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Case 72
Published in Simon Lloyd, Manohar Bance, Jayesh Doshi, ENT Medicine and Surgery, 2018
Simon Lloyd, Manohar Bance, Jayesh Doshi
A 13-year old is referred to you by the respiratory team with a history of a blocked nose and recurrent chest infections. Examination reveals bilateral nasal polyps. Their computed tomography (CT) scan is shown as follows.
Nasal Polyposis
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Nasal polyps are a chronic disease of the upper respiratory tract that form as an end result of severe inflammation in the nose and paranasal sinuses and are considered to be a subgroup of chronic rhinosinusitis. Although not life-threatening, they can cause severe symptoms with a significant impact on quality of life. Nasal polyps arise in patients with chronic inflammation resulting from many different pathologies and why certain patients develop polyps remains unknown. Extensive research has resulted in a greater understanding of this disease, with evidence that bacteria, fungi, allergens, and superantigens play a prominent role in the pathophysiology of nasal polyps. However the exact cause remains elusive. The annual incidence of nasal polyps is between 1 and 20 per 1000 population. Certain systemic diseases are associated with a much higher incidence of CRSwNP with a prevalence of around 7% in patients with asthma and up to 30–60% in patients with aspirin exacerbated respiratory disease.
The ear, nose and sinuses
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Nasal polyps are benign swellings of the sinus mucosa of unknown origin. Histologically, the polyps contain an oedematous stroma infiltrated with inflammatory cells and eosinophils. Inflammatory polyps tend to be bilateral and extend into the middle meatus. A single large polyp arising from the maxillary antrum is referred to as an antrochoanal polyp (Figure46.49). This usually fills the nose and eventually prolapses posteriorly down into the nasopharynx.
What happens to basophils and tryptase, LXA4 and CysLTs during aspirin desensitization?
Published in Journal of Asthma, 2023
Gülfem E. Çelik, Ömür Aydin, Deniz Güloğlu, Derya Seçil, Mehmet Melli, Figen Doğu, Aydan Ikinciogullari, Betül A. Sin, Yavuz Demirel, Zeynep Misirligil
The study involved consecutive subjects with N-ERD who were admitted to our tertiary care clinic. Diagnosis of aspirin hypersensitivity based mainly on history with/without aspirin provocation tests. If the patients had at least two convincing episodes with aspirin and/or other NSAIDS, they were not provoked by aspirin (11,20,21). However, if the patients have unconvincing history, aspirin provocation was performed in the same doses given in aspirin desensitization. Asthma diagnosis was based on a history of recurrent symptoms of wheezing, shortness of breath, cough, and demonstration of objective signs of reversible airway obstruction by means of at least a > 12% increase in forced expiratory volume in one second (FEV1) after 15 min with inhalation of 400 µg salbutamol (22). Nasal polyps were diagnosed through endoscopic examinations with or without computed tomography of paranasal sinuses. None of the patients with asthma were on specific immunotherapy or anti-IgE treatments. Patients aged under 18 years were not included.
Intranasal trigeminal function in chronic rhinosinusitis: a review
Published in Expert Review of Clinical Immunology, 2023
Anna Kristina Hernandez, Thomas Hummel
A summary of the included studies is found on Table 2. The included articles were published between 2006 and 2022, with authors based in Germany, Belgium, Canada, China, Turkey, Sweden, Greece, Switzerland, and Japan. Most studies included patients with nasal polyps. Eight studies explicitly stated the basis of diagnosis, which included clinical findings with nasal endoscopy, imaging, or clinical practice guidelines (European Position Paper on Rhinosinusitis and Nasal Polyps 2020 [13], Canadian guidelines for acute and chronic rhinosinusitis [26]). Although Huart et al. did not explicitly state the basis for CRS diagnosis in their study, this was later confirmed by the authors to have been based on clinical assessment [23]. There were no randomized controlled trials in the included studies. Most were prospective cohorts or cross-sectional studies. Only six studies had clearly defined control groups. Minovi et al. designated a ‘control group’ of individuals with little or no polyps, but it was unknown if these individuals had symptoms that still satisfied the criteria of CRS [19]. Most of the studies had small sample sizes for CRS patients (range: 10 to 45, mean = 23).
Safety review of current systemic treatments for severe chronic rhinosinusitis with nasal polyps and future directions
Published in Expert Opinion on Drug Safety, 2021
Chronic Rhinosinusitis (CRS) is a common condition that is defined as inflammation of the lining of the nose and paranasal sinuses. The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 defines CRS in adults as the presence of at least two or more symptoms, one of which should be nasal blockage/obstruction/congestion or discharge, with or without facial pressure/pain and reduction/loss of sense of smell for longer than 12 weeks [1]. There should be evidence of polyps or mucopurulent discharge or mucosal obstruction on nasal endoscopy, or mucosal changes within the ostiomeatal complex or sinuses on computed tomography [1]. CRS can occur with (CRSwNP) or without nasal polyps (CRSsNP). Nasal polyps are grape-like swellings of the nasal lining of the nasal passage and sinuses. Despite some heterogeneity in the underlying etiology and pathophysiology underpinning CRS, the vast majority of nasal polyps are inflammatory, with 85% of polyps demonstrating a type 2 pattern of inflammation characterized by eosinophilia and elevated type 2 inflammatory cytokines, including interleukin-4 (IL-4) and IL-5 [2].