nasal-polyposis-slides-080423

nasal-polyposis-slides-080423 - Medical Management of Nasal...

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Medical Management of Nasal Polyposis Camysha Wright, MD,MPH Jing Shen,MD University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation April 23, 2008
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Background The term nasal polyposis comprises all types of nasal polyps which emerge as blue-gray protuberances in the area of the ethmoid bone, middle meatus, nose and middle turbinate
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Background Nasal polyposis characterized by eosinophil inflammation, accompanied by acetylsalicylic intolerance in up to 25% of cases 40% of cases of nasal polyposis are associated with intrinsic asthma Samter’s triad (nasal polyps, aspirin allergy, and asthma) Associations have also been described between Churg-Strauss syndrome (a form of eosinophilic immunovasculitis) and eosinophilic nasal polyposis
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Background Nasal polyps represent edematous semitranslucent masses in the nasal and paranasal cavities mostly originating from the mucosal linings of the sinuses and prolapsing into the nasal cavities.
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Background Several hypotheses regarding the underlying mechanisms including chronic infection, aspirin intolerance, alteration in aerodynamics with trapping of pollutants, epithelial disruptions, epithelial cell defects/gene deletions (CFTR gene), and inhalant or food allergies.
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Anatomy Histologically polyps are characterized by edema or fibrosis, reduced vascularization, reduced number of glands and nerve endings in the presence of often damaged epithelium
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Pathophysiology In the majority of nasal polyps, eosinophils comprise more than 60% of the cell population. Besides eosinophils, mast cells and activated T cells are also increased.
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Pathophysiology An increased production of cytokines/chemokines like granulocyte/macrophag e colony-stimulating factor, IL-5, RANTES and eotaxin contribute to eosinophil migration and survival. Increased levels of IL-8 can induce neutrophil infiltration.
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Pathophysiology Increased expression of VEGF and its upregulation by transforming growth factor-[beta] contribute to edema and increased angiogenesis in nasal polyps. Transforming growth factor- [beta] modulate fibroblast function eosinophil infiltration and stromal fibrosis. Other mediators like albumin, histamine and immunoglobulins IgE and IgG are also increased in nasal polyps.
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History and Physical Exam Diagnosis is based on finding of pale-gray, semitranslucent, round or bag-shaped mucosal protrusions from the sinuses into the nasal cavity, filled with gelatinous or watery masses. Polyps originating from the middle and superior turbinates may be seen in more severe disease, and those from the inferior turbinate are extremely rare.
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History and Physical Exam Most nasal polyps arise from the clefts of the middle nasal meatus and ethmoidal cells, prolapsing into the nose, with some polyps originating in the maxillary, sphenoid, or frontal sinuses
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nasal-polyposis-slides-080423 - Medical Management of Nasal...

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