The Epidemiological and Clinical Aspects of Nasal Polyps that Require Surgery

Iranian Journal of Otorhinolaryngology No.2, Vol.24, Serial No.67, Spring-2012 Original Article The Epidemiological and Clinical Aspects of Nasal Polyps that Require Surgery Ahmad Meymane Jahromi1,*Ayeh Shahabi Pour2 Abstract Introduction: The objective of this retrospective cross-sectional study was to obtain epidemiological data from the charts of 297 patients with nasal polyposis who were operated on in a referral hospital in Mashhad and to determine the frequency of the presenting symptoms of nasal polyps. Materials and Methods: The variables recorded included age, gender, the presence of asthma or allergic rhinitis, family history, and previous treatments. We studied the main symptoms of nasal polyposis (nasal obstruction, rhinorrhea, anosmia, headache, epistaxis, snoring, and so on), as well as ear problems and facial deformity. Results: Nasal polyposis affects men (60.3%) more frequently, at a mean age of 39.5 years. The most frequent symptom was nasal blockage (81.1 %) followed by rhinorrhea (37.7%). A total of 11.1% of the patients had a history of epistaxis. Asthma was found in 10.4% of patients with nasal polyposis and the ears were affected in 5.1% of patients. In all, 7.4% of patients had first-degree relatives who suffered from asthma or allergic rhinitis. Conclusion: This study highlights the need for large-scale epidemiologic research exploring the prevalence and incidence of nasal polyposis in Iran. Keywords: Clinical features, Epidemiology, Nasal polyposis. Accepted date: 15 Jun 2011 Received date: 27 Dec 2011 1 Assistant Professor of Otolaryngology. Department of Otorhinolaryngology, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2 Otolaryngology Resident. Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. * Corresponding author Address: Imam Reza University Hospital, Ahmadabad Ave, Mashhad, Iran. Postal Code: 91766-99199 Tel: +98 9122886266 E-mail: ; 75 Nasal Polyps Introduction Nasal polyps are mucosal lesions of the nasal or paranasal sinuses that can result from a response to inflammatory or infectious stimuli. They appear as smooth, round, semi-translucent masses that are most commonly found in the middle meatus and ethmoid sinuses and affect 1% to 4% of the population. Males are affected more than females and adults more than children. If it happens in childhood, mucociliary and immunodeficiency diseases must be ruled out, for example, patients with cystic fibrosis have a prevalence of nasal polyposis between 6% and 48% (1). Patients with nasal polyposis may present clinically with complaints of nasal obstruction, congestion, hyposmia, rhinorrhea, epistaxis, postnasal drip, headaches, and snoring. Although nasal polyps more commonly appear bilaterally they can also present unilaterally. In unilateral nasal masses, benign or malignant pathologies must be considered and distinguished by nasal endoscopy, CT scan, and biopsy (1). The etiology of nasal polyps has been the subject of research for many years. Elevated levels of histamine and IgE found around polyps, and mast cells and eosinophilia found within polyps provide evidence suggesting that inflammation is a major factor in polyp formation (2). Previous studies have also revealed a relationship between nasal polyposis, aspirin intolerance, and allergic rhinitis and asthma (4,5). The prevalence of nasal polyposis is higher in subjects with asthma than in non-asthmatics and 16.5% of asthmatic patients over 40 years of age have been shown to have nasal polyps (3). The management of nasal polyposis can be both medical and surgical. Topical corticosteroids are drug of choice as they reduce the size of the polyp and improve nasal breathing and prevent recurrence. In patients who do not response to medical therapy or have large-sized polyps, functional endoscopic sinus surgery (FESS) is used to perform a polypectomy (4,5). The objective of this study was to obtain clinical data from patients with nasal polyposis who were managed surgically. Materials and Methods We reviewed the hospital charts of 297 patients with nasal polyposis (unilateral and bilateral) who were operated on between 1998 and 2002 in our referral hospital in Mashhad, Iran. The procedures performed included simple polypectomy, the Caldwell-Luc procedure, external ethmoidectomy, and functional endoscopic sinus surgery (FESS). In all cases, the patient’s medical history and notes from an otolaryngological physical examination were reviewed and a check list of 22 variables was completed. The variables included age, age of onset, gender, season of referral, location of nasal symptoms (bilateral or unilateral). History of allergic rhinitis, asthma, or cystic fibrosis was extracted from the hospital records. Symptoms of nasal polyps such as nasal obstruction, rhinorrhea, facial pain and headache, epistaxis, snoring, mouth breathing, voice changes, ear problems, and facial deformity due to polyposis were also included in the check list. Family history of asthma or allergy and previous medical or surgical treatments were other variables that were routinely present in the hospital records of our patients in the Otorhinolaryngology ward. All of our patients had a histologic diagnosis of inflammatory nasal polyps. For the quantitative data, descriptive statistical analysis was conducted to determine the mean and standard deviation. For the qualitative data, we calculated percentages of the recorded variable. Our study was approved by the Institutional Board Review of Mashhad University of Medical Sciences. Results Among the 297 patients with nasal polyps, 118 were female (39.7%) and 179 76, Iranian Journal of Otorhinolaryngology No.2, Vol.24, Serial No.67, Spring-2012 Jahromi A, et al were male (60.3%). The average age of the patients with nasal polyps included in the study was 39.49 ±16.63 16.63 years old, with a range of 7 to 79 years old. The average age of onset was 29.2 ± 15.93 years old. old In respect to age and age of onset, onset nasal polyps were most common in the second decade of life, followed by the third and then fourth decades. Most of the referrals occurred in the spring (36.7%) and summer (23.2%). In 161 (54.2%) of the patients the polyps were bilateral. Out of the total number of patients with nasal polyps, 31 (10.4%) presented with associated asthma and received treatment, treatment 54 (18.2%) presented with allergic allergi rhinitis, and 22 (7.4%) indicated that they had a first-degree degree relative (father/mother, brother/sister, son/daughter) who suffered from asthma or allergy.. None of the patients had been diagnosed with cystic fibrosis. The frequency of the major symptoms of o nasal polyps olyps in the patients studied can be seen in Figure 1. Fig 1: Frequency of major symptoms of nasal polyps (%) The most common symptom among patients was nasal obstruction (81.1%). In our study 11.1% of patients had a history of epistaxis. (...truncated)