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Unilateral nasal polyposis: clinical presentation and pathology
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American Journal of Otolaryngology–Head and Neck Medicine and Surgery 29 (2008) 230 – 232 www.elsevier.com/locate/amjoto
Unilateral nasal polyposis: clinical presentation and pathology Shawn Tritt, MD, Kevin C. McMains, MD, Stilianos E. Kountakis, MD, PhD⁎ Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, GA, USA Received 13 February 2007
Abstract
Objectives: The aim of this study is to determine the clinical presentation and pathology of unilateral nasal polyposis (UNP). Study design: Retrospective chart review. Methods: A retrospective analysis was completed on 301 consecutive patients with nasal polyposis that underwent functional endoscopic sinus surgery from 1995 to 2004. Of the charts reviewed, 46 patients were identified with UNP. In this group, there were 28 males and 18 females with a mean age at presentation of 34.85 years. Pathologic diagnosis was not available for 2 patients, so there were 44 UNP patient records for analysis. Presenting symptoms, surgical findings, and pathology were analyzed. Results: All 44 patients underwent surgical management for their symptoms, and specimens were sent for pathologic evaluation. There were 17 cases of chronic rhinosinusitis, 15 of allergic fungal sinusitis, 7 of inverting papilloma, 2 of squamous cell carcinoma, 1 of esthesioneuroblastoma, 1 of mucocele, and 1 of human papilloma virus polyp–type papilloma. The only presenting symptom that correlated with the presence of inverted papilloma or neoplastic process in our patients with UNP was epistaxis. Conclusions: Chronic rhinosinusitis, allergic fungal sinusitis, inverting papilloma, and other neoplasms account for most UNP cases and must be considered when a patient presents with symptoms of unilateral polyps. A careful history and endoscopic examination play a key role in identifying possible disease processes and proper management. © 2008 Elsevier Inc. All rights reserved.
1. Introduction Nasal polyps are described as abnormal lesions that emanate from any portion of the nasal mucosa or paranasal sinuses [1]. They are typically smooth, round, semitranslucent, and commonly located along the middle meatus and ethmoid sinus, although more rarely originating from the maxillary or sphenoid sinuses. Nasal polyps are present in 1% to 4% of the population. They are found more commonly in adults than in children and more commonly in males than in females [1]. Patients with nasal polyposis may present clinically with complaints of nasal obstruction, congestion, hyposmia, rhinorrhea, epistaxis, postnasal drip, headaches, and snoring. ⁎ Corresponding author. Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, 1120 Fifteenth ST, Augusta, GA 30912, USA. Tel.: +1 706 721 6100; fax: +1 706 721 0112. E-mail address: [email protected] (S.E. Kountakis). 0196-0709/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.amjoto.2007.07.001
The etiology of nasal polyps has been debated for many years. The prevailing theory is that nasal polyps are formed in response to inflammatory and infectious stimuli. The contributing role of inflammation is supported by the presence of elevated histamine and IgE levels found around polyps, the presence of degranulated mast cells and eosinophilia found within polyps, as well as the association of polyps with asthma that develops later in life [2]. Nasal polyps may be managed medically and surgically. The most common and preferred medical treatment for nasal polyps is administration of corticosteroids, nasally or orally [3]. Corticosteroids have been shown effective in reducing the size of the polyp as well as the rhinitis symptoms. Although some may benefit from medical treatment, others are not relieved based on medical therapy alone. After appropriate workup with nasal endoscopy and computed tomography and failing medical therapy, functional endoscopic sinus surgery (FESS) with nasal polypectomy is performed for nasal polyposis [4].
