Clinical presentation of a sphenochoanal polyp

Although choanal polyps frequently arise from the maxillary sinus, a choanal polyp originating from the sphenoid sinus is a rare entity. In this report, an unusual case of a large choanal polyp taking origin from the sphenoid sinus is presented. The reasons for its development and methods of management are discussed. Received: 1 August 1996 / Accepted: 20 January 1997     

Regression of a sphenochoanal polyp in a child

OBJECTIVES: To present an unusual case of a sphenochoanal polyp that regressed and review the etiology of such polyps in comparison to the commoner antrochoanal polyp. STUDY DESIGN: Case study. METHODS: One was incidentally discovered in a girl aged 3 years, 8 months at postnasal mirror examination after adenotonsillectomy. RESULTS: Computed tomography scans 1 month later confirmed the polyp, but three months later, MRI scans only revealed sphenoid sinus opacification. Sphenoidotomy revealed normal sinuses implying inflammation had resolved. CONCLUSION: This patient is believed to be the youngest reported to have sphenochoanal polyp, and the only one where the polyp had completely regressed. This regression suggests that sphenochoanal polyps may be more common than is thought but are mostly asymptomatic.     

内窥镜鼻窦手术160例小结

采用鼻内窥镜进行鼻窥手术１６０例，其中慢性复发性鼻窥炎患者１０３例，鼻息肉伴鼻炎患者４９例，鼻窦囊肿８例，术扣随肪，复发性鼻窦炎患者６４．１％治愈，３０．１％明显好转；鼻息肉患者全部正常通气，息肉复发率为１０．２％，鼻窦囊肿患者全部治愈。     

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.     

出血坏死性鼻息肉内镜治疗及临床分析

目的探讨鼻内镜手术治疗出血坏死性鼻息肉的疗效,并分析其临床特点。方法29例患者采用鼻内镜下手术治疗,并对术中所见结合CT特征及临床表现进行分析。结果术后6个月疗效评定,29例患者均治愈,内镜及CT检查显示患侧术后中鼻道及上颌窦口宽敞;筛窦、上颌窦腔黏膜基本恢复正常;鼻塞、头痛、血涕等症状均消失。结论鼻内镜手术是治疗出血坏死性鼻息肉的有效方法。     

鼻内窥镜下诊治Killian息肉22例

目的：探讨内窥镜检查和手术治疗Ｋｉｌｌｉａｎ息肉的优越性;方法,分析应用鼻内窥镜检查和手术治疗２２例Ｋｉｌｌｉａｎ息肉患者的临床资料。结果：术前行鼻内窥镜可清楚地窥见息肉的来源和发现上颌窦的病变,较之ＣＴ和Ｘ线对于鉴别诊断和手术更具指导意义。结论：鼻内窦镜手术治疗Ｋｉｌｌｉａｎ息肉既能根治病灶,又能保留粘膜功能,但对于窦内病变严重者,上颌窦根治手术仍为最佳选择,表明鼻内窥镜下诊治Ｋｉｌｌｉａｎ息肉     

Choanal polyp originating from the middle turbinate

Choanal polyps usually originate from the maxillary sinus. Unusual origins such as the sphenoid sinus, ethmoid sinus, nasal septum and hard and soft palate have been reported in the literature. Herein, we report a rare case of choanal polyp originating from the middle turbinate that was removed by an endoscopic surgery technique. The computed tomographic findings are described and the literature is reviewed.     

Choanal polyp originated from the inferior nasal concha

Almost all choanal polyps originate from the maxillary sinus and a choanal polyp (CP) originating from the inferior nasal concha (INC) is a rare entity. It presents in a similar manner to the more common antrochoanal polyp and may be confused on anterior rhinoscopy. In this report, an unusual case of a CP taking origin from the INC that was removed by endoscopic endonasal surgery in a young man is presented. No intraoperative or postoperative complication occured, and the symptoms immediately resolved after the operation. Although very rare, CPs arising from the INC should be kept in mind in the differential diagnosis of a solitary nasal polyp.     

