Latest Treatment of Nasal Polyps
Tomographic (CT) imaging of the nose and paranasal sinuses are the gold standards of evaluation.8 In contrast to the more translucent bilateral inflammatory polyps, IP is usually unilateral (although in rare cases it is bilateral), vascular, and bulky. However, IP often arises along with nasal polyps, making the diagnosis difficult. The surgeon should always submit operative specimens according to their site of origin, rather than as a combined specimen. IP can display bone invasion on a CT scan, even to the extent that skull base erosion occurs this finding requires craniofacial resection despite no evidence of cancer.7,15,35 As a whole, intracranial invasion is rare, found in only 5 of 1468 cases reviewed.18 Snyder and Perzin5 demonstrated bone erosion in 5 of 34 nonmalignant IP cases. However, in patients with cancer, bone erosion occurred in all cases. By contrast, 3 cases of malignancy in Rothfield's study showed no erosion.36 IP can also cause sinusitis, which can lead to...
Uses PO Short-term (up to 5 days) management of severe, acute pain that requires analgesia at the opiate level. Always initiate therapy with IV or IM followed by PO only as continuation treatment, if necessary. IM IV Ketorolac has been used with morphine and meperidine and shows an opioid-sharing effect. The combination can be used for breakthrough pain. Ophthalmic Relieve itching caused by seasonal allergic conjunctivitis. Reduce ocular pain and photo phobia following inci-sional refractive surgery. Contraindications Hypersensitivi-ty to the drug, incomplete or partial syndrome of nasal polyps, an-gioedema, and bronchospasm due to aspirin or other NSAIDs. Use in
Late-phase reaction after exposure to antigen.71 Accordingly, steroid nasal sprays are especially useful in children with allergic rhinitis or nasal polyps or both. Nasal sprays containing ipatropium bromide have a different mechanism of action, and no studies have been done to validate the efficacy of this drug in rhinosinusitis.
Chronic sinusitis may develop from incomplete resolution of an acute infection. The onset, however, may be insidious and secondary to nasal obstruction (e.g., due to a deviated septum, nasal polyps, or, in children, to enlarged adenoids. Apical infection of the teeth related to the antra can also cause chronic sinusitis. Nasal polyps are a common cause of nasal obstruction, and may cause anosmia. They are benign and do not present with bleeding. Examination shows a gray pendulous opalescent swelling arising from the ethmoid. A polyp is very different in appearance from the red inferior turbinate adjacent to it. Polyps may be solitary or multiple, often extending from the nasal vestibule to the posterior choana. They are usually bilateral. Nasal polyps may become extremely large, causing expansion of the nasal bones and alae nasi. A nasal polyp which is ulcerated and bleeds is probably malignant. Nasal polyps result from a distension of an area of nasal mucous membrane with...
An association between cystic fibrosis, nasal polyposis, and chronic rhinosinusitis is recognized.58 Studies indicate that nasal polyposis generally occurs after 5 years of age, although mucopy-osinusitis of the maxillary sinus can occur as early as 3 months of age.59 The maxillary sinus seems to be the first sinus affected by cystic fibrosis,59 although eventual pansinusitis is the norm. A positive family history and nasal polyposis in a child are indications for sweat testing to rule out cystic fibrosis nasal polyps are otherwise uncommon in the pediatric population. Characteristic CT findings of this disease are pansinusitis with uncinate process demineralization and bilateral medial displacement of the lateral nasal wall.60 Despite management of the underlying disorder, cystic fibrosis is a progressive disease. Cystic fibrosis may be associated with massive polyposis and complete nasal obstruction, and is frequently an indication for endoscopic sinus surgery unfortunately,...
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