By Oghenekaro, EN; Onotai, LO; Oparaodu, UA (2022).

Greener Journal of Medical Sciences

Vol. 12(1), pp. 59-62, 2022

ISSN: 2276-7797

Copyright ©2022, the copyright of this article is retained by the author(s)

https://gjournals.org/GJMS

 

 

 

 

Surgical Review and Clinico-Pathologic Profile of Nasal Polyps in the University of Port Harcourt Teaching Hospital

 

 

Oghenekaro E. N.1, Onotai L.O. 1 and Oparaodu U.A. 2

 

 

1.     Ear Nose and Throat Surgery Department, University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt.

2.     Ear Nose and Throat Surgery Department, Rivers State University (RSU), Port Harcourt.

 

 

 

ARTICLE INFO

ABSTRACT

 

Article No.:020722014

Type: Research

Full Text: PDF, HTML, EPUB, PHP

 

Background: Nasal polyps are benign growth arising from the mucosa of the nose or sinuses protruding into the nasal cavity. They are translucent to pale gray, pear shaped, smooth, soft, and freely mobile. The aim of the study was to determine the clinical and histolgical pattern of nasal polyps in UPTH.

Patients and methods: This is a retrospective study that involves all patients that were managed for nasal polyp at the ENT surgery department of UPTH. Data collection was from June 2008 to June 2018. The clinic registers and patients folders were the source data from which the biodata, clinical presentations, treatment, complications and histology were extracted. These were analyzed using simple statistical tools SPSS 20.0.

Results: A total of 46 patients were treated for nasal polyp, 24 male and 22 female with a ratio of 1.1:1.0. The age range was 14-65 years with the mean age of 32 years. The duration of symptom range from 3mths – 10 years. The mean duration of post op stay was 5days. Complications seen were recurrence 20.5%, adhesions 9.1%.

Conclusion: Nasal polyp is a common nasal condition that often requires surgical intervention to reduce the attendant morbidity.  Nasal blockage being the commonest presenting complaint and recurrence the commonest complication.

 

 

Accepted:  07/02/2022

Published: 17/02/2022

 

*Corresponding Author

Dr. U.A. Oparaodu

E-mail: Ureh64@yahoo.com

 

Keywords: Nasal polyps, pathologic profile, nasal blockage.

 

 

 

 

 


INTRODUCTION:

 

Nasal polyps are benign growth arising from the mucosa of the nose or sinuses protruding into the nasal cavity. 1,2They are translucent to pale gray, pear shaped, smooth, soft, and freely mobile. 2,3They initially begin as small growth that slowly increases in size to occupying the nasal cavity.1,4The prevalence of nasal polyp worldwide is 1-4%.2,5Nasal polyps are not common in children however when they occur it’s usually associated with cystic fibrosis.2Nasal polyps aetiology is very complex and not well-understood.1 Some causes of nasal polyp are inflammatory (recurrent nasal infections, sinusitis), disorders of ciliary motility (cystic fibrosis), allergy, fungi and deviation of the nasal septum.2,3 Polyps which are sessile in the beginning become pedunculated due to gravity and the excessive sneezing5.The commonest sites of involvement are the anteriorethmoid and maxillary sinuses.2, 6 Clinical features of nasal polyps include nasal congestion or blockage, post-nasal discharge,rhinorrhea, headache, pain, or facial pressure and anosmia.2The treatment of nasal polyps consists of two categories of medical and surgical treatments.6Medical treatment involves the use of topical or systemic corticosteroids with systemic antihistamines.7Surgical treatment is indicated in case of nasal obstruction and lack of response to medical treatment.7 The surgical treatment of choice is endoscopic sinus surgery7. However, there are other surgical options of simple polypectomy, intranasal ethmidectectomy, external ethmoidectomy and Caldwell-Lucs procedure.7 Diagnosis of nasal polyps is confirmed by histopathology report from tissue specimen. The aim of this study is determine the clinical and histolgical pattern of nasal polyps in UPTH.