白细胞介素-5及嗜酸性粒细胞在鼻息肉中的相关性研究

目的探讨白细胞介素-5(IL-5)在鼻息肉中的表达及其在鼻息肉形成与发展中的作用。方法采用双抗体夹心酶联免疫吸附测定法检测31例鼻息肉患者、11例慢性鼻窦炎患者及6例正常人组织匀浆中IL-5含量;对15例鼻息肉、11例慢性鼻窦炎及6例正常人进行HE切片染色,以观察组织中嗜酸性粒细胞的数量。结果①鼻息肉、慢性鼻窦炎及正常对照组IL-5含量(pg／mg)分别为23．44±6．68,16．41±3．09,12．86±4．17,鼻息肉组织IL-5含量高于慢性鼻窦炎及正常对照组(P<0．01)。②鼻息肉、慢性鼻窦炎及正常对照组的苏木精伊红染色嗜酸性粒细胞数分别为7．42±2．33,1.30±0．59,1．07±0．70,鼻息肉组嗜酸性粒细胞数高于慢性鼻窦炎和正常对照组(P<0．05)。结论鼻息肉是以嗜酸性粒细胞浸润为特征的疾病过程,对嗜酸性粒细胞有活化作用的IL-5对鼻息肉的形成起着一定的作用。     

Toll-like receptor 2, 3, 4, 5 ligands and interleukin-4 synergistically induce TARC production in nasal polyp fibroblasts

Objective

Although type 2 T helper (Th2) cytokines such as IL-4 and IL-5 play a crucial role in the pathogenesis of chronic sinusitis with allergy, the mechanism underlying the predominance of Th2 cytokines has yet to be clarified. Thymus and activation-regulated chemokine (TARC) has been known to facilitate the recruitment of Th2 polarized cells, resulting in high levels of Th2 cytokines in the sinus mucosa as well as nasal polyps. The nasal and sinus cavities are ideal sites for studying the interplay between microbial Toll-like receptor (TLR) ligands and chemokines. We investigated whether nasal polyp fibroblasts produce TARC when stimulated with the breakdown products of microorganisms (TLR ligands) and a Th2 cytokine (IL-4).

Methods

Fibroblast lines were established from nasal polyp tissues. The expression of TARC mRNA was evaluated by real-time RT-PCR. The amount of TARC in the supernatants was measured by ELISA.

Results

Combined stimulation with TLR 2, 3, 4, 5 ligands and IL-4 induced TARC gene expression and protein production in the cultured nasal polyp fibroblasts. This response was time-dependent.

Conclusions

These results suggest that nasal polyp fibroblasts contribute to innate immunity and may play an important role in the recruitment of Th2 cells into nasal polyps through the production of TARC.     

鼻腔鼻窦出血性息肉的诊断和手术治疗(附23例报告)

目的：总结鼻腔鼻窦出血性息肉的临床表现和影像学特征,以减少误诊和避免术式扩大化。方法：23例经病理确诊、资料完整的鼻腔鼻窦出血性息肉患者均行手术切除。1例疑鼻窦恶性肿瘤行鼻侧切开,2例经前鼻孔切除,余20例行上颌窦根治术。结果：术后全部确诊为鼻腔鼻窦出血性息肉。随访8个月～10年,无复发。结论：本病术前诊断靠综合判断,上颌窦穿刺及鼻窦CT对诊断有一定价值,最后确诊依赖术中肉眼观察及术后病理检查。手术是惟一有效的治疗方法,上颌窦根治术是本病较适宜的术式。     

鼻息肉中总IgE与嗜酸粒细胞浸润的相关性研究

目的:探讨总IgE及嗜酸粒细胞(EOS)在鼻息肉中的表达及其相关关系,以分析其在鼻息肉发病中的作用。方法:采用免疫组织化学SP法检测38例鼻息肉、15例中鼻甲黏膜组织中总IgE阳性细胞表达;采用Chromotrope2R染色法检测EOS浸润情况。结果:①鼻息肉组织中总IgE及EOS水平均明显高于中鼻甲黏膜组织,均P<0.01;②鼻息肉组织中总IgE与EOS呈明显正相关关系(r=0.843,P<0.01)。结论:EOS浸润在鼻息肉的形成和发展中起重要作用,IgE介导的Ⅰ型变态反应对鼻息肉中EOS浸润发挥一定作用。     

The Role of Platelet-Derived Growth Factor in the Pathogenesis of Sinonasal Polyps: Immunohistochemical Assessment in Epithelial,Subepithelial and Deep Layers of the Mucosa

Objectives

The aim of this study is to investigate the role of platelet-derived growth factor (PDGF) in the pathogenesis of sinonasal polyps.

