scholarly journals Prevalence of Eosinophilic/Non Eosinophillic Nasal Polyps and Analysis of Their Presentation in Hospital Universiti Sains Malaysia Kelantan, Malaysia

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Ramiza Ramza Ramli ◽  
Irfan Mohamad ◽  
Yahia Hussein Al-Hadeethi

Introduction: This study is aimed to examine the predominant inflammatory cells in nasal polyps (NP) in the local community and its correlation to the clinical presentations. Materials and Methods: The study was done retrospectively looking at patients who had undergone functional endoscopic sinus surgery (FESS) in Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia with a histopathological diagnosis of nasal polyposis (NP), between the years 2004 to 2008. Sixty-two patients between the ages of 18 years to 60 years old were selected and data relevant to the study were collected from the patient’s folders using a specially created form prepared for the study. The NP histopathology report from each patient underwent FESS were analysed and the patients were divided into eosinophilic and non-eosinophilic dominant group. Clinical presentations from each patient were also gathered and analysed according to the NP group. Results: In HUSM, there were a higher number of eosinophilic types NP as compared to the neutrophilic type NP which is contrary to other study conducted on Asian populations. The clinical symptom correlations between either eosinophilic or non-eosinophilic type of NP have not shown any significant associations. Conclusion: The study showed that the incidence of histological subtypes of nasal polyp in HUSM is almost the same as that found in other parts of the world (Europe and North America) which will reduce the possibility of racial or geographical influence on the pathogenesis of the nasal polyp. Clinical symptoms and presentation alone are not enough to differentiate the type of the nasal polyp without the histological study.

1993 ◽  
Vol 72 (6) ◽  
pp. 401-411 ◽  
Author(s):  
Paul R. Cook ◽  
William E. Davis ◽  
Robert McDonald ◽  
Joel P. McKinsey

We report on a series of 33 consecutive cases of antrochoanal polyp (ACP) treated by endoscopic sinus surgery over a five-year period. All but one patient was treated by endoscopic sinus surgery alone. This method of treatment was quite effective for ACPs. These 33 patients represent 22.3% of all nasal polyp patients on whom we operated during the same period. This incidence of ACP is greater than that generally reported in the literature. Some authors have attempted to distinguish ACPs from common nasal polyps primarily on the basis of morphology, histology, and the clinical behavior of the ACPs. In our series, a multivariate analysis, including histopathologic correlation, did not support the notion that ACPs are clearly distinct from common nasal polyps. Some interesting differences between the polyp groups did, however, become evident in our data analysis. Generally, ACPs are not thought to be associated with allergic disease; however, in our series we found the association of allergic disease with ACPs to be statistically significant (Chi-square=4.575, p<.05).


2017 ◽  
Vol 71 (6) ◽  
pp. 27-32 ◽  
Author(s):  
Joanna Nowosielska-Grygiel ◽  
Piotr Pietkiewicz ◽  
Kalina Owczarek ◽  
Jurek Olszewski ◽  
Jarosław Miłoński

Introduction. The aim of this study was to analyse the occurrence of inverted papillomas of the nose and paranasal sinuses in patients that underwent endoscopic sinus surgery in our department. Material and methods. Between 2006 and 2016, 3,574 patients underwent surgery due to paranasal sinus diseases. Patients were qualified for surgery based on medical history, computed tomography, and laboratory tests. Data were gathered from medical files, and they included age, sex, and histopathological diagnosis. Results. Among 3,574 patients that underwent surgery due to chronic inflammatory changes, on histopathology, inverted papillomas were diagnosed in 80 patients, including 31 women (38.75%) and 49 men (61.25%). Most patients were aged 60-70 years (women, 12.5%; men, 15%) or 50-60 years (women, 5%; men, 21.25%). Between 2006 and 2016, the number of surgeries ranged from 264 (7.38%) in 2013 to 355 (9.93%) in 2016, and the number of inverted papillomas ranged from 4 in 2007 and 2015 (1.23%) to 12 in 2014 (3.87%). Over the last 4 years of the study period, the incidence of inverted papillomas increased. Conclusions. Among 3,574 patients operated on due to chronic inflammatory changes, on histopathology, inverted papillomas were diagnosed in 80 cases (2.23%); thus, all patients qualified for endoscopic surgery due to inflammatory or hypertrophic changes should undergo rhino-fiberoscopy. Recurrence of inverted papillomas was observed in 17.50%, typically in patients with nasal polyps that co-occurred with inverted papillomas. We regard rhino-fiberoscopy as the most valuable method for detecting tumour recurrence in patients after surgery for inverted papillomas.