S. Tritt et al. / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 29 (2008) 230–232
Nasal masses of other histological origins can be difficult to distinguish from nasal polyps on the basis of symptoms, nasal endoscopy, and computed tomography. Nasal polyps typically present bilaterally but can present unilaterally. Unilateral nasal masses may be benign unilateral nasal polyps (UNP) in the context of chronic rhinosinusitis (CRS), fungal or bacterial disease, mucoceles, and benign and malignant neoplastic processes. Although usually bilateral, allergic fungal sinusitis (AFS) can involve only one side and may result in the clinical presentation of a nasal polyp [5]. The most common neoplastic cause of unilateral nasal mass is an inverting papilloma (IP) [6], which typically originate in the middle meatus and extend through the maxillary antrum [7] and comprise approximately 4% of all nasal polyps. Squamous cell carcinoma (SCCa) and esthesioneuroblastoma may also present as unilateral nasal masses and be mistaken for benign nasal polyps. Mucoceles may grossly resemble a polyp but are typically formed by sinus ostial obstruction that results in accumulation of secretions. They are most frequently found in the frontoethmoidal region but are also seen within middle meatus emanating from the maxillary sinus [8]. Patients with unilateral nasal masses present clinically with signs and symptoms similar to UNP: nasal obstruction, congestion, hyposmia, epistaxis, pain, and headaches. The treatment for unilateral nasal masses varies depending on the etiology of the disease process [9]. Surgical treatment is the mainstay for IP, other malignant processes, and mucoceles. With the advent of endoscopic sinus surgery in addition to en bloc resections, it is often possible to resect the entirety of a unilateral nasal mass, thus decreasing the chance of a recurrence. Evidence of invasion and destruction suggests aggressive and possibly neoplastic disease and dictates more urgent management. This study attempts to determine the presenting symptoms and correlate them with the surgical pathology findings for patients presenting with UNP. Statistical analysis was further used to correlate clinical presentation.
231
Presenting symptoms were correlated with pathologic findings using a χ2 analysis. Statistical significance was defined as P b .05. 3. Results The diagnosis of nasal polyps was made in 301 patients over the study period. Bilateral polyps were present in 255 of these patients. Forty-six patients were identified as having undergone FESS for UNP diagnosed through clinical examination and radiography. In this group, there were 28 males and 18 females with a mean age at presentation of 35 years. Pathologic diagnosis was not available for 2 patients, leaving 44 UNP patients included in this study. Patient diagnoses included CRS, AFS, IP, SCCa, mucocele, esthesioneuroblastoma, or HPV-type papilloma. Chronic rhinosinusitis was the most common pathologic diagnosis, found in 17 (39%) of 44 patients (Fig. 1). Allergic fungal sinusitis was the second most common pathologic diagnosis, found in 15 (34%) of 44 patients. Inverting papilloma was seen in 7 (16%) of 44 patients. Squamous cell carcinoma was seen in 2 (4.5%) of 44 patients. Mucocele, esthesioneuroblastoma, and HPV-type papilloma were the least common findings, each seen in 1 (2.2%) of 44 patients. Presenting symptoms included unilateral congestion or obstruction, unilateral epistaxis, headaches, or incidental findings on radiographic examinations. The most common major presenting symptom for CRS was unilateral congestion, found in 11 (65%) of 17 patients. Epistaxis and headaches were found in 3 (18%) of 17 and 2 (12%) of 17 patients, respectively. The most common major presenting symptom for AFS was unilateral congestion, found in 14 (93%) of 15 patients. Epistaxis, the second most common presenting symptom, was found in 1 (7%) of 15 patients. Mucocele and HPV-type papilloma both presented with congestion and without epistaxis in 1 (100%) of 1 patients, respectively. Patients presenting with a neoplastic process (IP, SCCa, and esthesioneuroblastoma) presented with epistaxis in 5 (45%) of 11 patients and with congestion, headache,
2. Methods An institutional review board–approved retrospective chart review was completed at a tertiary care academic center evaluating all patients with a diagnosis of nasal polyps and having undergone FESS. Three hundred one consecutive patients with nasal polyposis presenting from 1995 to 2004 were identified. Of these, 46 patients were identified as having UNP. Patients were evaluated for presenting symptoms, surgical findings, and pathology. Patients were grouped according to pathologic diagnosis: CRS, AFS, IP, SCCa, esthesioneuroblastoma, mucocele, and human papilloma virus polyp (HPV)-type papilloma. Patients without pathologic diagnosis were excluded from the study.