 

 

PATIENTS AND METHODS

 

This is a retrospective study that involves all patients that were managed for nasal polyp at the ENT surgery department of UPTH. This is a retrospective study that involves all patients that were managed for nasal polyp at the ENT surgery department of UPTH. Data were collected from the clinic registers, clinical records of the patients from June 2010 to June 2020. The clinic registers and patient’s folders were the source data from which the biodata, clinical presentations, treatment, complications and histology were extracted. These were analyzed using simple statistical stools SPSS 20.0

 

RESULTS

 

A total of 46 patients were treated for nasal polyp, 24 male (52%) and 22 female (48%) with a ratio of 1.1:1. The age range was 14-65 years with the mean age of 32 years. The commonest symptom was nasal blockage 100%, this was closely followed by nasal discharge 84.7%, reduced smell was 68.5%, nasal growth 68.5%, post nasal drips 66.2%, allergic symptoms 50.0%. The duration of symptom ranged from 3mths – 10 years. Duration from 1st visit to surgery ranged from 1month to 2years 6months. The modal period of stay, post-surgery was 4 days while the range was 3-10 days. Nasal polyp found on the left 45.7%, right 36.9%, bilateral 17.4%, antrochoanal 13.0%.  The surgery done was nasal polypectomy 73.9%, calwell- luc 26.1%, intranasalethmoidectomy 15.2%. Histological report showed inflammatory polyp in 66.9%, allergic polyp predominately oesophilia 13.0%, fibrous polyp 6.5%, chronic non-specific inflammatory polyp 6.5%, inverted papilloma 4.3%. The mean duration of post op stay was 5days. Complications seen were recurrence 20.5%, adhesions 9.1%, and facial swelling.

 

Figure 1: AGE DISTRIBUTION OF PATIENTS

 

 

 

 

Table 1: SITE OF POLYP SEEN IN PATIENTS

LATERALLY

NUMBER

%

RIGHT

17

36.9%

LEFT

21

45.7%

BILATERAL

8

17.4%

ANTROCHOANAL

6

13.0%.

 

 

Table 2: PATIENT SYMPTOMATOLOGY

SYMPTOMS

NUMBER

%

Nasal blockage

46

100%

Nasal discharge

39

84.7%

Reduced smell

32

68.5%

Nasal growth

32

68.5%

Post nasal drips

30

66.2%,

Allergic symptoms

23

50.0%

Mouth breathing

17

36.9%

Frontal headache

9

19.6%

Halitosis

4

8.7%

Epitaxis

3

6.5%

 

 

Table 3: SURGERY PERFORMED FOR POLYPECTOMY

SURGERY

NUMBER

%

Intra Nasal polypectomy

34

73.9%

Calwell- luc

12

26.1%

Intranasal ethmoidectomy

7

15.2%

 

Table 4: HISTOLOGICAL PATTERN OF TISSUE SPECIMEN

HISTOLOGIC PATTERN

N0

%

INLAMMATORY POLYP

32

66.9%

FIBROUS POLPY

6

13.0%

CHRONIC NON-SPECIFIC INFLAMMATION

3

6..5%

ALLERGIC POLYP PREDOMINANLY EOSINOPHILIA

3

6.5%

INVERTED PAPILLOMA

2

4.3%

 

 

DISCUSSION

 

