The Hoanalny polyp is a good-quality formation of a nasopharynx. The main symptoms are unilateral violation of nasal breath up to its total absence, feeling of dryness and a congestion, existence of allocations from a nose, the closed twang, snore. Further tubootita, conductive relative deafness, violation of the act of swallowing and a chronic hypoxia develop. In the course of diagnostics the anamnestichesky information supplied the general survey, a rinoskopiya, a mezofaringoskopiya, a X-ray analysis and a computer tomography at otitis symptoms is used – otoskopiya and audiometriya. The main method of treatment – surgical removal.
The Hoanalny polyp or fibromiksoma of a nasopharynx – a relative rare disease, its prevalence fluctuates within 3-7% of all quantity of polipozny rinosinusit. The most often found forms – antrokhoanalny and sfenokhoanalny. They make about 75% of total number of cases. Most often the disease is diagnosed for persons aged from 15 up to 35 years. Pathology with an identical frequency is found among men and women. Geographical features are not traced. Complications develop at 25-30% of patients, often – in the form of an anosmiya, chronic diseases of the top airways, dysfunction of an acoustical pipe. The hearing disorder is observed by 15-20% of patients. Frequency of a recurrence after full treatment does not exceed 1,5%.
Reasons of a hoanalny polyp
The exact etiology is unknown. Most of otolaryngologists assign the leading role to hereditary predisposition and allergic diseases, is more rare – to a mukovistsidoz and neurologic violations. There are also endocrine and disembrionalny theories of development. Emergence of a fibromiksoma is connected with simultaneous influence of several factors which number treat:
- Congenital anomalies of a nose. Tendency to formation of polyps is characteristic of persons with the deformed, narrow nasal courses, the bent nasal partition, malformations of mucous membranes of a nasal cavity.
- Frequent infectious diseases. Include all respiratory viral infections which are followed steady against therapy or recurrent rhinitis.
- Long use of medicines. Regular or constant reception of antibacterial medicines, topichesky corticosteroids can provoke development of a fibromiksoma.
- Immunodeficiency. It can be caused by passing beam or chemotherapy, the present oncohematological pathologies, HIV infection, genetic anomalies, a chronic stress and overfatigue.
The Hoanalny polyp develops from the affected mucous membranes of a cavity of a nose or additional bosoms, often – against the background of recidivous or chronic inflammatory reactions. Histologically similar educations represent the connecting fabric impregnated with serous liquid with poorly expressed melkokletochny infiltration. Often they contain small cystous cavities, a small number of blood vessels, ekzokrinny glands. Externally polyps have the form of "bell-tongue" – oblong, with a spherical disteel thickening. In the course of growth they gradually fill a nasopharynx cavity, over time extending in space between a soft palate and a back pharyngeal wall. Simultaneous growth of several polipozny educations is seldom observed.
Depending on localization allocate the following morphological forms of a disease:
- Antrokhoanalny. The polyp originates from a cavity of a maxillary bosom. The most widespread option.
- Sfenokhoanalny. A zone of primary localization is the wedge-shaped sine.
- Etmokhoanalny. It is characterized by growth of a polyp from a trellised bosom.
- Frontokhoanalny. The polyp grows from fabrics of a frontal sine.
- Septokhoanalny. Education develops from a nasal partition.
- Konkhokhoanalny. Is followed by formation of polipozny structure from nasal sinks. Meets extremely seldom.
Symptoms of a hoanalny polyp
Clinical symptoms develop gradually. The unilateral complication of nasal breath becomes the first manifestation often. In process of increase in the sizes of a polyp this symptom is aggravated, dryness, discomfort, feeling of a foreign matter in one of half of a nose, puffiness of the nasal courses, continuous sneezing joins it. Gradually worsens and completely sense of smell disappears. During sleep there is expressed snore. Poor mucous or mucopurulent allocations from a nose which the patient cannot remove because of existence of the expiratory valve – a nasopharynx obturation with a polyp are often observed. Later breath through a nose becomes completely impossible because of what the patient constantly holds a mouth a little slightly opened. Change of a timbre of a voice as the closed twang is formed.
