symptoms of nasal polyps, early symptoms and signs of nasal polyps
- nasal Polyp Examination, nasal Polyp Diagnosis
- How To Diagnose And Differentiate nasal Polyps-nasal Polyps Are Easily Confused Diseases
Symptoms of nasal polyps
Typical symptoms: 1. Persistent nasal congestion, hypoolfaction, obstructive nasal sounds, sleep snoring and mouth opening breathing. 2. There may be runny nose, headache, tinnitus, stuffy ears and hearing loss. 3. Mucinous polyp, quite like peeled grape or fresh litchi meat, with smooth and translucent surface, pink, thin bands mostly from the middle nasal meatus, and soft activities. 4. Hemorrhagic polyps (less) have smooth surface, congestion, soft touch and easy bleeding. 5. Fibrous polyps are gray-white, with smooth surface, which is difficult to bleed when touched.
Related symptoms: Polyps seem to have snot and stuffy nose that can't be blown out
1. Persistent nasal congestion, hypoolfaction, occlusive nasal sounds, sleep snoring and mouth opening breathing.
2. There may be runny nose, headache, tinnitus, stuffy ears and hearing loss.
3. Mucinous polyp, quite like peeled grape or fresh litchi meat, with smooth and translucent surface, pink, thin bands mostly from the middle nasal meatus, and soft activities.
4. Hemorrhagic polyps (less) have smooth surface, congestion, soft touch and easy bleeding.
5. Fibrous polyps are gray-white, with smooth surface, which is difficult to bleed when touched.
6. Multiple polyps often come from ethmoid sinus, and single polyps often grow from maxillary sinus and fall into posterior nostril, which is called "posterior nostril polyp".
7. Nasal polyps increase and become larger. If they are not treated for a long time, the nasal back will widen and form a "frog nose".
Second, physical signs:
Long medical history and large polyp volume can cause changes in nasal shape. The bridge of the nose is widened and flat, and the back of the nose on both sides is bulged, which is called "frog nose". If polyps protrude from the anterior nostril, the surface of the nasal meat at the anterior nostril is reddish because of the stimulation of air and dust. In the nasal cavity, the polyp is round, smooth, soft and gray-white cystic tumor, and its pedicle is in the middle nasal meatus. Johansen et al. (1993) put forward a scoring method to describe the size of polyps: polyps are small in size, only cause mild nasal congestion, and those who do not reach the upper edge of inferior turbinate will score 1 point; Causing obvious nasal congestion, the polyp size is located between the upper and lower edges of the inferior turbinate, and 2 points are recorded; If the nasal cavity is completely blocked and the front end of polyp has reached below the lower edge of inferior turbinate, 3 points will be recorded.
Nasal polyps consist of highly edematous nasal mucosa. Nasal polyps are often divided into three pathological types: edematous, acinar and fibrous. The first two types are mainly the result of inflammatory cell infiltration, increased vascular exudation and exuberant gland secretion, while the latter originates from fibroblasts and collagen fiber proliferation. Kakoi et al. (1987) believed that the first two types are active manifestations of nasal mucosal tissue reaction, while the latter is the final stage of nasal mucosal tissue reaction. Its complete pathological changes are: round cells infiltrate into the sinus mucosa, lamina propria edema, further cause mucosal limited protrusion, and have glands in local hyperplasia. The protruding mucosa is gradually aggravated by edema of lamina propria, which can expand into nasal cavity through sinus ostium and continue to grow. This is the active stage, and some of them can evolve into fibrous type, that is, the terminal stage.
