Endoscopic view of ostial polyps of the maxillary sinus

June 11, 2013     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; and Eiji Yanagisawa, MD, FACS

Ostial polys in the maxillary sinus can cause recurring maxillary sinus disease by obstructing the ethmoid infundibulum and natural ostium of the maxillary sinus.

Endoscopic view of a septochoanal polyp

April 17, 2013     Jae Hoon Lee, MD

Most nasal cavity polyps develop from the mucosa of the anterior ethmoid sinus, the contact areas of the uncinate process, and the middle turbinates.

Otic polyp

October 31, 2012     Lester D.R. Thompson, MD

An uncommon entity, otic polyp arises in response to a long-standing inflammatory or infectious process of the middle ear, most often in young boys.

Osseous metaplasia in a nasal polyp: Report of a rare case and review of the literature

September 7, 2012     Hasan Mercan, MD; Deniz Tuna Edizer, MD; Erkan Kilic, MD; Tugce Esen, MD; Rana Ramazanoglu, MD; Harun Cansiz, MD


Metaplasia is the conversion of one adult tissue or cell type into another tissue or cell type. Although osseous metaplasia has been described in many parts of the body, it is rarely encountered in the head and neck region, especially in nasal polyps. This article reports a case of unilateral sinonasal polyp containing areas of osseous metaplasia in a 44-year-old woman presenting with nasal obstruction. Also included are a brief discussion of osseous metaplasia in the head and neck region and a literature review.

Bipolar microdebrider may reduce intraoperative blood loss and operating time during nasal polyp surgery

August 10, 2012     Nishant Kumar, MD; Raj Sindwani, MD, FACS


Bleeding during endoscopic sinus surgery (ESS) can interrupt the flow of the procedure and increase the risk of complications. Advances in microdebrider design now allow for bleeding to be controlled by bipolar energy during the suctioning and shaving of polyps. We conducted a retrospective study to examine the effects of this technology on blood loss and operating times during ESS for chronic rhinosinusitis with nasal polyps (CRS+P). Our patient population was made up of 80 patients who had undergone ESS for CRS+P by the same surgeon from January 2007 through May 2008. All surgeries were performed with either the PK diego bipolar microdebrider (Gyrus ACMI, ENT Division; Bartlett, Tenn.) or a standard microdebrider. There were 40 patients in each group. The PK group was made up of 23 males and 17 females, aged 14 to 66 years (mean: 43.1), and the control group included 21 males and 19 females, aged 17 to 71 years (mean: 43.1); there were no statistically significant differences between the two groups in terms of sex and age. In addition to demographic data, the charts were reviewed for comorbidities and operative variables; the latter included blood loss, operating room (OR) time, and complications. The preoperative treatment and anesthesia protocols were similar for all patients, and all patients demonstrated a similar disease burden on imaging (mean Harvard CT stage: 3.12 for the PK group and 3.15 for the controls; p > 0.05). We found that during ESS, the PK group experienced significantly less intraoperative blood loss than did the controls (means: 86.0 and 123.0 ml, respectively; p = 0.015). In addition, the PK device was associated with significantly shorter OR times (means: 88.9 and 101.4 min, respectively; p = 0.026). There were no complications in either group. We conclude that using a microdebrider with bipolar capabilities during ESS may offer the advantages of less blood loss and shorter operating times in patients with nasal polyps.

Expression and clinical significance of PLUNC protein in nasal polyp and chronic sinusitis tissue

