ENDOSCOPIC GRADING OF BILATERAL NASAL POLYPI AND ITS VALIDITY IN CHOICE OF TREATMENT LINE
Mohamed Z. Helal* MD, Mahmoud El-Mallah MD, Ahmed S. Elkady MD, Hamed Elsherbiny MD, Abubakr E.Ras MD and Yasser Haroon MD
Department of Otorhinolaryngology, Faculty medicine, Benha and Ain Shams* universities.
Nasal polyposis is a common chronic disease affecting the nasal mucous membrane. Management of nasal polyposis is one of the major challenges for both conservative and surgical approaches. Staging of the polyposis is the target of this study utilizing C.T. scan finding with endoscopic and intraoperative findings as a test for C.T. scan validity. Sixty eight patients were included in this study with bilateral nasal polypi, they were endoscopically assessed and staged according to polyp size and site, then C.T. scan was done for all patients. At the start of the study 3 patients had stage II, 22 patients had stage III, 31 patients had stage IV and 12 patients had stage V, there were no patients with stage I or 0. The patients received a course of systemic steroids for 15 days and local steroid for 11 weeks from the end of the first week of the systemic steroid therapy. Patients were assessed and staged again by the end of the first, fourth and twelfth weeks. The results of the study showed marked improvement of the polyp size, in patients with stage I, II and III, when systemic steroids are used. A topical steroid has a mild effect in reducing polyp size, and it might help to stabilize the effect gained by the systemic steroid for some time. There were 38 patients, mainly with stage IV, still symptomatic after medical treatment, 35 from those were consented for surgery and the intraoperative endoscopic findings (polypi or viscous secretions) were correlated to the opacification seen on C.T. done preoperatively. It was found that it is difficult to differentiate between retained secretions, polypoidal mucosa and nasal polypi from C.T. Scan reading only. It is recommended that the lines of treatment for the staged nasal polyps are, medical treatment for patients with stage I and II, surgical treatment for patients with stage IV and V to be followed by a course of steroids and for those with stage III the treatment started medically and the patients must kept under supervision that they might needs surgery.