Nasal polyp is marked by the formation of benign, stem-like growths on the mucous membrane, severely affecting daily life.Nasal polyp is a common disease affecting the nose and Paranasal sinus with a prevalence of 1-4% globally. 2,3In this study nasal polyp was found to be commoner in the age group 30 – 40 years,this is similar to the review by Mohammad S.S that report nasal polyp to be common in adult older than 20 yrs6. Nasal polyps are uncommon in children less than 10 years,however when they do occur it could be a sign of cystic fibrosis6. Qaisar K. et al also noted that majority of the patients (33.33%) were in age group 11-20 years followed by (21.21%) in age group 21-30 year7.The mean age in this study is similar to that by Ogunleye A.O and Fasunla A. J. Who reported 33.5 years3.Tezer I. et al reported a mean age of 34 years, range: 15–53 years in their study8.This study showed nasal polyp to be slightly commoner in male. Other studies also reported higher male preponderance. Ogunleye and Fasunla, Qaisar K et al., Fahy C. et al., Payman D. et al., Andrijana V. et al.3, 7 9,10,11,However Tezer I. et al., report female preponderance in his work in Iran8.Left nasal polyp was commoner, however Ogunleye and Fasunla reported bilateral to be more, followed by left nasal polyp3.

The commonest symptom was nasal blockage seen in all patients, this is similar to report by other authors Ogunleye and Fasunla, Parvin B. et al.,3,10,12Payman D et al, reported was alsoSimilar to this work in which the commonest symptoms was nasal obstruction or congestion, smelling disturbance, headache and facial pain, nasal discharge, post nasal discharge (PND)10.Lathi also found that nasal obstruction was the most common (97.3%) presenting complaint, followed by rhinorrhoea (49.1%), hyposmia (31.25%), intermittent epistaxis (17.9%), headache (16.9%), facial swelling (11.6%) and eye-related symptoms (10.7%).13 Epistaxis was seen in 3 patients, with two of the patients having infected nasal polyp and one having inverted papilloma. However,Ogunleyeand Fasunla did not report epistaxis, as it is not frequent in nasal polyp.If it does occur, it may indicate a more sinister underlying pathology than nasal polyps3.Qaisar K. et al reported epistaxis as a symptom in 15.15% in their study but no sinister underlying pathology was found in these patients7.The duration of symptom ranged from 3 months to 10 years.Duration from first visit to surgery ranged from 1month to 2years 6months. Patients living with these discomforting symptom for such a long time would affect their quality of life.These delays may be due to the poor health seeking behaviour people and low socio economy status of our country.

This treatment options for nasal polyps are medical and surgical.3,12Medical treatment involves the use of topical or systemic corticosteroids with systemic antihistamines.12Mohammad S.S et al in their work showed the effectiveness of antileukotrienes (montelukast, zafirlukast) in the treatment of nasal polyp6.Nasal polyps are shown to have more leukotriene C4 and leukotriene B4 than the normal nasal tissue6.The presence of leukotriene C4 in nasal polyps is likely the cause of early polyp recurrence 6.Cysteinyl-leukotrienes have been noted to be the cause of mucus production, mucosal edema and inflammation 6.Surgical treatment is indicated in case of nasal obstruction and lack of response to medical treatment.In the study most of our patient had intra-nasal polypectomy, others had caldwell-Lucs and few had intranasal ethmoidectomy this similar to the study by Ogunleye and Fasunla3. None of our patient had endoscopic sinus surgery, which is the treatment choice due to no availability of facilities for it7.

This study had recurrence rate as high as 20.5%.Drake lee reported 5% while Ogunleye and Fasunla reported 13%14. Our study was about four times that recorded by Drake-Lee14. The exact cause of recurrence is not known but all the patients had topical steroid to prevent recurrence. Adhesion was observed in 9.1% of our patients for which the patients had adhesiolysis and stenting done.This study, histopathologic report showed more of inflammatory polyp 66.9%, allergic polyp predominately eosinophilia 13.0%, fibrous polyp 6.5%. whileQaisar K, et al reported that all their sample had histopathology report as simple inflammatory polyps7.Our study differs with; Anjali D. et al report allergic polyps (67.3%) and inflammatory (32.7%)15. Luciano G.F. et al., reported eosinophilic polyp (73%); fibro-inflammatory polyp: (18%); and polyp with stromaatypia: (2.3%). 16

 

 

CONCLUSION:

 

Nasal polyp is a common nasal condition that often requires surgical intervention to reduce the attendant morbidity. Nasal blockage being the commonest presenting complaint and recurrence the commonest complication.

