NASAL POLYP
It is the prolapsed, pedunculated part of the oedematous nasal mucosa or that of paranasal air sinuses and is usally smooth, pearly white or yellowish mass of variable size. It is composed of loose fibro-odematous tissue and the surface is lined with ciliated columnar epithelium. They are generally multiple, nearly always bilateral and produce nasal blockage by their presence. Polyp commonly arise from the ethmoid labyrinth and sometimes may arise from the Antrum. When they project posteriorly into the naso – pharynx, it is called an anterochoanal polyp.

Aetiology
Aetiology of polyposis is uncertain. Various views have been put forward to explain the aetiology.

Role of Allergy
Allergic reactions of nasal mucosa produce vaso-dialatation and increased permeability of the vessels as a result of which fluid moves out of the intera-vasucular compartment and causes water logging of the tissues. This oedematous mucosa subsequently presents as a polypoidal mass.

Infection
it is also believed that longstanding infection gives rise to perilymphangitis and periphlebitis resulting in poor absorbtion of the tissue fluid in the mucosa and thus this water – logged mucosa leads to polyp formation.

Mixed Aetiology
Allergy predisposes the tissues to infection and the allergy itself may be to bacterial proteins, hence it is cantended that both allergy and infection are in aetiological factors.

Barnoullie’s Phenomenon
States that passage of gas of liquid in a constriction induces negative pressure.

Types
Sl no: Antrochoanal Polyp Ethmoidal polyp
1. Arise from maxillary anthrum and passing to the choanal aperture Arising from ethmoidal are cells
2. Aetiology: mainly Allergic in Origin Allergy & infection
3. Age: Children & young Adults Adults
4. Number: Single Multiple, look like bunch of grapes
5. Situation: Unilateral Bilateral
6. Maxillary Antrum Ethmoidal air cells
7. Presentation: in posterior nares; a long standing polyp may even hang down to the oro-pharynx In anterior nares
8. No Deformity: Broadening of the nose, if long standing.
9. No eveidence of infection in meatus. Pus seen in middle meatus
10. Recurrence : Uncommon Common
11. Extends backwards and best seen in by posterior rhinoscopy Extends forwards and best seen in by Anterior rhinoscopy

Clinical Symptoms
• The main symptoms are nasal obstruction, hyposmia and post-nasal drip. There is often some discharge which may be mucoid or purulent. Pus indicates associated Sinus suppuration.
• Sneezing & rhinorhea; purulent rhinorhoea – ethamoidal.
• Headache, may occur with or without sinus infection. Symptoms of allergy are seldom an obvious feature, though asthma may co-exist and there is often a previous history of Eczema.
• Hawking & cough may be present due to post-nasal discharge.

Examination:
In advanced cases, the external nose may become broadened, the condition is known as Frog – face.
Ethmoidal polyp are seen as anterior rhinoscopy as pale, bluish white or greenish, smooth & soft masses. They are usually bilateral & multiple.
Antrochoanal polyp arising from the antrum goes towards the posterior choana and is seen on Posterior rhinoscopy as a bluish white, pale, polypoidal mass in the naso-pharynx. The soft palate is sometimes displaced downwards and the polyp may be present in the oropharynx.

Differential diagnosis
Hypertrophied turbinates;
the turbinates are pink in colour. Sensitive to touch as compared to an ethmoidl polyp and is firm to feel when comparing eith softness of polyp. A probe can’t be passed around the turbinates as it is attached laterally and has no pedicle like an ethmoidal polyp.

Rhinosporodosis:
This fungal infection of thew nose produces a bleeding polypoidal in the nose usually arising from the septum and is strawberry like in apppearence. Common in people living costal areas of India.

Angio – fibroma of Septum
Presents as bleeding mass in the nose. A careful examination reveals its site of origin.

Transilitionalcell or squamous papilloma:
Papilloma arising from the lateral wall in the region of the middle meatus may present as a polypoidal mass. This is usually single nd has an opaque and fleshy look.

Meningocele
A prolongation of meninges mass occur in the nasal cavity and appear as soft, cystic, polyp like swelling particularly in young children. Hence, it is always advisable to aspirate a polypoidal swelling in a younger patient for cerebro-spinal fluid.

Malignancy of nose
A malignant lesion in the nose may present as a polypoidal mass. It is usually friable and bleeds easily on touch. Some times polypoidal changes are associated features of malignancy.