Fig. 1. Diagnosis of patients with unilateral nasal polyps. EN indicates esthesioneuroblastoma.
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seizures, and incidental findings in 6 (55%) of 11 patients. Patients with a malignant process only (SCCa and esthesioneuroblastoma) presented without epistaxis in 2 (67%) of 3 patients and with epistaxis in 1 (33%) of 3 patients. Epistaxis was found in 4 (57%) of 7 patients with IP alone. Congestion, headache, and incidental findings were the presenting symptoms for 3 (43%) of 7 patients. For all patients, epistaxis was significantly associated with IP (χ2 = 4.59 and P = .032). For patients with all neoplastic disorders (IP, SCCa, or esthesioneuroblastoma), epistaxis approached but did not achieve statistical significance (χ2 = 3.27 and P = .070). Epistaxis was not significantly associated with malignancy (χ2 = 0.12 and P = .730). Epistaxis was not associated with CRS or AFS.
context. We postulate that this association may be due to the slightly increased vascularity of IP compared with other types of nasal polyps. Another possible explanation is the increase in inflammation surrounding the IP and increased friability of the IP tissue. In our study, epistaxis in the presence of a neoplastic process approached statistical significance with P = .070. This tendency may be related to the changes caused by invasion of the neoplasm and background inflammation of tissues surrounding the neoplasm. Further studies investigating the relationship will contribute to a more complete understanding of this correlation.
4. Discussion
Although one must be vigilant in the search for progressively destructive processes in patients with unilateral nasal polyposis, our findings demonstrate that neoplastic processes are present in a minority of these cases. Epistaxis is significantly associated with IP in the setting of UNP. These findings underscore the importance of correlating careful clinical history, endoscopic examination, and radiologic findings in diagnosis, patient counseling, and treatment tailored to the patient's specific pathology.
Nasal polyps are present in approximately 1% to 4% of the population, more often in males than females [1]. Several disease processes account for the formation of polyps. Neoplastic diseases that present with UNP have an increased chance of being life-threatening to a patient if not identified and treated early. Special attention must be paid to any patient presenting with unilateral nasal symptoms. The focus of this study was to describe the disease processes that accounted for UNP in our study population, presenting symptoms, and correlation of these symptoms with final pathologic diagnosis. One important finding in this study is that most patients that present with UNP do not present with a neoplastic process. This is similar to patients who present with unilateral maxillary sinus opacification as reported in the literature [10]. Chronic rhinosinusitis and AFS accounted for 34 (77%) of 44 cases reviewed in our study. Allergic fungal sinusitis typically occurs bilaterally but may occur unilaterally in a significant portion of cases [11]. In our patient population, AFS was diagnosed in 15 (34%) of 44 patients who presented with UNPs. Treatment involves decreasing environmental exposure, conservative and complete sinus surgery, and aggressive medical management, including systemic corticosteroids [12]. Inverted papillomas differ from infectious or allergic polyps through their etiology, behavior, and presentation. Inverting papillomas most commonly form through proliferating epithelium on the lateral nasal wall, although can originate from many sites throughout the sinonasal cavities, and have a tendency to recur [13]. Inverted papillomas are usually associated with a unilateral polypoid mass [14]. In our study, IP was diagnosed in 7 (39%) of 44 patients who presented with unilateral nasal polyposis. The clinical presentation and history of a patient can be an indicator of the patient's pathologic process. In this study, we demonstrate that unilateral epistaxis in the presence of UNP is statistically significant for IP. This finding should raise the concern of IP in any patient that presents in this clinical