2020 ◽  
Author(s):  
Xiaodan Pan ◽  
Yuan Zhang ◽  
Chengshuo Wang ◽  
Luo Zhang

Abstract Background: Patients with eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) have poorer outcomes after endoscopic sinus surgery and a higher recurrence rate. This study aimed to investigate the profile of clinical symptoms of eCRSwNP and the related risk factors.Methods: We prospectively enrolled 298 CRSwNP inpatients from February 2019 to December 2019. Patients were divided into eCRSwNP and non-eCRSwNP groups based on the percentage of blood eosinophils. Clinical data on questionnaires, visual analogue scale (VAS) scores, and laboratory tests were collected. The differences in clinical symptoms, including nasal congestion, rhinorrhea, olfactory disorders, and head/facial pain, between the two groups were analyzed to identify the influential factors. Logistic analysis and receiver operating characteristic curves were used to determine the diagnostic benefit for the specific symptom in eCRSwNP patients.Results: Of the four major clinical symptoms, nasal congestion and olfactory disorders were significantly different between eCRSwNP and non-eCRSwNP groups. Patients with eCRSwNP more frequently complained about olfactory disorders (P = 0.002), while patients with non-eCRSwNP mostly had nasal congestion (P = 0.001). The logistic analysis showed that the primary risk factors for olfactory disorders of eCRSwNP were disease duration (P = 0.014) and alcohol intake (P = 0.012). Olfactory disorders were not associated with the disease course of eCRSwNP but were correlated with the disease duration of non-eCRSwNP (P = 0.008). When the clinical duration was less than 10 years, there was a significant difference in olfactory disorders between eCRSwNP and non-eCRSwNP groups (P < 0.01). However, when the clinical duration was over 10 years, the difference was not statistically significant (P = 0.264). The VAS score of olfactory disorders of over 5.75 could be used to predict the diagnosis of eCRSwNP (area under the curve =0.674, 95% confidence intervals: 0.559–0.689, P = 0.000). Conclusions: Olfactory disorder was the major nasal symptom that could be used to distinguish eCRSwNP and non-eCRSwNP. ECRSwNP patients were more prone to have olfactory dysfunction. Our findings suggested that evaluation of nasal symptoms would help diagnose eCRSwNP and determine subsequent clinical treatment strategies.


2021 ◽  
Vol 42 (3) ◽  
pp. 214-221 ◽  
Author(s):  
Xiaodan Pan ◽  
Yuan Zhang ◽  
Chengshuo Wang ◽  
Luo Zhang

Background: Patients with eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) have poorer outcomes after endoscopic sinus surgery and a higher recurrence rate. Objective: This study aimed to investigate the profile of clinical symptoms of eCRSwNP and the related risk factors. Methods: We prospectively enrolled 298 inpatients with CRSwNP from February 2019 to December 2019. The patients were divided into eCRSwNP and non-eCRSwNP groups based on the percentage of blood eosinophils; the cutoff value was set at 3.05%. Clinical data on questionnaires, visual analog scale (VAS) scores, and laboratory tests were collected. The differences in clinical symptoms, including nasal congestion, rhinorrhea, olfactory disorders, and head and/or facial pain, between the two groups were analyzed to identify the influential factors. Logistic analysis and receiver operating characteristic curves were used to determine the diagnostic benefit for the specific symptom in the patients in the eCRSwNP group. Results: Nasal congestion and olfactory disorders were significantly different between the eCRSwNP and non-eCRSwNP groups. The patients in the eCRSwNP group more frequently had concerns about olfactory disorders (p = 0.002), whereas patients in the non-eCRSwNP group mostly had nasal congestion (p = 0.001). The logistic analysis showed that the primary risk factors for olfactory disorders of eCRSwNP were disease duration (p = 0.014) and alcohol intake (p = 0.012). Olfactory disorders were not associated with the disease course of the eCRSwNP group but were correlated with the disease duration of non-eCRSwNP (p = 0.008). A VAS score for the olfactory disorders of >5.75 could be used to predict the diagnosis of eCRSwNP (area under the curve, 0.674 [95% confidence intervals, 0.559‐0.689]; P < 0.001). Conclusion: Olfactory disorder might be the major nasal symptom that could be used to distinguish a peripheral eosinophilia‐based definition of eCRSwNP and non-eCRSwNP. The disease duration was a limiting factor for using olfactory to distinguish two subgroups of nasal polyp. The investigation with regard to the accurate time boundary should be further addressed.