Nasopharyngeal angiofibroma
Particularly a less vascular variety may be confused with an antrochoanal polyp. A History of epistaxis in an adolescent male with a lobulalar mass in the nasopharynx indicates a nasopharyngeal lesion rather than anthrochoanal polyp. Sometimes prominent vessels are visible on the tumour surface.

Hamaetoma
Developmental malformation consisting of a tumour like growth of tissue. It is a beneign lesion but may become large enough to cause trouble according to size & location but it rarely becomes malignant.

Cyst of the nose
Compressible, painless, usually produses naso-facial deformity.
Difference between Allergic polyp and Infective polyp
Allergic polyp Infective polyp
1. History of nasal allergy History of chronic sinusitis
2. Appearance: Pale, boggy & oedematous Fleshy red
3. Increased eosinophil count in blood examination Increased Neutrophil count in blood examination
4. Biopsy: Excess eosinophil in the matrix Excess neutrophil in the matrix

Therapeutics
Allium cepa
Amm mur
Apis
Arum mac
Aurum mur
Aurum sulph
Aurum met
Cadm sulph
Calc carb
Con mac
Graphitis
Kali bi
Kali nitr
Lemna minor
Lyco
Mer-i-r
Natr mur
Nitr acid
Phos
Psor
Sang nitrcum
Sang canad
Sepia
Silicea
Sulphur
Thuja


ALLIUM CEPA
• Feeling of a lump at root of nose.
• Acute catarrhal inflammation of mucous membranes, with increased secretion.
• Coryza : profuse, watery and acrid nasal discharge, with profuse, bland lachrymation Acrid, watery discharge dropping from tip of nose. Sneezing, especially when entering a warm room.
• Strong craving for raw onions, cannot take any other nourishment.
• Aggravation: in the evening, in warm room.
• Amelioration: in open air, and in cold room.

AMMONIUM MURIATICUM
• Especially adapted to those who are fat and sluggish; or body large and fat, but legs too thin.
• Free acrid, hot watery discharge corroding the lip.
• Sneezing, nose sore to touch; ulcerative pain in nostrils.
• Loss of smell obstructed, stuffy feeling; constant and unavailing efforts to blow it out.
• Aggravation: head and chest symptoms in the morning;
• Amelioration:, open air, from warm bath.

APIS MELLIFICA
• Adapted to the strumous constitution; glands enlarged, indurated;
• Extreme sensitiveness to touch. pain: burning, stinging, sore; suddenly migrating from one part to another.
• Coldness of tip of nose.
• Thirstlessness; Craving for milk.
• Aggravation: After sleeping; closed, especially warmed and heated rooms are intolerable; from getting wet, heat in any form; touch; pressure;. Right side.
• Amelioration: from washing or moistening the part in cold water, In open air, uncovering.

ARUM MACULATUM
• Inflammation and ulceration of mucous membranes. Violent irritation of nose and eyes. Pain left side of nose.

CADMIUM SULPH
• Polypus with tightness at the root of nose. Nose obstructed;
• Tightness at root and tension in nose.- Obstruction of nose by swelling
• Cadmium is a chilly medicine. There is icy coldness. Coldness even when near a fire.
• Aggravation: walking or carrying burdens; after sleep; from open air, stimulants.
• Amelioration: eating and rest.

CALCAREA CARBONICA
• Dry, Nostrils sore, ulcerated. Stoppage of nose, also with fetid, yellow discharge. Offensive odor in nose.
• POLYPI; swelling at root of nose. Takes cold at every change of weather. Catarrhal symptoms with hunger; coryza alternates with colic.
• Leucophlegmatic, blond hair, light complexion, blue eyes, fair skin; tendency to obesity in youth. Psoric constitutions; pale, weak, timid, easily tired when walking. Disposed to grow fat, corpulent, unwieldy.
• Head sweats profusely while sleeping, wetting pillow far around. Profuse perspiration, mostly on back of head and neck, or chest and upper part of body.
• Aggravation: from exertion, mental or physical; ascending; cold in every form; water, washing, moist air, wet weather; during full moon; standing.
• Amelioration: dry climate and weather; lying on painful side. Sneezing (pain in head and nape).