5. Conclusion
References [1] Slavin RG. Nasal polyps and sinusitis. Review. JAMA 1997;278 (22):1849-54. [2] Pawanker R. Nasal polyposis: an update: editorial review. Curr Opin Allergy Clin Immunol 2003;3(1):1-6. [3] Badia L, Lund V. Topical corticosteroids in nasal polyposis. Drugs 2001;61(5):573-8. [4] Lanza DE, Kennedy DW. Current concepts in the surgical management of nasal polyposis. J Allergy Clin Immunol 1992;90:543-6. [5] Marple BF. Allergic fungal rhinosinusitis: current theories and management strategies. Laryngoscope 2001;111:1006-19. [6] Savy L, Lloyd G, Lund VJ, et al. Optimum imaging for inverting papilloma. J Laryngol Otol 2000;114:891-3. [7] Dammann F, Pereira P, Laniado M, et al. Inverted papilloma of the nasal cavity and the paranasal sinuses: using CT for primary diagnosis and follow-up. Am J Rhinol 1999;172:543-8. [8] Lloyd G, Lund VJ, Savy L, et al. Optimum imaging for mucoceles. J Laryngol Otol 2000;114:233-6. [9] Hu WH, Xie FY, et al. Prognosis and treatment for 98 patients with carcinoma of the nasal cavity. Ai Zheng 2004;23(11 Suppl 1):1542-5. [10] Ahsan F, El-Hakim H, Ah-See KW. Unilateral opacification of paranasal sinus CT scans. Otolaryngol Head Neck Surg 2005;133 (2):178-80. [11] Ferguson BJ. Eosinophilic mucin rhinosinusitis: a distinct clinicopathological entity. Laryngoscope 2000;110(5 Pt 1):799-813. [12] Schubert MS. Allergic fungal sinusitis: pathogenesis and management strategies. Drugs 2004;64(4):363-74. [13] Lawson W, Kaufman MR, Biller HF. Treatment outcomes in the management of inverted papilloma: an analysis of 160 cases. Laryngoscope 2003;113(9):1548-56. [14] Pelausa EO, Fortier MA. Schneiderian papilloma of the nose and paranasal sinuses: the University of Ottawa experience. J Otolaryngol 1992;21(1):9-15.
American Journal of Otolaryngology–Head and Neck Medicine and Surgery 29 (2008) 230 – 232 www.elsevier.com/locate/amjoto
Unilateral nasal polyposis: clinical presentation and pathology Shawn Tritt, MD, Kevin C. McMains, MD, Stilianos E. Kountakis, MD, PhD⁎ Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, GA, USA Received 13 February 2007
Abstract
Objectives: The aim of this study is to determine the clinical presentation and pathology of unilateral nasal polyposis (UNP). Study design: Retrospective chart review. Methods: A retrospective analysis was completed on 301 consecutive patients with nasal polyposis that underwent functional endoscopic sinus surgery from 1995 to 2004. Of the charts reviewed, 46 patients were identified with UNP. In this group, there were 28 males and 18 females with a mean age at presentation of 34.85 years. Pathologic diagnosis was not available for 2 patients, so there were 44 UNP patient records for analysis. Presenting symptoms, surgical findings, and pathology were analyzed. Results: All 44 patients underwent surgical management for their symptoms, and specimens were sent for pathologic evaluation. There were 17 cases of chronic rhinosinusitis, 15 of allergic fungal sinusitis, 7 of inverting papilloma, 2 of squamous cell carcinoma, 1 of esthesioneuroblastoma, 1 of mucocele, and 1 of human papilloma virus polyp–type papilloma. The only presenting symptom that correlated with the presence of inverted papilloma or neoplastic process in our patients with UNP was epistaxis. Conclusions: Chronic rhinosinusitis, allergic fungal sinusitis, inverting papilloma, and other neoplasms account for most UNP cases and must be considered when a patient presents with symptoms of unilateral polyps. A careful history and endoscopic examination play a key role in identifying possible disease processes and proper management. © 2008 Elsevier Inc. All rights reserved.
