake-Lee AB (1987) Nasal polyps. In Kerr AG, Groves J, eds. Scott-Brown's Otolaryngology. London Butterworths, pp. 142-153. Slavin RG (1997) Nasal polyps and sinusitis. JAMA. 278 184954.
Ostia, thereby interfering with aeration of the sinuses and creating a closed space that is susceptible to bacterial infection. Sinusitis is, therefore, more likely in the elderly with allergic rhinitis, nasal septal deviation, nasal fractures, nasal polyps or tumors. About 5-10 of cases of bacterial maxillary sinusitis are secondary to dental root infection. Sinusitis is generally subdivided into acute sinusitis (symptoms less than 3 wk), subacute sinusitis (symptoms lasting 3 wk-3 mo) and chronic sinusitis (symptoms lasting longer than 3 mo). Sinusitis may potentially cause serious intracranial suppurative complications such as meningitis, brain abscess, epidural abscess, and subdural empyema. Acute bacterial sinusitis is commonly due to S. pneumoniae and H. influenzae. Less frequently isolated organisms include Streptococcus pyogenes, a-hemolytic streptococci, S. aureus, and M. catarrhalis (30). The -lactamase production by most strains of M. catarrhalis and a variable proportion...
|Nasal Polyps No More|
Where Can I Get Nasal Polyps Treatment Miracle
Free version of Nasal Polyps Treatment Miracle can not be found on the internet. And you can safely download your risk free copy of Nasal Polyps Treatment Miracle from the special discount link below.