2009 ◽  
Vol 24 (1) ◽  
pp. 13-17
Author(s):  
Michael Joseph C. David ◽  
Gil M. Vicente ◽  
Antonio H. Chua

Objective: To describe the clinical and demographic profile of patients who underwent pediatric Endoscopic Sinus Surgery (ESS), and the indications for which the procedure was performed. Methods: Design: Cross-sectional Study Setting: Tertiary Government Hospital Subjects: Using the medical record registry, all patients below 18 years of age who underwent ESS under the Department of Otorhinolaryngology – Head and Neck Surgery of a tertiary government hospital in Metro Manila between December 31, 1999 and January 1, 2008 were reviewed. The age, sex, clinical presentation, and indications for doing ESS, and extent of surgery done were described. The Lund MacKay Grading for nasal polyposis and Scoring for sinusitis were also applied and cross-referenced. Results: Twenty-seven children aged 7 to 17 years underwent ESS. The mean age was 12.9 years, with most (15 patients) belonging to the adolescent age group (13-17 years). Male to female ratio was 1.45:1. The mean interval from onset of symptoms to the first outpatient consultation was 1.5 years; the most common presenting symptoms were nasal obstruction (85.2%) and discharge (59.3%). All of the patients who underwent pediatric ESS had chronic rhinosinusitis: either with nasal polyposis (85.2%), an antrochoanal polyp (11.1%), or both (3.7%). The Lund Mackay Grading for nasal polyps and sinusitis scores were cross-referenced: patients with larger, grade III nasal polyps tended to have more extensive sinus disease than those with grade II polyps. On their first consultation, the patients tended to present with extensive nasal polyp and sinus disease, indicating the need for surgery. All patients with CRS and nasal polyposis underwent polypectomy with ethmoidectomy, uncinectomy and maxillary antrostomy, with additional frontal sinusotomy for a 17 year old male and a 17 year old female, both with grade 3 polyposis. The three patients who had antrochoanal polyps underwent polypectomy with uncinectomy and maxillary antrostomy. There were no operative complications such as cerebrospinal fluid leak and orbital injury reported. Conclusion: Most of the patients who underwent pediatric ESS were older children who were brought for consultation with long-standing, extensive nasal polyp and sinus disease or with antrochoanal polyps, necessitating surgical management. Patients with larger polyps tended to have more extensive sinus disease. They all underwent conservative surgery, with extent of the procedure limited to the extent of the disease present. Efforts to raise public awareness about chronic rhinosinusitis and nasal polyposis in children may result in seeing such cases at an earlier, conservatively treatable stage   Keywords: Pediatric Endoscopic Sinus Surgery, Nasal Polyposis in Children


2014 ◽  
Vol 44 (1) ◽  
pp. 76
Author(s):  
Retno Sulistyo Wardani ◽  
Ika Dewi Mayangsari