1. Introduction Nasal polyps are described as abnormal lesions that emanate from any portion of the nasal mucosa or paranasal sinuses [1]. They are typically smooth, round, semitranslucent, and commonly located along the middle meatus and ethmoid sinus, although more rarely originating from the maxillary or sphenoid sinuses. Nasal polyps are present in 1% to 4% of the population. They are found more commonly in adults than in children and more commonly in males than in females [1]. Patients with nasal polyposis may present clinically with complaints of nasal obstruction, congestion, hyposmia, rhinorrhea, epistaxis, postnasal drip, headaches, and snoring. ⁎ Corresponding author. Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, 1120 Fifteenth ST, Augusta, GA 30912, USA. Tel.: +1 706 721 6100; fax: +1 706 721 0112. E-mail address: [email protected] (S.E. Kountakis). 0196-0709/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.amjoto.2007.07.001
The etiology of nasal polyps has been debated for many years. The prevailing theory is that nasal polyps are formed in response to inflammatory and infectious stimuli. The contributing role of inflammation is supported by the presence of elevated histamine and IgE levels found around polyps, the presence of degranulated mast cells and eosinophilia found within polyps, as well as the association of polyps with asthma that develops later in life [2]. Nasal polyps may be managed medically and surgically. The most common and preferred medical treatment for nasal polyps is administration of corticosteroids, nasally or orally [3]. Corticosteroids have been shown effective in reducing the size of the polyp as well as the rhinitis symptoms. Although some may benefit from medical treatment, others are not relieved based on medical therapy alone. After appropriate workup with nasal endoscopy and computed tomography and failing medical therapy, functional endoscopic sinus surgery (FESS) with nasal polypectomy is performed for nasal polyposis [4].
S. Tritt et al. / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 29 (2008) 230–232
Nasal masses of other histological origins can be difficult to distinguish from nasal polyps on the basis of symptoms, nasal endoscopy, and computed tomography. Nasal polyps typically present bilaterally but can present unilaterally. Unilateral nasal masses may be benign unilateral nasal polyps (UNP) in the context of chronic rhinosinusitis (CRS), fungal or bacterial disease, mucoceles, and benign and malignant neoplastic processes. Although usually bilateral, allergic fungal sinusitis (AFS) can involve only one side and may result in the clinical presentation of a nasal polyp [5]. The most common neoplastic cause of unilateral nasal mass is an inverting papilloma (IP) [6], which typically originate in the middle meatus and extend through the maxillary antrum [7] and comprise approximately 4% of all nasal polyps. Squamous cell carcinoma (SCCa) and esthesioneuroblastoma may also present as unilateral nasal masses and be mistaken for benign nasal polyps. Mucoceles may grossly resemble a polyp but are typically formed by sinus ostial obstruction that results in accumulation of secretions. They are most frequently found in the frontoethmoidal region but are also seen within middle meatus emanating from the maxillary sinus [8]. Patients with unilateral nasal masses present clinically with signs and symptoms similar to UNP: nasal obstruction, congestion, hyposmia, epistaxis, pain, and headaches. The treatment for unilateral nasal masses varies depending on the etiology of the disease process [9]. Surgical treatment is the mainstay for IP, other malignant processes, and mucoceles. With the advent of endoscopic sinus surgery in addition to en bloc resections, it is often possible to resect the entirety of a unilateral nasal mass, thus decreasing the chance of a recurrence. Evidence of invasion and destruction suggests aggressive and possibly neoplastic disease and dictates more urgent management. This study attempts to determine the presenting symptoms and correlate them with the surgical pathology findings for patients presenting with UNP. Statistical analysis was further used to correlate clinical presentation.
