Sphenochoanal polyp presenting with concomitant nasal polyps

A sphenochoanal polyp is a rare lesion that originates in the sphenoid sinus. It occurs most often in adolescents and young adults. We present what to the best of our knowledge is the first reported case of a sphenochoanal polyp associated with concomitant nasal polyps. The patient was a 54-year-old man who presented with bilateral nasal obstruction, possible obstructive sleep apnea, and an altered voice, all of which had likely been caused by the presence of a massive left sphenochoanal polyp and bilateral grade III anterior and posterior ethmoid polyps. Because the patient had dilated cardiomyopathy, he was not a good candidate for general anesthesia. Therefore, the polyps were removed endoscopically under local anesthesia. The sphenochoanal polyp measured 7.5 cm in its greatest dimension and weighed 41 g. The patient remained symptom-free at the 1-year follow-up. The presentation of a sphenochoanal polyp is similar to that of the more common antrochoanal polyp, but the two can usually be differentiated on computed tomography. Endoscopic sinus surgery allows for complete removal of the polyp, including its site of origin, which minimizes the risk of recurrence.     

Sphenochoanal polyp—Surgical review

A sphenochoanal polyp is a rare lesion that originates in the sphenoid sinus and protrudes through the choana into the nasopharynx. It can occur at any age but is especially common in adolescents and young adults. We present a case of a sphenochoanal polyp in a seven-year-old girl who presented with bilateral nasal obstruction and an altered voice. The presentation of a sphenochoanal polyp is similar to that of the more common antrochoanal polyp, but the two can only be differentiated on cross-sectional imaging (computed tomography and/or magnetic resonance imaging). Endoscopic sinus surgery allows for complete removal and minimizes the risk of recurrence.     

蝶窦后鼻孔息肉的诊断和治疗(附3例报告)

目的探讨鼻内镜在蝶窦后鼻孔息肉的诊断和治疗中的作用.方法3例蝶窦后鼻孔息肉患者均在鼻内镜下切除息肉.结果术后平均随访12个月,3例患者头痛及鼻塞症状均消失,息肉未复发,无并发症发生.结论鼻内镜检查和CT扫描是诊断蝶窦后鼻孔息肉的重要辅助方法;经鼻内镜手术是蝶窦后鼻孔息肉的首选治疗方法.     

Simultaneous antrochoanal and sphenochoanal polyps: a rare clinical entity

Choanal polyps almost always appear as solitary growths and most commonly arise from the maxillary sinus. Sphenochoanal and ethmoidochoanal polyps are extremely rare. Co-existence of more than one choanal polyp is even more infrequent. We present a patient with an antrochoanal and an accompanying sphenochoanal polyp for the first time in the literature. We discuss the clinical presentation, pathogenesis and surgical management of this rare clinical entity.     

Sphenochoanal polyp: report of two cases

OBJECTIVE: Report of 2 cases of sphenochoanal polyp. MATERIAL AND METHOD: We present two cases of sphenochoanal polyp aged of 22 and 53. They were operated by endonasal endoscopic approach. They are still free of symptoms and no recurrence are observed after 13 and 56 months of follow-up. CONCLUSION: The clinical, radiological and pathological features of the sphenochoanal polyp are reviewed. Different etiopathogenic hypothesis are discussed and particular the gastroesophageal reflux. The treatment is surgical.     

Sphenochoanal polyp: endoscopic surgery

Sphenochoanal polyp is a rare entity originating from sphenoid sinus. It may be confused with antrochoanal polyp on anterior rhinoscopy because of its similar appearance. Computerized tomography and nasal endoscopy have contributed to an increase of accuracy in the diagnosis of these masses. Simple polypectomy that leaves some part of the polyp inside the sphenoid sinus carries a high risk of recurrence. Destructive external approaches to gain access to the sphenoid sinus are also not advisable in children for a benign disease. We present two cases of sphenochoanal polyps in two children that were operated by endonasal endoscopic approach. They were free of symptoms after surgery. No complications and recurrences were observed at 28 and 18 months of follow-up periods respectively.     