Background: Extensive nasal polyp growth in the paranasal sinuses can lead to bone erosion of the sinus walls and cause facial disfigurement due to continuous pressure or chronic inflammation. This extremely rare phenomenon is called Woakes syndrome. This syndrome consist of several symptoms include the destruction of ethmoid sinus that cause broadening of the bridge of the nose, frontal sinus aplasia and bronchiectasis. Purpose: To give complete information about the diagnosis and management of Woakes Syndrome. Case: A 16-year-old boy with deformity of the left nose, nasal obstruction and frequent episodes of rhinorrhea since 4 months before admission. Nasoendoscopic evaluation showedhuge nasal polyps filling the left nasal cavity, pushing the septum and narrowing the right nasal cavity. Histopathology result was edematous polyp with necrosis and massive bleeding without signs of malignancy. Management: Patient was managed in two stages operations. First, nasal polyp removal by FESS technique in general anesthesia, and the second stage four months later, was septorhinoplasty for aesthetic bridge reconstruction. Conclusion: Nasal polyps could be related to Woakes syndrome, characterized by broadening of nasal bridge which needs functional and aesthetic surgery. Keyword: Woakes Syndrome, nasal polyps, Functional Endoscopic Sinus Surgery, Septorhinoplasty ABSTRAKLatar Belakang: Polip hidung besar yang meluas dalam sinus paranasal dapat menyebabkan erosi dinding sinus dan menyebabkan cacat wajah akibat tekanan terus-menerus atau peradangan kronis. Fenomena ini sangat langka dan disebut sebagai sindrom Woakes. Sindrom ini terdiri dari beberapa gejala termasuk kerusakan dinding sinus etmoid yang menyebabkan hidung melebar, aplasia sinus frontal dan bronkiektasis. Tujuan: Untuk memberikan informasi yang lengkap tentang diagnosis dan penatalaksanaan Woakes Syndrome. Kasus: Seorang anak laki-laki 16 tahun dengan deformitas hidung kiri, hidung tersumbat dan pilek berulang sejak 4 bulan. Evaluasi nasoendokopi menunjukkanpolip hidung masif mengisi rongga hidung kiri, mendorong septum dan menyempitkan rongga hidung kanan. Pemeriksan histo-patologi memperlihatkan polip edematosa dengan nekrosis dan perdarahan masif tanpa tanda-tanda keganasan. Penatalaksanaan: Pada pasien dilakukan dua tahap tindakan. Pertama, dilakukan Bedah Sinus Endoskopik Fungsional (BSEF) dan polipektomi dalam anestesi umum, dan empat bulan kemudian pasien menjalani septorinoplasti untuk rekonstruksi wajah. Kesimpulan: Polip hidung pada kasus ini kemungkinan terkait dengan sindrom Woakes, ditandai dengan pelebaranpyramid hidung yang membutuhkan tindakan operasi fungsional dan estetika.Kata kunci: sindroma Woakes, polip hidung, Bedah Sinus Endoskopik Fungsional, Septorinoplasti.


2018 ◽  
Vol 159 (3) ◽  
pp. 581-586 ◽  
Author(s):  
Erica Corredera ◽  
Binh L. Phong ◽  
John A. Moore ◽  
Lawrence P. Kane ◽  
Stella E. Lee

Objectives To identify whether TIM-3 expression is present in the mast cell population within nasal polyps and to determine its correlation with clinical severity in patients with chronic rhinosinusitis with nasal polyposis. Study Design Basic science, translational study. Setting Nasal polyp tissue collected from patients seen at a tertiary care hospital (2015-2016). Subjects and Methods Nasal polyp tissue obtained during functional endoscopic sinus surgery (n = 24) was enzymatically digested into epithelial and stromal fractions. Viable mast cells expressing TIM-3 were identified using flow cytometry for the following: CD45, Live/Dead, c-kit, FcεR1, TIM-3. Disease severity was assessed using the Sino-Nasal Outcome Test, Lund-Mackay staging system, Lund-Kennedy staging system, and complete blood counts. Results Mast cells were found in both the epithelial and stromal layers of polyps, with a greater %TIM-3+ mast cells in the epithelial layer compared with that of the stromal layer ( P = .001). As the percentage of mast cells increased, there was a comparative worsening in endoscopic severity after comparing pre- and postoperative LK scores (ρ = −0.455, P = .029). In a subgroup of patients with concomitant asthma, increased epithelial %TIM-3+ mast cells also correlated with worsening endoscopic appearance postoperatively (ρ = 0.866, P = .001, n = 11). Oral corticosteroid treatment did not change the viability of mast cells nor their influence on the increased postoperative endoscopic disease severity (ρ = −0.544, P = .020, n = 18). Conclusion Viable mast cells were found to be present in polyps with increased TIM-3 expression at the epithelial layer. This suggests that TIM-3 may play a role in chronic inflammation in CRSwNP via mast cell activation.


2018 ◽  
Vol 127 (11) ◽  
pp. 763-769 ◽  
Author(s):  
Hyun Gi Sohn ◽  
Seung Jin Park ◽  
In Sun Ryu ◽  
Hyun Woo Lim ◽  
Yong Jin Song ◽  
...  

Introduction: The authors assessed clinical presentations and anatomic variants among patients with recurrent acute rhinosinusitis (RARS), chronic rhinosinusitis (CRS) without nasal polyps (CRSsNP), and CRS with nasal polyps (CRSwNP). Additionally, differences in the postoperative improvement of each category were evaluated. Methods: The authors performed an analysis of 304 patients who underwent endoscopic sinus surgery. They were divided into groups with RARS, CRSsNP, and CRSwNP. Patients had to complete the Sino-Nasal Outcome Test (SNOT-20) on surgery 1 day before and 6 months after surgery. Patient demographics and comorbidities were reviewed. We reviewed all patients’ computed tomographic findings to analyze anatomic variants. Results: No significant differences were found among the average preoperative SNOT-20 scores of the 3 groups. Patients with RARS were significantly more likely to show agger nasi cells, Haller cells, and septal deviation on computed tomography. Those with CRSwNP had significantly smaller mean infundibular widths. All groups showed significantly improved SNOT-20 scores postoperatively. Conclusion: The different anatomic variants found among patients with RARS, CRSsNP, and CRSwNP can facilitate surgical prognostic evaluation.