Methods

Study group (groups 1-3) consisted of nasal polyp samples of patients with sinonasal polyps and the control group consisted of inferior turbinate samples of patients without nasal polyp. In group 1, 14 specimens from ethmoid sinus; in group 2, 10 specimens from nasal cavity; in group 3, 10 specimens from maxillary sinus; and in group 4 (control), 9 specimens from inferior turbinate were included. By immunohistochemical staining technique, the PDGF positivity index (PI) in mucosal layers and in the inflammatory cells were assessed at the epithelium (EP), subepithelial layer of lamina propria (SE), and deep paraglandular layer of the mucosa (D).

Results

Polymorphonuclear cell (PMNC)-percentage (%) values of ethmoid and maxillary sinus, and the PDGF PI from all cells of ethmoid sinus and nasal cavity were significantly higher than those of the control group. As mononuclear cell-% (MNC-%) increased, the PDGF_EP_basal PI, PDGF_SE_endothelial PI, and PDGF_D_endothelial PI decreased. As PMNC-PDGF PI increased, the PDGF_D_perivascular PI decreased and PDGF_D_endothelial PI increased. As PDGF-MNC PI increased, the PDGF_EP_apical PI, PDGF_SE_endothelial PI, and PDGF_D_endothelial PI decreased. As PDGF-all cells (PMNCs, MNCs, and fibroblasts) PI increased, the PDGF_EP_basal PI and PDGF_D_endothelial PI decreased, and the PDGF_D_perivascular PI increased.

Conclusion

We concluded that the PDGF systems play important roles in polyp pathogenesis. Fibroblast-derived PDGF may be more important than MNC-derived PDGF in polyp developing process. Increased perivascular-PDGF-PI in deep layers of the mucosa may result in sinonasal polyp formation by causing an increase in vascular permeability and extracellular edema, and thus promoting migration of inflammatory cells to extracellular area. Tissue oxygenization may be important for the initiation of PDGF release system. Because of this reason, nasal obstruction should be medically treated earlier, and, if necessary, by surgical approaches.     

鼻腔良性阻塞性病变嗅功能障碍的处理

对筛选出的鼻腔良性阻塞性嗅觉异常的39例（62侧）鼻腔进行CT及鼻内窥镜检查,发现因中鼻甲变异致嗅裂消失者14侧（22.58％）,筛泡肥大及中鼻道息肉26侧（41．93％）,中鼻道合并嗅裂息肉15侧（24.19％）,鼻中隔高位偏曲4侧（6.45％）。鼻中隔代偿性肥厚3侧,经功能性鼻窦内窥镜手术处理后,对其嗅觉变化进行了动态观察,发现术后12周嗅觉治愈率为48．4％（30／62）,嗅觉好转为25.8％（16／62）,25.8％（16／62）无变化。鼻窦炎越严重者,嗅觉恢复越慢,由此认为嗅觉障碍常与中鼻甲变异,窦口鼻道复合体及嗅裂的阻塞和炎症有关,早期处理上述病变,可使嗅觉有较好的恢复。     

Prevalence of Helicobacter pylori in patients with nasal polyps: a preliminary report