蝶窦后鼻孔息肉的鼻内镜治疗(附3例报告)

目的探讨蝶窦后鼻孔息肉的临床特征、诊断和鼻内镜手术治疗效果。方法对3例蝶窦后鼻孔息肉病人术前行冠状位CT扫描并行鼻内镜手术治疗。结果鼻内镜检查和冠状位CT扫描可确定息肉的起源。所有病人均一次治愈,术后随访8~26个月未见复发。结论临床特征、鼻内镜检查和冠状位CT扫描对蝶窦后鼻孔息肉的诊断起重要作用,鼻内镜手术是最佳治疗方法。     

Angiomatous ethmoidochoanal polyp in an infant: case report

Nasal polyps are rare in children younger than 10 years. We describe the case of an infant girl who had undergone a traumatic intubation at birth that had resulted in nasal bleeding. At the age of 5 months, she was brought to us with an obstructive left nasal mass. Imaging revealed the presence of an ethmoidochoanal polyp, as well as a fracture of the posterior cribriform plate and a small associated meningocele. Four months later, the polyp was excised, and the meningocele was corrected with endoscopic nasal surgery. Pathologic evaluation identified the lesion as an angiomatous polyp, which was probably related to the previous traumatic episode. We discuss the clinical aspects of a pathologic entity that has not been previously reported in an infant.     

Isolated sphenochoanal polyp: A rare clinical entity

Choanal polyps almost always appear as solitary growth and most commonly arise from the maxillary sinus. Isolated polyp originating from the anterior wall of the sphenoid sinus or from its interior and extending as choanal polyp in to the nasopharynx are extremely rare clinical entities. Here we report a 34-year-old male presenting with a history of headache, intermittent nasal discharge and nasal obstruction. A diagnosis of sphenochoanal polyp (SCP) was made on nasal endoscopy and magnetic resonance imaging. The SCP was removed endoscopically via a transnasal sphenoidotomy and histopathologically it was confirmed as inflammatory polyp. In this paper we discuss the clinical presentation and surgical management of this rare clinical entity.     

Sphenochoanal polyp - a rare diagnosis in nasal obstruction

One of the most common nasal pathologies to present to an otolaryngologist is polyposis. Two well-recognized forms occur, the common antrochoanal polyp and the rare sphenochoanal polyp. Differentiation between the two is necessary for proper management by endoscopic sinus surgery.     

Choanal polyp of sphenoidal origin

Sphenochoanal polyp is a rare entity which originates in the sphenoid sinus cavity and extends into the choana via the ostium. It presents in a similar manner to the more common antrochoanal polyp. Radiological examination is necessary to differentiate between these two types. We present a case of sphenochoanal polyp and review the clinical, radiological and pathological features. The role of endoscopic sinus surgery is emphasised. Received: 31 December 1999 / Accepted: 25 February 2000     