231
Presenting symptoms were correlated with pathologic findings using a χ2 analysis. Statistical significance was defined as P b .05. 3. Results The diagnosis of nasal polyps was made in 301 patients over the study period. Bilateral polyps were present in 255 of these patients. Forty-six patients were identified as having undergone FESS for UNP diagnosed through clinical examination and radiography. In this group, there were 28 males and 18 females with a mean age at presentation of 35 years. Pathologic diagnosis was not available for 2 patients, leaving 44 UNP patients included in this study. Patient diagnoses included CRS, AFS, IP, SCCa, mucocele, esthesioneuroblastoma, or HPV-type papilloma. Chronic rhinosinusitis was the most common pathologic diagnosis, found in 17 (39%) of 44 patients (Fig. 1). Allergic fungal sinusitis was the second most common pathologic diagnosis, found in 15 (34%) of 44 patients. Inverting papilloma was seen in 7 (16%) of 44 patients. Squamous cell carcinoma was seen in 2 (4.5%) of 44 patients. Mucocele, esthesioneuroblastoma, and HPV-type papilloma were the least common findings, each seen in 1 (2.2%) of 44 patients. Presenting symptoms included unilateral congestion or obstruction, unilateral epistaxis, headaches, or incidental findings on radiographic examinations. The most common major presenting symptom for CRS was unilateral congestion, found in 11 (65%) of 17 patients. Epistaxis and headaches were found in 3 (18%) of 17 and 2 (12%) of 17 patients, respectively. The most common major presenting symptom for AFS was unilateral congestion, found in 14 (93%) of 15 patients. Epistaxis, the second most common presenting symptom, was found in 1 (7%) of 15 patients. Mucocele and HPV-type papilloma both presented with congestion and without epistaxis in 1 (100%) of 1 patients, respectively. Patients presenting with a neoplastic process (IP, SCCa, and esthesioneuroblastoma) presented with epistaxis in 5 (45%) of 11 patients and with congestion, headache,
2. Methods An institutional review board–approved retrospective chart review was completed at a tertiary care academic center evaluating all patients with a diagnosis of nasal polyps and having undergone FESS. Three hundred one consecutive patients with nasal polyposis presenting from 1995 to 2004 were identified. Of these, 46 patients were identified as having UNP. Patients were evaluated for presenting symptoms, surgical findings, and pathology. Patients were grouped according to pathologic diagnosis: CRS, AFS, IP, SCCa, esthesioneuroblastoma, mucocele, and human papilloma virus polyp (HPV)-type papilloma. Patients without pathologic diagnosis were excluded from the study.
Fig. 1. Diagnosis of patients with unilateral nasal polyps. EN indicates esthesioneuroblastoma.
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S. Tritt et al. / American Journal of Otolaryngology–Head and Neck Medicine and Surgery 29 (2008) 230–232
seizures, and incidental findings in 6 (55%) of 11 patients. Patients with a malignant process only (SCCa and esthesioneuroblastoma) presented without epistaxis in 2 (67%) of 3 patients and with epistaxis in 1 (33%) of 3 patients. Epistaxis was found in 4 (57%) of 7 patients with IP alone. Congestion, headache, and incidental findings were the presenting symptoms for 3 (43%) of 7 patients. For all patients, epistaxis was significantly associated with IP (χ2 = 4.59 and P = .032). For patients with all neoplastic disorders (IP, SCCa, or esthesioneuroblastoma), epistaxis approached but did not achieve statistical significance (χ2 = 3.27 and P = .070). Epistaxis was not significantly associated with malignancy (χ2 = 0.12 and P = .730). Epistaxis was not associated with CRS or AFS.
context. We postulate that this association may be due to the slightly increased vascularity of IP compared with other types of nasal polyps. Another possible explanation is the increase in inflammation surrounding the IP and increased friability of the IP tissue. In our study, epistaxis in the presence of a neoplastic process approached statistical significance with P = .070. This tendency may be related to the changes caused by invasion of the neoplasm and background inflammation of tissues surrounding the neoplasm. Further studies investigating the relationship will contribute to a more complete understanding of this correlation.
4. Discussion
Although one must be vigilant in the search for progressively destructive processes in patients with unilateral nasal polyposis, our findings demonstrate that neoplastic processes are present in a minority of these cases. Epistaxis is significantly associated with IP in the setting of UNP. These findings underscore the importance of correlating careful clinical history, endoscopic examination, and radiologic findings in diagnosis, patient counseling, and treatment tailored to the patient's specific pathology.
