Section 10


What is the diagnosis?

  • Nasal polyposis

 

Describe the most common grading system for the above condition

  • Meltzer Clinical Scoring System 
    • 0 = no polyps
    • 1 = polyps confined to the middle meatus
    • 2 = multiple polyps occupying the middle meatus
    • 3 =polyps extending beyond middle meatus
    • 4 = polyps completely obstructing the nasal cavity

Describe two medical management options.

  • Nasal steroids
  • Antihistamines
  • Saline douche

Describe 5 potential complications associated with surgery

  • Bleeding
  • Infection
  • Pain
  • CSF leak
  • Orbital injury

What would be a potential diagnosis if this was seen in a 4 year old?

Cystic fibrosis

What are the elements of Samter’s triad and what is this condition also known as?

  • Nasal polyposis
  • Aspirin sensitivity
  • Asthma
  • Aspirin-exacerbated respiratory disease

Supporting Information

Nasal polyps– herniation of nasal mucosa- due to oedema of connective tissue- contains eosinophilic tissue. Symptoms:

  • Obstruction
  • Discharge
  • Anosmia
  • Widening of the distance between medial corners of the eyes

Causes– Allergic. If bilateral lesions in a child think of cystic fibrosis and do a sweat test. 

Management

  • Medical- intranasal steroids, antihistamines
  • Polypectomy- high recurrence rate
  • Histology on suspicious polyps
  • Antro-choanal polyps- large unilateral polyps from the maxillary sinus- prolapse through the nasal cavity- normally can manage with:
    • FESS
    • Caldwell-Luc incision may be required

Samter’s triad- AKA: Aspirin exacerbated respiratory disease:

Triad:

  1. Recurrent nasal polyposis
  2. Aspirin sensitivity
  3. Asthma
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