Impact of nasal polyps on quality of life of chronic sinusitis patients

Objective To study the significance of nasal polyps on the symptoms of chronic rhinosinusitis (CRS) and their influence on surgical outcomes. Methods Retrospective analysis of prospectively collected data comparing two groups of patients diagnosed with CRS with and without polyps who underwent surgery with a minimum of 3 month follow up period. Subjective scoring was performed using the Sino-nasal Outcome Test (SNOT-20) questionnaire. Computed tomography (CT) scans were compared using the Lund-Mackay scoring system. Endoscopic findings were graded according to Lanza and Kennedy staging system. The two groups were analyzed for the need of revision surgery. Results 30 patients underwent surgical management of CRS over a period of one year. 20 were male, 10 were female and the average age was 26 years (range 15–55years). Polyps were present in 15 patients with CRS while, the other 15 did not have polyps. The average CT score was 10.13 for the polyp group and 9.79 for patients without polyp.The Polyp group SNOT-20 preoperative scores averaged 20.27 with improvement to 3.80 at 2 weeks, 2.67 at 1 month and 2.93 at 3 months (86.21% improvement p=0.001). Non-polyp group SNOT-20 scores were 18.80 preoperatively with improvement to 4.67 at 2 weeks, 3.40 at 1 month and 3.27 at 3 months (81.83% improvement). Preop diagnostic endoscopy on polyp group was 5.27 which improved to 2.13 in 2 weeks, 1.33 in 1 month and 1.53 in 3 months (73% improvement). In the non polyp group it was 4.53 pre-operatively which improved to 1.20 in 2 weeks, 0.93 in 1 month and to 1.13 in 3months (69% improvement). 6 patients required revision surgery (20%), 3 (10%) belonging to polyp group and 3 (10%) who did not have polyps. Conclusion Nasal Polyp has a significant negative impact on the patients with CRS. Patients with polyps have higher symptom scores, worse objective findings compared with patients without polyp, but patients with polyp show more improvement after surgical intervention and need for revision surgery is equal in both groups.     

Immunohistochemical demonstration and semi-quantitation of vascular endothelial growth factor in recurrent versus non-recurrent nasal polyps

OBJECTIVE: The expression of some growth factors in nasal polyps has been examined, although investigations addressing the reason for recurrence in some patients are lacking. Vascular endothelial growth factor (VEGF) is expressed by inflammatory cells, as well as by endothelial and epithelial cells of nasal polyps. To determine whether VEGF may play a role in the recurrence of nasal polyps, we aimed to compare VEGF expression in recurrent versus non-recurrent polyps. In addition, expression in polyps from asthmatic patients was compared with that in polyps from non-asthmatics. MATERIAL AND METHODS: A total of 30 patients with newly diagnosed nasal polyposis were included. Polypectomy was performed at enrolment in the long-term follow-up study. Fifteen patients had only 1 polypectomy (non-recurrence group; median observation period 81 months) and 15 had a median of 6.4 polypectomies (multiple recurrence group; median observation period 108 months). Five of 10 patients with asthma belonged to the non-recurrence group and 5 to the recurrence group. The polyp obtained at the initial polypectomy was examined for expression of VEGF by immunohistochemistry, using a polyclonal antibody. A blinded semi-quantitation and comparison of the intensity of immunolabelling were performed in recurrent versus non-recurrent polyps, as well as in asthmatics versus non-asthmatics. RESULTS: VEGF expression was seen as varying staining of the polyp surface and gland epithelium, as well as of the vessel endothelium and some stromal mono- and polymorphonuclear leukocytes. Semi-quantitation of the staining intensity showed no significant differences between recurrent and non-recurrent polyps, or between asthmatics and non-asthmatics. CONCLUSION: Our findings indicate that the level of immunohistochemical expression of VEGF in recurrent and nonrecurrent nasal polyposis is equivalent. Thus, the level of VEGF expression cannot predict a subsequent recurrence. The expression of VEGF is not upregulated in patients with asthma. Further studies are needed to determine the role of VEGF in nasal polyposis, with special reference to different stages of polyp formation, vascularization and growth.     

Basic fibroblast growth factor expression in recurrent versus non-recurrent nasal polyposis