July 5, 2012     Min-man Wu, MD; Hong Sun, MD, PhD; Qiong Nan, MD


We conducted a study to validate the expression of PLUNC (palate, lung, and nasal epithelial clone) protein in nasal polyp and chronic sinusitis tissue by immunohistochemistry. We also explored the relationship between the intensity of positive immunohistochemical staining for PLUNC protein and postoperative therapeutic efficacy. Our study population consisted of 34 patients with nasal polyps and 30 with chronic sinusitis who had undergone surgical treatment, along with 18 healthy controls who did not undergo surgery. All samples were stained according to the streptavidin-peroxidase immunohistochemical method to examine PLUNC protein expression. The surgical patients were evaluated for clinical therapeutic efficacy 6 months postoperatively. The association between efficacy and the intensity of PLUNC protein positivity was examined by the Spearman rank correlation analysis. Intensity was rated as either +++(>50% positive cells), ++ (26 to 50% positive cells),+ (≤25% positive cells), or(no positive cells). We found that the most common levels of PLUNC positivity were + in the patients with nasal polyps, +++ in the patients with chronic sinusitis, and ++ in the controls (p< 0.01). Analysis of the Spearman rank correlation indicated that the intensity of PLUNC protein expression was significantly correlated with postoperative therapeutic efficacy (p< 0.001). We conclude that PLUNC protein is an essential factor in the innate defense mechanism of the nasal mucosa. The immunohistochemical staining of PLUNC protein could have clinical benefit in terms of predicting therapeutic efficacy and outcomes in patients with nasal polyps or chronic sinusitis.

Lymphangiomatous polyp of the nasal cavity: A rare presentation

April 30, 2012     Subhash C. Gupta, MS; Sachin Jain, MS; Himanshu P. Singh, MBBS; Atul Sachan, MBBS; Soumit Dey, MBBS


Lymphangiomatous polyp of the nasal cavity is a very rare condition. We are reporting a case of a unilateral nasal mass presenting with noisy breathing during sleep, change of voice, watery nasal discharge, and anosmia in a 5-year-old boy. The mass was removed via a transnasal endoscopic approach, and a diagnosis of lymphangiomatous nasal polyp was established by histopathology.

Angiomatous ethmoidochoanal polyp in an infant: Case report

November 22, 2011     Nuno Oliveira, MD, Nuno Trigueiros, MD, Delfim Duarte, MD, and Manuel Rodrigues eRodrigues, MD


Nasal polyps are rare in children younger than 10 years. We describe the case of an infant girl who had undergone a traumatic intubation at birth that had resulted in nasal bleeding. At the age of 5 months, she was brought to us with an obstructive left nasal mass. Imaging revealed the presence of an ethmoidochoanal polyp, as well as a fracture of the posterior cribriform plate and a small associated meningocele. Four months later, the polyp was excised, and the meningocele was corrected with endoscopic nasal surgery. Pathologic evaluation identified the lesion as an angiomatous polyp, which was probably related to the previous traumatic episode. We discuss the clinical aspects of a pathologic entity that has not been previously reported in an infant.

Bilateral vocal fold polyps with occult sulcus mucosal bridge

June 13, 2011     Colleen N. Johnson, MD, MPH, MAJ USAF and Robert L. Eller, MD, MAJ USAF

Identification of bacteria isolated from nasal polyps and their ability to produce superantigens and biofilms in Lebanese patients

March 31, 2011     Marita Chakhtoura, MS, Usamah Hadi, MD, Charbel Rameh, MD, Jihad Nassar, MD, and Alexander M. Abdelnoor, PhD


Staphylococcus aureus superantigens and bacterial biofilms have been implicated in the development of chronic rhinosinusitis and nasal polyps. We conducted a study of 32 Lebanese patients-21 males and 11 females, aged 15 to 71 years (mean: 39)-to identify bacteria isolated from nasal polyps and to determine if these bacteria produced superantigens and biofilms. Polyps were surgically removed, homogenized, and subjected to bacteriologic studies. The presence or absence of S aureus enterotoxin A, B, C, and D (superantigen) genes was determined in all isolates by polymerase chain reaction. Biofilm production by coagulase-negative staphylococci and Pseudomonas aeruginosa was assessed by tissue culture plate assay. A total of 34 bacterial species/groups were isolated from the nasal polyps. Of these, only 3 (8.8%) were S aureus, and only 1 possessed an enterotoxin-coding gene (enterotoxin B). Moreover, of the 21 coagulase-negative staphylococci isolates that were found, none possessed the investigated genes, and only 1 had a strong biofilm-formation property. Our results could not confirm that S aureus enterotoxins (superantigens) or biofilm-producing bacteria play a role in the development of nasal polyps in the Lebanese group studied.

Polyps in bilateral conchae bullosa

January 1, 2011     K. Cagdas Kazikdas, MD

Large vocal fold polyp

January 1, 2011     Venu Divi, MD, Robert T. Sataloff, MD, DMA, and Jacqueline Oxenberg, DO
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