Nasal polyps are present in approximately 1% to 4% of the population, more often in males than females [1]. Several disease processes account for the formation of polyps. Neoplastic diseases that present with UNP have an increased chance of being life-threatening to a patient if not identified and treated early. Special attention must be paid to any patient presenting with unilateral nasal symptoms. The focus of this study was to describe the disease processes that accounted for UNP in our study population, presenting symptoms, and correlation of these symptoms with final pathologic diagnosis. One important finding in this study is that most patients that present with UNP do not present with a neoplastic process. This is similar to patients who present with unilateral maxillary sinus opacification as reported in the literature [10]. Chronic rhinosinusitis and AFS accounted for 34 (77%) of 44 cases reviewed in our study. Allergic fungal sinusitis typically occurs bilaterally but may occur unilaterally in a significant portion of cases [11]. In our patient population, AFS was diagnosed in 15 (34%) of 44 patients who presented with UNPs. Treatment involves decreasing environmental exposure, conservative and complete sinus surgery, and aggressive medical management, including systemic corticosteroids [12]. Inverted papillomas differ from infectious or allergic polyps through their etiology, behavior, and presentation. Inverting papillomas most commonly form through proliferating epithelium on the lateral nasal wall, although can originate from many sites throughout the sinonasal cavities, and have a tendency to recur [13]. Inverted papillomas are usually associated with a unilateral polypoid mass [14]. In our study, IP was diagnosed in 7 (39%) of 44 patients who presented with unilateral nasal polyposis. The clinical presentation and history of a patient can be an indicator of the patient's pathologic process. In this study, we demonstrate that unilateral epistaxis in the presence of UNP is statistically significant for IP. This finding should raise the concern of IP in any patient that presents in this clinical
5. Conclusion
References [1] Slavin RG. Nasal polyps and sinusitis. Review. JAMA 1997;278 (22):1849-54. [2] Pawanker R. Nasal polyposis: an update: editorial review. Curr Opin Allergy Clin Immunol 2003;3(1):1-6. [3] Badia L, Lund V. Topical corticosteroids in nasal polyposis. Drugs 2001;61(5):573-8. [4] Lanza DE, Kennedy DW. Current concepts in the surgical management of nasal polyposis. J Allergy Clin Immunol 1992;90:543-6. [5] Marple BF. Allergic fungal rhinosinusitis: current theories and management strategies. Laryngoscope 2001;111:1006-19. [6] Savy L, Lloyd G, Lund VJ, et al. Optimum imaging for inverting papilloma. J Laryngol Otol 2000;114:891-3. [7] Dammann F, Pereira P, Laniado M, et al. Inverted papilloma of the nasal cavity and the paranasal sinuses: using CT for primary diagnosis and follow-up. Am J Rhinol 1999;172:543-8. [8] Lloyd G, Lund VJ, Savy L, et al. Optimum imaging for mucoceles. J Laryngol Otol 2000;114:233-6. [9] Hu WH, Xie FY, et al. Prognosis and treatment for 98 patients with carcinoma of the nasal cavity. Ai Zheng 2004;23(11 Suppl 1):1542-5. [10] Ahsan F, El-Hakim H, Ah-See KW. Unilateral opacification of paranasal sinus CT scans. Otolaryngol Head Neck Surg 2005;133 (2):178-80. [11] Ferguson BJ. Eosinophilic mucin rhinosinusitis: a distinct clinicopathological entity. Laryngoscope 2000;110(5 Pt 1):799-813. [12] Schubert MS. Allergic fungal sinusitis: pathogenesis and management strategies. Drugs 2004;64(4):363-74. [13] Lawson W, Kaufman MR, Biller HF. Treatment outcomes in the management of inverted papilloma: an analysis of 160 cases. Laryngoscope 2003;113(9):1548-56. [14] Pelausa EO, Fortier MA. Schneiderian papilloma of the nose and paranasal sinuses: the University of Ottawa experience. J Otolaryngol 1992;21(1):9-15.