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Nasal Polyp Surgery Workup

  • Author: Andrew Cheng, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Jul 31, 2015
 

Laboratory Studies

See the list below:

  • Relevant allergy or asthma studies (if indicated)
  • Nasal smears or cultures for fungus and bacteria (if indicated)
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Imaging Studies

See the list below:

  • CT scan of sinuses without contrast: Specify coronal CT with 3-4 mm cuts and appropriate soft tissue and bone windows.
    • Evaluate the CT scan results with attention to anterior ethmoid artery, orbital and skull base anomalies, optic nerve and carotid in posterior ethmoidal (Onodi) cells, and sphenoid sinus.
    • Focus especially on previous surgical changes. Consider role and use of image-guidance system in revision or difficult cases.[4]
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Other Tests

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  • Olfactory testing (if indicated)
  • Medical workup for cystic fibrosis (if indicated)
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Diagnostic Procedures

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  • A nasal and sinus endoscopy with evaluation of anatomy, site of origin, past surgical changes, and evidence of other disease-causing polyps (tumor, infection, systemic diseases such as Sarcoidosis, Wegener granulomatosis) may be appropriate (see Nasal Polyps, Nonsurgical Treatment).
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Histologic Findings

Pseudostratified epithelium is usually found. Pay special attention to unilateral polyps that may be neoplastic, and examine them for malignancy or possible malignant transformation of benign neoplasia(20% in inverting papilloma).

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Staging

Staging is relevant in inverted papilloma with malignant transformation.

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Contributor Information and Disclosures
Author

Andrew Cheng, MD Clinical Assistant Professor, Department of Otolaryngology-Head & Neck Surgery, New York Medical College

Andrew Cheng, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Nader Sadeghi, MD, FRCSC Professor, Otolaryngology-Head and Neck Surgery, Director of Head and Neck Surgery, George Washington University School of Medicine and Health Sciences

Nader Sadeghi, MD, FRCSC is a member of the following medical societies: American Head and Neck Society, American Thyroid Association, American Academy of Otolaryngology-Head and Neck Surgery, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Eric J Moore, MD, FACS Residency Director, Associate Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Graduate School of Medicine

Eric J Moore, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate-Craniofacial Association

Disclosure: Nothing to disclose.

References
  1. Tang J, Liu S, Zhang L, Chen W, Shi S, Yu Q, et al. Correlation analysis of prognostic and pathological features of patients with chronic sinusitis and nasal polyps following endoscopic surgery. Exp Ther Med. 2013 Jul. 6(1):167-171. [Medline]. [Full Text].

  2. Deal RT, Kountakis SE. Significance of nasal polyps in chronic rhinosinusitis: symptoms and surgical outcomes. Laryngoscope. 2004 Nov. 114(11):1932-5. [Medline].

  3. Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl. 2007. (20):1-136. [Medline].

  4. Kingdom TT, Orlandi RR. Image-guided surgery of the sinuses: current technology and applications. Otolaryngol Clin North Am. 2004 Apr. 37(2):381-400. [Medline].

  5. Mendelsohn D, Jeremic G, Wright E, Rotenberg E. Revision Rates After Endoscopic Sinus Surgery: A Recurrence Analysis. Ann Otol Rhinol Laryngol. March 2011. 120(3):162-166.

  6. Kumar N, Sindwani R. Bipolar microdebrider may reduce intraoperative blood loss and operating time during nasal polyp surgery. Ear Nose Throat J. 2012 Aug. 91(8):336-44. [Medline].

  7. Bassiouni A, Wormald PJ. Role of frontal sinus surgery in nasal polyp recurrence. Laryngoscope. 2013 Jan. 123(1):36-41. [Medline].

  8. Vento SI, Blomgren K, Hytönen M, Simola M, Malmberg H. Prevention of relapses of nasal polyposis with intranasal triamcinolone acetonide after polyp surgery: a prospective double-blind, placebo-controlled, randomised study with a 9-month follow-up. Clin Otolaryngol. 2012 Apr. 37(2):117-23. [Medline].

  9. Nguyen DT, Felix-Ravelo M, Arous F, Nguyen-Thi PL, Jankowski R. Facial pain/headache before and after surgery in patients with nasal polyposis. Acta Otolaryngol. 2015 Jun 25. 1-6. [Medline].

  10. Brescia G, Marioni G, Franchella S, et al. A prospective investigation of predictive parameters for post-surgical recurrences in sinonasal polyposis. Eur Arch Otorhinolaryngol. 2015 Mar 13. [Medline].

  11. Bhattacharyya N. Progress in surgical management of chronic rhinosinusitis and nasal polyposis. Curr Allergy Asthma Rep. June 2007. 3:216-20. [Medline].

  12. Garrel R, Gardiner Q, Khudjadze M, Demoly P, Vergnes C, Makeieff M. Endoscopic surgical treatment of sinonasal polyposis-medium term outcomes (mean follow-up of 5 years). Rhinology. 2003 Jun. 41(2):91-6. [Medline].

  13. Gosepath J, Mann WJ. Current concepts in therapy of chronic rhinosinusitis and nasal polyposis. ORL J Otorhinolaryngol Relat Spec. 2005. 67(3):125-36. [Medline].

  14. Mostafa BE, Abdel Hay H, Mohammed HE, Yamani M. Role of leukotriene inhibitors in the postoperative management of nasal polyps. ORL J Otorhinolaryngol Relat Spec. 2005. 67(3):148-53. [Medline].

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