OBJECTIVES: The aim of the study is to determine the presence of H. pylori in nasal polyps by both immunohistochemical staining with H. pylori antibody of biopsy specimens and enzyme-linked immunoadsorbent assay (ELISA) of sera. STUDY DESIGN: A prospective, controlled, clinical trial. METHODS: We enrolled 30 patients with nasal polyps and 20 controls with middle concha bullosa undergoing endoscopic sinus surgery (ESS). Blood samples of both the study and control groups were evaluated for anti-H. pylori specific immunoglobulin (Ig)G antibodies by ELISA. In addition, biopsy specimens of the removed polyps and the mucosal part of middle conchas were examined by the immunohistochemical analysis with H. pylori antibody. RESULTS: In the blood samples, specific IgG antibodies to H. pylori were found in 26 (86.7%) of 30 polyp patients and 17 (85%) of 20 controls. In 6 (20%) of the 30 patients, H. pylori was identified in the nasal polyp tissue, but it was not detected in the mucosal part of the middle concha specimens. No significant statistical difference was observed for H. pylori antibodies by ELISA among the patients with nasal polyps and the control group (Fisher's exact test, P = .59). However, there was a statistical difference between the polyp biopsy specimens and the control biopsy specimens by immunohistochemical staining (Fisher's exact test, P = .037). CONCLUSIONS: This study indicates that H. pylori was found in increased prevalence in the nasal polyps. However, further controlled epidemiologic studies would be necessary to confirm our results and clarify the potential underlying pathogenetic mechanisms.     

Antrochoanal polyp: a comparative study of endoscopic endonasal surgery alone and endoscopic endonasal plus mini-Caldwell technique

Antrochoanal polyp (ACP) originates in the maxillary sinus. To diminish the regrowth rate of choanal polyp, a complete removal of the antral portion and its attachment is necessary. There are several methods for this purpose, but in this study two techniques were comparatively investigated. This retrospective study was conducted by analyzing the database of 40 operated patients for ACP, 19 of whom underwent an endoscopic endonasal removal of polyps and 21 experienced endoscopic endonasal surgery with mini-Caldwell operation. The two techniques were compared with regard to their complications and regrowth rate. It emerged that post-operative complications (bleeding, synechia, ostia stenosis) in both groups were mild and there was not any significant difference between the two groups. Out of 19 cases in the endoscopic endonasal surgery group, 4 had recurrences, while in the mini-Caldwell group we had no recurrence. (P = 0.042)). This result implies that, in order to prevent incomplete excision and recurrences, combined approaches (endoscopic endonasal surgery and mini-Caldwell) should be considered, particularly when the attachment site of the antral part of ACP is undetected.     

鼻窦内窥镜手术的临床体会

对４５例７４侧鼻息肉合并鼻窦炎病例,在鼻窦内窥镜下进行了下述手术：①窦口鼻道复合体手术,②全筛窦和蝶窦手术,③辅以鼻外径路上颌窦手术。其中１７例（３７．８％）为传统手术后复发病例,经６个月以上随访,治愈５６侧（７５．７％）,好转 １３侧（１７．６％）,总有效率为９３．３％,无严重手术并发症。本文对手术的方式、并发症、复发症例再手术问题等方面进行了探讨。     

飞行人员鼻窦炎鼻息肉的临床诊治和医学鉴定研究

目的：总结飞行人员鼻窦炎鼻息肉的临床诊治和医学鉴定经验。方法：分析飞行人员鼻窦炎鼻息肉资料93份。结果：急性鼻窦炎11例，慢性鼻窦炎鼻息肉82例。慢性鼻窦炎鼻息肉Ⅰ类46例（包括Ⅰa地面有症状39例和Ⅰb体检时发现7例），Ⅱ类36例（地面无症状、飞行中有继发性气压伤，包括Ⅱa继发性鼻窦气压伤14例，Ⅱb继发性耳气压伤13例，Ⅱc继发性鼻窦气压伤＋耳气压伤9例）。慢性鼻窦炎鼻息肉Ⅰ型1期24例，Ⅰ型2期38例，Ⅰ型3期7例；Ⅱ型1期2例，Ⅱ型2期6例，Ⅱ型3期3例；Ⅲ型2例。84例恢复飞行，9例永久停飞。结论：鼻窦炎鼻息肉可直接或因继发性气压伤而危及飞行安全，慢性鼻窦炎鼻息肉伴继发性耳气压伤者是医学停飞的重要原因，患鼻窦炎鼻息肉的飞行人员只有在获得良好治疗效果及耳气压功能和鼻窦气压功能正常的情况下方可恢复飞行。