2020 ◽  
Author(s):  
Xiaodan Pan ◽  
Yuan Zhang ◽  
Chengshuo Wang ◽  
Luo Zhang

Abstract Background: Patients with eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) have poorer outcomes after endoscopic sinus surgery and a higher recurrence rate. This study aimed to investigate the profile of clinical symptoms of eCRSwNP and the related risk factors.Methods: We prospectively enrolled 298 CRSwNP inpatients from February 2019 to December 2019. Patients were divided into eCRSwNP and non-eCRSwNP groups based on the percentage of blood eosinophils. Clinical data on questionnaires, visual analogue scale (VAS) scores, and laboratory tests were collected. The differences in clinical symptoms, including nasal congestion, rhinorrhea, olfactory disorders, and head/facial pain, between the two groups were analyzed to identify the influential factors. Logistic analysis and receiver operating characteristic curves were used to determine the diagnostic benefit for the specific symptom in eCRSwNP patients.Results: Of the four major clinical symptoms, nasal congestion and olfactory disorders were significantly different between eCRSwNP and non-eCRSwNP groups. Patients with eCRSwNP more frequently complained about olfactory disorders (P = 0.002), while patients with non-eCRSwNP mostly had nasal congestion (P = 0.001). The logistic analysis showed that the primary risk factors for olfactory disorders of eCRSwNP were disease duration (P = 0.014) and alcohol intake (P = 0.012). Olfactory disorders were not associated with the disease course of eCRSwNP but were correlated with the disease duration of non-eCRSwNP (P = 0.008). When the clinical duration was less than 10 years, there was a significant difference in olfactory disorders between eCRSwNP and non-eCRSwNP groups (P < 0.01). However, when the clinical duration was over 10 years, the difference was not statistically significant (P = 0.264). The VAS score of olfactory disorders of over 5.75 could be used to predict the diagnosis of eCRSwNP (area under the curve =0.674, 95% confidence intervals: 0.559–0.689, P = 0.000). Conclusions: Olfactory disorder was the major nasal symptom that could be used to distinguish eCRSwNP and non-eCRSwNP. ECRSwNP patients were more prone to have olfactory dysfunction. Our findings suggest that evaluation of nasal symptoms will help diagnose eCRSwNP and determine subsequent clinical treatment strategies.


Author(s):  
Eren Altun ◽  
Figen Aslan ◽  
Serpil Paksoy ◽  
Gulay Turan

Background: Although nasal polyps are one of the most frequent diseases, their etiopathogenesis remains unclear. Since eosinophils are the main inflammatory cells in the substantial proportion of nasal polyp tissues, they are considered potentially responsible for the etiopathogenesis and prognosis of the disease. Aim of this study was to investigate the relation between mucosal and peripheral eosinophilia and their relation with disease severity in nasal polyps. Methods: The study included 53 patients with nasal polyps who underwent endoscopic sinus surgery. Preoperative Lund-MacKay computed tomography (CT) scores and the Lund-Kennedy endoscopic scores of the patients were recorded. Nasal polyp tissues were stained with hematoxylin and eosin, eosinophil counts were performed using high-power field (HPF, 400×) under the light microscope, and the patients were grouped as those with high mucosal eosinophil count and those with low mucosal eosinophil count. Results: The mean Lund-MacKay CT score and the mean Lund-Kennedy endoscopic score were higher in the patients with high mucosal eosinophil count than in those with low mucosal eosinophil count. Likewise, the mean Lund-MacKay CT score and the mean Lund-Kennedy endoscopic scores were significantly higher in the patients with high peripheral eosinophil count than in those with low peripheral eosinophil count (p < 0.05 for both). Moreover, the mean peripheral eosinophil count was significantly higher in the patients with high mucosal eosinophil count than in those with low mucosal eosinophil count (p < 0.05). Conclusion: Mucosal and peripheral eosinophilia can be used as a marker to predict disease severity in nasal polyps.


Sign in / Sign up

Export Citation Format

Share Document