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NASAL POLYPOSIS                                    57

CLINICAL FEATURES. Anterior rhinoscopy will reveal the smooth, glossy,
movable, bluish-grey swelling which is characteristic of the nasal polypus
(Plate II9 2). When the polypus reaches the anterior nans the epithelium
undergoes a change to the squamous type from exposure and trauma, and the
surface is less glistening, and the polypus appears white or pinkish in colour
(Plate II, 3). If a pedunculated polypus twists on its stalk it may become
congested. The polypus may be mistaken for the enlarged end of the inferior

Fig. 24. Nasal enlargement; the result of
neglected polypi.

concha to the inexperienced eye but it is more common for the enlarged
concha to be taken for a polypus. It may be difficult to distinguish an enlarged
or cystic middle concha from a polypus unless it is probed. The polypus is
soft, mobile and insensitive, and may thus be moved inside the nose without
causing discomfort.

Posterior rhinoscopy should always be attempted. It may be that the
posterior ethmoidal cells are responsible for polypus formation and the
growths will be seen in the choana or in the nasopharynx.

The nature of any nasal discharge should be noted. A thin mucoid discharge
will suggest allergy while the presence of mucopus will denote an infective
origin. Nasal polypi will shrink if a pledget of cotton-wool soaked in 10 per
cent cocaine hydrochloride is placed against them, and this shrinkage is
especially noticeable with allergic polypi.

Radiography of the nasal sinuses should be done because the films may
show the underlying sinus pathology, and because any infection within the
maxillary sinuses may conveniently be treated at the same time as the polypi
are removed.

TREATMENT. Nasal polypi may decrease in size to some extent with the use of
a decongestant nasal spray of 1 per cent ephedrine hydrochloride in normal
saline. They may also decrease after a course of corticotrophin (ACTH)
injections, giving 40-120 units daily by intramuscular injection in suitable