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NASAL POLYPOSIS                                    59

in size because of the oedema within it, and it passes posteriorly towards the
choana and enters the nasopharynx. Here it enlarges to fill the nasopharynx,
and as greater growth occurs the polypus then grows forward through the
nasal cavity of the original side, and thus becomes bilobed (Fig. 25). It
resembles the ordinary nasal polypus in structure.

SYMPTOMS. A naso-antral polypus is more commonly found in childhood or
adolescence than in adult life. There is a complaint of unilateral nasal

Fig. 25. Naso-antral polypus showing stalk of attachment and bilobed appearance. (Reproduced by
permission ofBailliere Tindallfrom 'The Ear Nose and Throat Diseases of Children'.)

obstruction which becomes bilateral as the polypus fills the nasopharynx. A
mucoid discharge is noted, again unilaterally at first and later bilaterally. The
voice becomes affected and hyponasality develops. Snoring may be complained
of initially. There is no pain, nor is there earache, but deafness may be present
because of the occlusion of the auditory tubes.

CLINICAL FEATURES. Anterior rhinoscopy in the early stages may reveal no
abnormality, although there may be accumulated mucus on the floor of the
nasal cavity of the obstructed side. It may occasionally be possible to see the
polypus far back in the nasal cavity. When the polypus becomes bilobed it
will be seen with increasing ease. Posterior rhinoscopy is not always easy to
perform in the young, but when it is successful a smooth, greyish-white,
spherical mass will be seen hi the choana early on, and later filling the
nasopharynx (Plate II, 4). Once the nasopharynx is filled the polypus may
project below the soft palate, or may be seen when the palate rises on phona-
tion. It presents as a greyish convex mass on examining the pharynx. Radio-
graphy will show a lack of air entry into the affected maxillary sinus, while a
lateral projection will demonstrate the polypoid swelling in the nasopharynx.

TREATMENT. This is essentially surgical. A small polypus may be snared off
in the same way as a nasal polypus if the snare wire can be passed round the
polypus hi the choana. When the choanal polypus is fully developed it is
easier to avulse it under endotracheal anaesthesia. The main mass in the
nasopharynx is grasped with forceps and steady traction will avulse the
growth from the accessory ostium, and the polypus is removed completely.