Various growth factors are expressed in nasal polyps, and some of these have been suggested to play a role in polyp formation. A potential relation between growth factor expression and polyp recurrence, however, is undetermined. Basic fibroblast growth factor (bFGF) is expressed in mononuclear cells, as well as in endothelial and epithelial surface and gland cells of nasal polyps. To determine whether bFGF may play a role in the recurrence of nasal polyps, the present study aimed at a comparison of bFGF expression in recurrent versus non-recurrent polyps. Further, the expression in polyps from asthmatic patients was compared with that from non-asthmatics. Thirty patients with newly diagnosed nasal polyposis were included. Polypectomy was performed at entry to the long-term follow-up study. Fifteen patients only had one polypectomy (no recurrence group, with a median observation time of 81 months). Fifteen patients had a median of 6.4 polypectomies (multiple recurrence group, with a median observation time of 108 months). Five of nine patients with asthma belonged to the non-recurrence group and four to the recurrence group. The polyp from the entrance polypectomy was examined for expression of bFGF by immunohistochemistry, using a polyclonal antibody. A masked semi-quantification of staining intensity was performed in recurrent versus non-recurrent polyps, as well as in asthmatics versus non-asthmatics. bFGF expression was seen as varying staining of the polyp surface and gland epithelium, as well as of some mononuclear cells and some fibroblast-like cell profiles in the polyp stroma. Vascular endothelium was labeled occasionally. Semi-quantification of the staining intensity showed no significant differences between recurrent and non-recurrent polyps, or between asthmatics and non-asthmatics. We conclude that the level of immunohistochemical expression of bFGF in recurrent and non-recurrent nasal polyposis is equivalent. Thus, the level of bFGF expression in the primary polyp can not predict a subsequent recurrence. The expression of bFGF is not up-regulated in patients with asthma. Further studies are needed to determine a potential role of bFGF in nasal polyposis, with special reference to different stages of polyp formation and growth.     

Office pulsed dye laser treatment for benign laryngeal vascular polyps: a preliminary study

OBJECTIVES: The 585-nm pulsed dye laser (PDL) was recently deemed relatively safe and effective for treatment of laryngeal papilloma, dysplasia, and granuloma. We report on in-office PDL treatment of laryngeal vascular polyps. METHODS: Retrospective case results from 29 consecutive cases of laryngeal polyps were evaluated to determine the percent change in polyps after PDL treatment. Preoperative and postoperative measurements of polyp size, total power delivered to the site, and whether patients opted for postprocedure phonomicrosurgery were analyzed. RESULTS: After PDL treatment, the results varied from complete to partial resolution of the polyp. Four patients requested conventional phonomicrosurgery, and the rest had enough improvement to defer surgery. Almost 40% of patients with larger polyps desired operative intervention after laser treatment, whereas only 13% of those with small polyps opted for phonomicrosurgery. Thirty-eight percent (11 of 29) of the lesions had greater than 70% improvement after 1 or 2 laser treatments (average of 1.1 procedures). Smaller lesions responded better. Thirty-nine percent of small polyps resolved by greater than 70%, whereas only 20% of larger lesions improved by the same amount. There were no adverse events from the office procedure. CONCLUSIONS: In-office use of the PDL for treatment of vascular polyps may be a safe alternative to phonomicrosurgery. Small polyps seem to show a better response.     

The early stages of polyp formation.

The purpose of this study is to describe polyp formation in the mucosa of the middle ear as a possible model for the pathogenesis of nasal polyps. In 65 Wistar rats, the eustachian tube was occluded on the left side for up to 20 months; 60 right-sided, nonoccluded ears served as controls. Following occlusion, the middle ear mucosa was examined for signs of polyps. Signs of polyp formation or fully developed polyps were seen in 14 (22%) of the middle ears, and were only seen in middle ears with signs of actual or previous infection. It was established that the first stages of polyp formation include epithelial rupture, proliferation of fibrous tissue through the epithelial defect, and epithelialization of the prolapsed fibrous tissue by proliferation and migration of epithelial cells from the surrounding epithelium until there is full epithelial covering of the polyp. This report discusses whether the described middle ear model may form basis for the explanation of the pathogenesis of nasal polyps.     

