Ethmoidal Polyps

Nasal polyposis can occur in any of the paranasal sinuses and can be unilateral, bilateral, single or multiple. The two types of nasal polyps are ethmoidal and antrochoanal polyps.

Ethmoidal air cells are multiple air cells present on medial to the eyes. Ethmoidal polyps are multiple, bilateral painless polyps arising from the ethmoid sinuses from the middle and superior meatus. The causes include increased eosinophil count, allergy, chronic sinusitis, allergic rhinitis, hay fever or deviated nasal septum.

The symptoms of ethmoidal polyps include nasal obstruction, anosmia(Loss of sensation of smell), watery nasal discharge, headache , watering of the eyes, epiphora due to blockage of nasolacrimal duct, sneezing is common as these polyps are allergic in origin.

The extent of infection can be best evaluated by CT scans. Conservative treatment of nasal polyps involves treatment with steroids, antihistamines and decongestants. Surgical Treatment includes Functional Endoscopic Sinus Surgery (FESS), Ethmoidectomy and Polypectomy. Ethmoidectomy and polypectomy using FESS and microdebrider has considerably reduced the incidence of recurrence. This is the treatment of choice as it is minimally invasive, is performed under direct vision and meticulous clearance is achieved. Precise postoperative care which includes nasal douching, regular follow up endoscopy and topical steroids is essential for achieving control.

CerebroSpinal Fluid (CSF) leak

Cerebrospinal fluid (CSF) leak may occur from the nose (rhinorrhea), from the external auditory canal (otorrhea), or from a traumatic or operative defect in the skull or spine. Cerebrospinal fluid depletion may be caused by a leak, a shunt, and inadequate production, result of meningeal dural and arachnoid laceration with fistula formation or too rapid absorption. Head or spine injury, surgery, infection or tumor can cause acquired leaks, whereas congenital leaks are associated with the development of anomalous transcranial pathways. Spontaneous leaks from the nose are uncommon.

Symptoms commonly include headaches, which are more severe in the upright position and are alleviated by head-lowered below chest positioning.

Treatment may include bed rest, hydration and steroids. Patients with spinal leaks who fail noninvasive measures can be treated with epidural blood patch. Blood patches are generally thought to be safe but occasional reports of increased CSF pressure and persistent epidural fluid collections have been reported. Surgical repair is used in patients with leaks in the skull.

Antroconal Polyps

Polyps are non cancerous tumors that usually grow in the lining tissues of a specific organ. An antrochoanal polyp is a solitary polyp or benign lesion that develops within the maxillary sinus but passes through and enlarges the sinus. The nasal cavity is therefore extended posteriorly into the nasopharynx through the posterior chonae.

The causes of antrochoanal polyps are unclear, but infections, bacteria and allergies in the sinuses are possible causes. In some cases antrochoanal polyps may stick out into the nasopharyngeal airway and even the pharynx when left untreated, sometimes causing minor displacement of the soft palate.

The main symptoms of antrochoanal polyps are: Nasal obstruction, post nasal drip, snoring, sleep apnea, pain in the cheek area, mouth breathing, diminished sense of smell, secondary sinus infection that is accompanied by headaches.
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