 

Conflict of interest

 

There was no conflict of interest.

 

Funding

 

There was no grant for the research work.

 

 

 

REFERENCES

 

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2.        Pawankar R. Nasal Polyposis: an update: editorial review.  Curr. Opin Allergy Clin. Immunol; 2003; 3: 1-6.

 

3.        Ogunleye AO, Fasunla AJ. Nasal polyps-clinical profile and management in Ibadan, Nigeria. Nigerian journal of surgical research. 2005;7(1):164-7.

 

4.        Cimmino M, Carvaliere M, Mardone M, Plantulli A, Orefice A, Esposito V, Ravia V. Clinical characteristics and genotype analysis of patients with cystic fibrosis and nasal polyposis.  ClinOtolaryngol; 2003; 28: 125 – 132.

 

5.        Lanrent C, Yvon YJ, Hvidsten I, Hellstrom S, Hyaluronan and alpha-atrial natriurectic polypeptide in human nasal polyps: contributing factors to oedema formation and polyp growth? ActaOtolaryngol, 2003;123: 406 – 412.

 

6.        Soltankhah MS, Majidi MR, Shabani S. Medical treatment of nasal polyps: a review. Reviews in Clinical Medicine. 2015;2(1):24-7.

 

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8.        Tezer I, Erdivanli OC, Sanli A, Aydin S. Could cellular proliferation be a predictive index for the relapse of nasal polyposis and down-regulated by nasal steroid treatment?. Indian Journal of Otolaryngology and Head & Neck Surgery. 2013 Aug 1;65(2):329-32.

 

9.        Fahy C, Jones NS. Nasal polyposis and facial pain. Clinical Otolaryngology & Allied Sciences. 2001 Dec;26(6):510-3.

 

10.     Payman D, Seraj JM, Bastaninejad S, Meighani A, Mokhtari Z. The efficacy of clarithromycin in patients with severe nasal polyposis. ActaMedicaIranica. 2013;51(6):359-64.

 

11.     Andrijana V, Đanić D, Včev A, Birtić D, Mihalj H, Zubčić Ž, Kotromanović Ž, Hadžibegović AĐ. The significance of Helicobacter pylori in patients with nasal polyposis. MedicinskiGlasnik. 2012 Aug 1;9(2).

 

12.     Parvin B, Madani SA, Aliabadi BM, Kamalinejad M, Yousofpoor M. Comparative study of nasal polyp with Bawseer–e-Anff in Persian medicine sources. Journal of Fundamental and Applied Sciences. 2018;10(6S):1861-72.

 

13.     Lathi A, Syed MMA, Kalakoti P, Qutub D and Kishve SP. Clinico-pathological profile of sinonasal masses: a study from a tertiary care hospital of India. ActaOtorhinolaryngol Ital. 2011; 31(6): 372–377

 

14.     Drake-Lee AB, Lowe D, Swamston A, Grace A.  Clinical profile and recurrence of nasal polyps.  J. Laryngol Otol. 1984; 98: 783-793

 

15.     Dasgupta A, Ghosh RN, Mukherjee C. Nasal polyps—histopathologic spectrum. Indian Journal of Otolaryngology and Head and Neck Surgery. 1997 Jan 1;49(1):32-7.

 

16.     Couto LG, Fernades AM, Brandão DF, Neto S, Valera FC, Anselmo-Lima WT. Histological aspects of rhinosinusal polyps. RevistaBrasileira de Otorrinolaringologia. 2008 Apr;74(2):207-12.

 


 

 

Cite this Article: Oghenekaro, EN; Onotai, LO; Oparaodu, UA (2022). Surgical Review and Clinico-Pathologic Profile of Nasal Polyps in the University of Port Harcourt Teaching Hospital. Greener Journal of Medical Sciences, 12(1): 59-62.