The release of histamine from nasal polyp tissue and peripheral blood when challenged with antihuman IgE, house dust mite extract and mixed grass pollen extract and compared with positive skin tests

Nasal polyps are a condition of uncertain aetiology but are associated with diseases of the lower respiratory tract, in particular, asthma and cystic fibrosis. Asthma may be mediated by mast cell reactions and the commonest allergen to degranulate mast cells is house dust mite. Mast cells have been shown to be degranulated in nasal polyps. This study looks at thirty-six patients who had nasal polypectomy and of whom fourteen were asthmatic to see if histamine was released from polyp tissue and peripheral blood when they were challenged with antihuman IgE and extracts of house dust mite and mixed grass pollens. These results were compared with skin tests to these allergens. A release of above 15 per cent of the total histamine was considered positive. Eight patients released histamine from polyp tissue but only three patients released histamine with both anti IgE and allergen extracts. The release from blood compared well with positive skin tests (p greater than 0.05 corrected chi square). Although allergy may cause mast cell degranulation in polyp tissue, this study suggests that it is unlikely to be a common cause of nasal polyps.     

Choanal polyp originating from the nasal septum: a case report

Almost all nasal polyps originate from the mucosa of the lateral walls of the nasal cavity or from the paranasal sinuses. A choanal polyp is the intranasal portion of a cyst that has arisen from the wall of the maxillary sinus near the ostium. Medially based polyps, such as those that arise from the nasal septum, are rare. The literature cites a wide range of incidence rates for polyps originating from this structure, but choanal extension of this type of polyp is extremely unusual. This report describes a polyp that arose from the superior aspect of the posterior nasal septum and extended through the choana into the nasopharynx. The histology of this choanal lesion was typical of nasal polyps, but the site of origin is rare. The ethiopathogenesis of nasal polyps with its common location remains controversial so it is difficult to speculate what mechanism triggered the development of this lesion on the nasal septum. Some form of local inflammation may have induced choanal polyp formation at this atypical site.     

Immunopathological characteristics of nasal polyps

The presence of immunoglobulins in nasal polyps and surrounding mucosa was studied by direct immunofluorescence in 14 patients. Specific and total IgE were determined in polyps and in the sera of this group. Significant immunofluorescence to IgE was demonstrated in 12 polyps but in only four samples of adjacent mucosa. Eight polyps showed significant immunofluorescence to IgM. Six patients had elevated total IgE levels within polyp sac fluid in the absence of elevated serum values. In seven cases, specific IgE was found in polyp sac fluid which could not be detected on skin or serum testing. These results may suggest local production of IgE and support the concept of nasal polyps being a manifestation of a local allergic phenomenon.     

Activated eosinophils in nasal polyps: a comparison of asthmatic and non‐asthmatic patients

Objectives: There is a recognized clinical association between nasal polyps and asthma. Nasal polyps and the airways of asthmatic patients demonstrate marked eosinophilia suggesting that this inflammatory cell may have a key role to play in both conditions. The objective of this study was to determine whether nasal polyps from patients with asthma had a greater density of activated eosinophils than patients with no associated respiratory disease. Design: Archived specimens were retrieved from patients who had undergone nasal polyp surgery and their case notes reviewed. Activated eosinophils were identified using immunohistochemistry for a monoclonal antibody to secreted eosinophil cationic protein (EG2). Setting: Teaching hospital otolaryngology unit. Participants: Consecutive patients who had undergone nasal polyp surgery in 1994 were recruited. The diagnosis of asthma was based on a documented physician diagnosis and appropriate drug treatment. Twenty‐four asthmatic and 35 non‐asthmatic patients were studied. Main outcome measures: Eosinophil density was measured using a standardized counting technique. Results: Asthmatic patients were significantly more likely to have had previous polyp surgery (chi‐square test: P < 0.05). Areas of intense eosinophilia were identified in all samples. There was a significant greater degree of activated eosinophilia in the asthmatic patients (t‐test: P < 0.05). Conclusions: We have demonstrated a higher number of previous operations in asthmatic patients, and also a greater degree of activated eosinophilia in asthmatic polyps compared with non‐asthmatics. This would suggest that eosinophil activity has a role to play in the pathogenesis of nasal polyps.