Patients often have a long history of nasal diseases when they see a doctor. At first, I felt that there was snot in my nose, which was caused by polyps blocking the upper half of my nasal cavity. At night, obvious nasal congestion can cause mouth opening breathing, and chronic pharyngitis can be secondary over time. Nasal congestion is mostly persistent, and vasoconstrictor nasal drops have no obvious curative effect, which is because there are few blood vessels distributed in nasal meat. Because polyps have no nerve distribution, patients rarely sneeze. However, if there is allergic inflammation in nasal mucosa, sneezing, clearing nasal discharge and other symptoms may also occur. The secretion of nasal polyposis is mostly pulp mucus, and if it is complicated with infection, it can have purulent secretion. The polyp that continues to grow and become bigger not only makes nasal congestion obviously aggravated, but also can cause dizziness or headache, which may be caused by sinus involvement. There are two kinds of sinus involvement: one is the same lesion from nasal polyps, and the other is the secondary lesion that polyps hinder sinus drainage. The former is the paranasal sinus mucosa hyperplasia not swollen hypertrophy, namely the so-called proliferative sinusitis, nasal polyps complicated with sinusitis is more of this kind. Antibiotics are ineffective for this kind of sinusitis, while corticosteroids can improve it to varying degrees. Secondary infection of the latter can be complicated with suppurative sinusitis. Patients with nasal polyps often have hypoesthesia and even lack of smell. If huge polyps block the posterior nostrils or even protrude into the nasopharynx, they can still cause ear symptoms such as hearing loss, which is caused by the compression of the pharyngeal orifice of the eustachian tube.
A few huge polyps can still cause invasive complications. Polyps with fast growth and huge volume can destroy the sinus wall or the top wall of nasal cavity by mechanical extrusion, and then invade the orbit, frontal sinus, anterior cranial fossa, sphenoid sinus and middle cranial fossa. For example, Kaufman et al. (1989) reported a case of nasal polyps filling the nasal cavity, entering the intracranial pituitary fossa and cistern through the sphenoid sinus, invading the orbit and compressing the cavernous sinus. The patient presented with ophthalmoplegia, exophthalmos and visual field loss.
Because nasal mucosa is a part of the whole respiratory mucosa, and there is nasal-pulmonary reflex between nose and airway, nasal mucosal lesions can be associated with other respiratory diseases by some mechanism.
1. A large number of clinical data of bronchial asthma show that patients with nasal polyps have a higher incidence of asthma. Moleney et al. (1977) The incidence of asthma is 2.9% ~ 72%, while asthma patients have nasal polyps23% ~ 42%. Most recently, Jantt-Alanko (1989) found asthma in 34 out of 85 patients with nasal polyps (40%). Voltolini (1871) first noticed that nasal polyps are related to asthma, and Vander Veer (1920) later reported that nasal polyp surgery can aggravate asthma, which immediately aroused people's attention to the relationship between them, but the exact mechanism is unclear. Robison (1962) found that compressing maxillary sinus mucosa with balloon can induce asthma attack, so it is believed that nasopulmonary reflex is involved in this mechanism. The histological changes of both patients were similar, including mucosal edema and eosinophils infiltration.
2. Aspirin intolerance and Widal triad
3. Congenital anomalies of respiratory mucosa These diseases include cystic fibrosis and immobile ciliary syndrome. Among them, cystic fibrosis patients complicated with nasal polyps are more. The incidence of polyps in children ranged from 7% to 28% (Schwachman, 1962; Schramm, 1980), reported up to 48% of adult patients (di Sant'agnese et al., 1979). Cystic fibrosis is a hereditary disease, which mainly occurs in white people, is more common in North America and Europeans, and is rare in Asians. The disease mainly involves glandular mucus secreting cells, which can make their secretion exuberant and secretion viscous. Therefore, patients' respiratory tract is often blocked by a large number of viscous secretions, resulting in repeated infection, pneumonia, lung abscess or bronchiectasis, pulmonary fibrosis and so on. The content of sodium and chlorine in sweat of children is 3 ~ 4 times higher than normal, while the deficiency of trypsin in duodenal fluid can be found in adults. The recurrent infection caused by this congenital abnormality of respiratory epithelium may be related to polyp formation.
4. Hypertension Granstrom (1990) investigated 224 patients with nasal polyps, and found that 78 (34.7%) of them suffered from hypertension, all of whom had a history of nasal polyps for more than 10 years. Like sleep dyspnea syndrome, long-term stagnation caused by nasal polyps can promote high blood pressure, he believes.
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