Over time there is a chronic hypoxia which is shown by a sleep disorder, depression and constant headaches. Integuments become pale, dark circles under eyes appear, the nose basis swells. At the same time the damage of a middle ear caused by obstruction of a pharyngeal opening of an acoustical pipe develops. Clinically it is followed by symptoms of conductive relative deafness: the decrease in auditory acuity, feeling of a congestion, a rumble or a ring in ears strengthened by perception of own voice. Polyps of the big sizes begin to squeeze surrounding fabrics including nervous trunks that is the reason of constant pain in the field of an orbit, the top jaw and a nose bridge. Restriction of mobility of a soft palate provokes violations of the act of swallowing, a poperkhivaniye.
Violation of passability of a nasopharynx leads to a constant congestion of mucous allocations in a nasal cavity, to development of chronic hypertrophic rhinitises and sinusitis, loss of sense of smell. The dysfunction of an acoustical pipe provoked by a hoanalny polyp becomes the reason of recurrent and chronic purulent average otitises against the background of which further there is a permanent deterioration in hearing. Need of breath through a mouth causes tendency to frequent SARS, bronchitis, pneumonia, exacerbations of bronchial asthma. At children the chronic hypoxia can become the reason of a delay of physical and intellectual development.
For diagnosis to the skilled otolaryngologist of rather fizikalny inspection and complaints of the patient. At poll of the patient the sequence and speed of development of the available clinical manifestations, the existence of potential etiologichesky factors accompanying pathology becomes clear. Full inspection of the patient with suspicion on a hoanalny polyp includes:
- Fizikalny survey. At the general survey pay attention to the nature of nasal breath or its total absence, expression and skin color of the person. At a conversation with the patient listen to twang. Constant nasal allocations are foreseen to puffiness and hyperaemia of wings of a nose.
- Rinoskopiya. At a classical forward rinoskopiya puffiness and hyperaemia of mucous membranes, presence of mucous or mucopurulent masses is defined. Performance of a rinoendoskopiya allows to visualize generally nasal to the course dense education pale gray or reddish.
- Mezofaringoskopiya. At survey of a mouth at patients the lower pole of dense formation of pinkish color decides on polyps of the big sizes behind free edge of a soft palate.
- Laboratory tests. The general blood test is informative only in the presence of infectious complications and a long hypoxia. In the first case in it it is displayed neytrofilny and increase in SOE, in the second increases quantity of erythrocytes.
- X-ray analysis of a facial skeleton. On the roentgenogram the structure with accurate contours which sprouts from one of okolonosovy sine is visible, fills the general nasal course, space between a back wall of a throat and a soft palate. Destruction of bone tissues is not observed.
- KT of a facial skeleton. It is shown at low informational content of the roentgenogram and impossibility to carry out differential diagnostics with cancer tumors. It is carried out with contrast strengthening. The tomography displays changes similar to a X-ray analysis in more detail, and also confirms lack of a neovaskulyarization.
In the presence of symptoms of dysfunction of an Eustachian tube and average otitis the otoskopiya and a voice-frequency threshold audiometriya is used. Visual survey of an eardrum allows to reveal its retraction and restriction of mobility, disappearance of a light reflex, protrusion of a short shoot of a hammer. At an audiogramma such patients have a deterioration in conductivity against the background of normal bone sound perception.
Treatment of a hoanalny polyp
The main way of treatment – surgical. The operation purpose – excision of fabrics of a polyp, restoration of passability of a nasopharynx. In parallel if necessary auxiliary medicamentous therapy is carried out. The full therapeutic program provides:
- To Polipotomy. The nature of surgery depends on the sizes and localization of a leg of education. Polyps of the small sizes can be removed endonazalno under local anesthesia by means of a special loop or curved nasal scissors. In hard cases removal of a hoanalny polyp is carried out with broad access to a nasopharynx and okolonosovy sine.
- Pharmacotherapy. It is applied at development of bacterial complications, consists of antibacterial means, anesthetics, antihistaminic and anti-inflammatory medicines, local processing of a cavity of a nose antiseptic solutions. As preoperative preparation topichesky corticosteroids are used.
Forecast and prevention
In general the forecast at a hoanalny polyp favorable. Early diagnostics and therapy allow to avoid complications. A recurrence practically does not meet. At the big sizes of a fibromiksoma the resistant anosmiya and conductive relative deafness is formed. Specific prevention concerning this pathology is not developed. Nonspecific actions mean fight against potential etiologichesky factors: correction of immunodeficiency and congenital anomalies of development of the region of a nasopharynx, rational reception of medicines, treatment of the promoting pathologies etc.