Posthemorrhagic polyp: Risk of misdiagnosis of the cause of glottic insufficiency

September 20, 2015     Massi Romanelli-Gobbi, MD; Julia Ellerston, MA; Rima A. DeFatta, MD; Joel Portnoy, MD; Robert T. Sataloff, MD, DMA, FACS

Patients with vocal fold hemorrhage often present with sudden dysphonia and may not be able to recall an inciting event.

Th1 and Th2 cytokine gene expression in atopic and nonatopic patients with nasal polyposis

June 4, 2015     Mohammad Farhadi, MD; Mitra Barati, MPH; Azardokht Tabatabaii, MS; Mehdi Shekarabi, PhD; Samileh Noorbakhsh, MD; Shima Javadinia, MD


The pathogenesis of nasal polyps has been debated for many years. The lymphocytes that infiltrate nasal polyps have been identified as predominantly memory T cells in an activated state, and these cells produce a mixed cytokine pattern of T1 helper (Th1) and T2 helper (Th2) cells. We conducted a prospective study to compare the expression levels of some Th1 and Th2 cytokines in atopic and nonatopic patients. Our study population consisted of 75 adults-42 men and 33 women (mean age: 38 yr)-with nasal polyposis. Patients with an allergy were distinguished from those without an allergy on the basis of the history, the results of skin-prick testing, and measurement of total IgE serum concentrations. Based on these criteria, patients were divided into two groups: atopic (n = 38) and nonatopic (n = 37). Levels of cytokine gene expression in the atopic patients were compared with those of the nonatopic patients by real-time polymerase chain reaction. Statistical analysis found no significant differences in the rate of interleukin (IL) 10 and IL-12 gene expression between the allergic and nonallergic patients. On the other hand, rates of interferon gamma and IL-4 gene expression were significantly higher in the atopic patients (p = 0.03 and p = 0.02, respectively). Our research suggests that an imbalance of Th1 and Th2 cells plays an important role in the pathophysiology of nasal polyps. Although nasal polyposis is a multifactorial disease associated with several different etiologic factors, chronic persistent inflammation is undoubtedly a major factor, regardless of the specific etiology.

The role of MMP-2, MMP-9, and TIMP-1 in the pathogenesis of nasal polyps: Immunohistochemical assessment at eight different levels in the epithelial, subepithelial, and deep layers of the mucosa

April 27, 2015     Nuray Bayar Muluk, MD; Osman Kürşat Arikan, MD; Pınar Atasoy, MD; Rahmi Kiliç, MD; Eda Tuna Yalçinozan, MD


We conducted a prospective study to investigate the role of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the pathogenesis of nasal polyps. Our study group consisted of 24 patients-21 men and 3 women, aged 23 to 70 years (mean: 45.97 ± 11.60)-with nasal polyposis who underwent functional endoscopic sinus surgery. For comparison purposes, we assembled a control group of 11 patients-6 men and 5 women, aged 18 to 56 years (mean: 29.90 ± 14.22)-without nasal polyps who underwent septoplasty and/or rhinoplasty. We analyzed 36 polyp specimens obtained from the study group (10 from the nasal cavity, 10 from the maxillary sinus, and 16 from the ethmoid sinus) and 11 tissue specimens from the control group (each control provided 1 specimen from the inferior turbinate). We then calculated the mean number of these cells in the epithelium, subepithelial layer of the lamina propria, and the deep paraglandular layer of the mucosa. In general, we found that MMP-2, MMP-9, and TIMP-1 values were higher in the nasal polyp group. These differences became less so as patients' ages and the duration of polyps increased. We conclude that the most important role that MMP-2 plays in polyp growth may be in terms of perivascular localization and an increase in vascular permeability, which causes inflammatory cell migration and edema in the extracellular matrix. An increase in MMP-2 in glandular tissue may lead to hydrolysis of tissue matrix components. The degraded extracellular matrix may result in fibrosis of the polyps. An increase of MMP-9 in the apical part of the epithelium in the polypoid tissue of the nasal cavity, maxillary sinus, and ethmoid sinus may facilitate the epithelial and endothelial cell migration that is observed during polyp development and growth.

Malignant otitis externa

April 27, 2015     Christina H. Fang, BS; James Sun, BS; Robert W. Jyung, MD

The advent of anti-pseudomonal antibiotics has significantly reduced the mortality of malignant otitis externa.

Frontal recess polyp extending to the posterior choana-a frontal recess-choanal polyp

April 27, 2015     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Frontal recess-choanal polyps, as found in the case described in this report, are rare.

Acute vocal fold hemorrhage after phonosurgery

July 13, 2014     Joel E. Portnoy, MD; Catherine Capo, BS; Robert T. Sataloff, MD, DMA, FACS

In this case, the KTP laser was used to vaporize the bilateral vocal fold varicosities.

Endoscopic view of an inferior meatal polyp

March 18, 2014     Jae Hoon Lee, MD

Most polyps in the nasal cavity develop from the mucosa of the anterior ethmoid sinus, the contact areas of the uncinate process, and the middle turbinate so that they are observed in the middle meatus.

Eosinophilic otitis media

February 12, 2014     Alejandro Vazquez, MD; Danielle M. Blake, BA; and Robert W. Jyung, MD

Eosinophilic otitis media is refractory to conventional therapy for otitis media and may lead to severe hearing impairment if not recognized promptly.

Unusual presentations of choanal polyps: Report of 3 cases

February 12, 2014     Ali Ozdek, MD; Halil Erdem Ozel, MD


Most choanal polyps arise from the maxillary sinus, and they are called antrochoanal polyps. Their typical endoscopic and radiologic appearance makes them easy to diagnose. However, some choanal polyps originate in unusual sites in the paranasal sinuses and nose, such as the sphenoid sinus and the lateral wall of the nose. These polyps usually present unilaterally, although bilateral presentations are possible. We describe 3 cases of atypical choanal polyps: a sphenochoanal polyp, bilateral antrochoanal polyps, and a giant antrochoanal polyp. In each case, nasal endoscopy and computed tomography clinched the diagnosis, and endoscopic surgery was performed to successfully remove the polyp. We discuss the clinical characteristics of these 3 cases.

Laryngeal tuberculosis: Use of videostroboscopy in diagnosis

February 12, 2014     Michelle Levian, DO; Amy Chapman, MA-SLP; and Reena Gupta, MD

The diagnosis of laryngeal tuberculosis is often suspected clinically, but in patients with less specific symptoms, flexible laryngoscopy may reveal only an inflammatory picture.

Larynx: Nodules and polyps

September 18, 2013     Lester D.R. Thompson, MD

Nodules usually affect the anterior to middle thirds of the true vocal folds, and they are nearly always bilateral.

A case of a nasal polyp originating in the cribriform plate

September 18, 2013     Osman Kursat Arikan, MD; Nuray Bayar Muluk, MD; Ozden Cirpar, MD


Nasal polyps were once believed to originate in sinus cavities, and from there to pass through ostia and into the nasal cavity. However, data gained from subsequent anatomic studies revealed that they can actually originate in numerous locations in the sinonasal area. We report a case of a nasal polyp that originated in the cribriform plate, which is a very rare site of origin for a nasal polyp.

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