CONIUM MACULATUM
• Swelling of the nostrils. Tip of nose thick red, hot, painful, worse left side, later a yellow blister full of pus appeared left side of lip. Purulent discharge from the nose. Nasal haemorrhage, frequent when sneezing. Increased acuteness of smell. Obstinate stoppage of the nostrils.
• Aggravation: lying down, Turning or rising in bed; Celibacy; before and during menses, from taking cold, bodily or mental exertion.
• Amelioration: while fasting, in the dark, from letting limbs hand down, motion and pressure.

GRAPHITES
• Sore on blowing it; is painful internally. Smell abnormally acute; cannot tolerate flowers.
• Suited to women, inclined to obesity, who suffer from habitual constipation; with a history of delayed menstruation.
• Aggravation: warmth, at night, during and after menstruation.
• Amelioration: in the dark, from wrapping up.

KALI BICHROMICUM
• Snuffles of children, Especially fat, chubby babies. Pressure and pain at root of nose, and sticking pain in nose. Fetid smell. discharge thick, ropy, greenish-yellow. tough, elastic plugs from nose; leave a raw surface. Dropping from posterior nares. Loss of smell. Inability to breathe through nose.
• Complaints occurring in hot weather. Liability to take cold in open air. Pains: in small spots, can be covered with point of finger; shift rapidly from one part to another; appear and disappear suddenly.
• Aggravation: beer, morning, hot weather, undressing.
• Amelioration: from heat.

KALI NITRICUM
• Sneezing. Swollen feeling; Worse, right nostril. Point red and itching. Violent coryza, with obstruction of nose, and loss of smell. The nasal bones are painful, especially to the touch.
• Tongue red, with burning pimples; burns at tip.
• Aggravation: eating veal; towards morning and in afternoon.
• Amelioration: drinking sips of water.

LEMNA MINOR
• Putrid smell; loss of smell. Crusts and muco-purulent discharge very abundant. Post-nasal dropping. Pain like a string from nostrils to ear. Reduces nasal obstruction when it is an oedematous condition.
• Foul smell from the nose and foul taste in the morning on waking are indications, also worse in damp weather.
• Aggravation: in damp, rainy weather, especially Heavy rains.

LYCOPODIUM
• Sense of smell very acute. Ulcerated nostrils. Crusts and elastic plugs. Fluent coryza. Nose stopped up. Snuffles; child starts from sleep rubbing nose. Fan-like motion of alae nasi.
• For persons intellectually keen, but physically weak; upper part of body emaciated, lower part semi-dropsical;
• Aggravation: right side, from right to left, from above downward, 4 to 8 p.m.; from heat or warm room, hot air, bed. Warm applications, except throat and stomach which are better from warm drinks.
• Amelioration: By motion, after midnight, from warm food and drink, on getting cold, from being uncovered.

MERCURIUS IODATUS RUBER
• Coryza and dull hearing; right side of nose hot. Hawks mucus from posterior nares. Turbinated bones swollen. Boggy mucous membrane of nose and throat; closure of Eustachian tube, opening with a pop.
• Aggravation: after sleep, After dinner, Afternoon and evening.

NATRUM MURIATICUM
• Violent, fluent coryza, lasting from one to three days, then changing into stoppage of nose, making breathing difficult.
• Discharge thin, watery mucus from nose. Like raw white of egg. Infallible for stopping a cold commencing with sneezing. Loss of smell and taste.
• Great emaciation; losing flesh while living well; throat and neck of children emaciate rapidly during summer complaint.
• Aggravation: noise, music, warm room, lying down; about 10 a.m., at seashore, mental exertion, consolation, Heat, talking.
• Amelioration: open air, cold bathing, going without regular meals, lying on right side; pressure against back, tight clothing.

NITRICUM ACIDUM
• Green casts from nose every morning. Coryza, with sore and bleeding nostrils. Tip red. Stitches, as of a splinter in nose. Chronic nasal catarrh, with yellow, offensive, Corrosive discharge. Nasal diphtheria, with watery and exceedingly excoriating discharge.
• Tongue clean, red and wet with center furrow.
• Acts best on the dark complexioned and past middle life.
• Aggravation: evening and night, cold climate, and also Hot weather.
• Amelioration: while riding in carriage.

PHOSPHORUS
• Fan-like motion of nostrils.
• Epistaxis instead of menses.
• Over-sensitive smell.
• Foul imaginary odors.
• Chronic catarrh, With small haemorrhages; handkerchief is always bloody.
• Polypi; bleeding easily.