--- title: "Antrochoanal Polyp" description: "ENT notes on Antrochoanal Polyp - Parts, Theories of etiology, Pathology, Symptoms & signs, Management." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/antrochoanal-polyp-symptoms-treatment-causes" categories: ["Rhinology"] video: "https://www.youtube.com/watch?v=SD3jCtdxl5s" image: "https://media.theentresident.com/og-images/antrochoanal-polyp-symptoms-treatment-causes.png" --- # Antrochoanal Polyp ENT notes on Antrochoanal Polyp - Parts, Theories of etiology, Pathology, Symptoms & signs, Management. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=SD3jCtdxl5s ## ๐Ÿ‘ƒ Antrochoanal Polyp Antrochoanal polyp, also known as **AC polyp**, is a very common OPD case and an important [**long case** in practical and viva exams](https://www.theentresident.com/ent-notes-lectures/antrochoanal-polyp-case-presentation.md). --- ### ๐Ÿ“ Definition of a Nasal Polyp A nasal polyp is an **inflammatory, non-neoplastic, hypertrophied, edematous mucosa** prolapsing out of the **nose or paranasal sinuses**. **Two Types** 1- Antrochoanal polyp 2- Bilateral ethmoidal polyp --- ### ๐Ÿ“Œ Antrochoanal Polyp Also Known As ๐Ÿ‘‰ **Killian's Polyp** #### ๐Ÿ” Origin * Arises from the **mucosa of the maxillary antrum**, near the **accessory ostium** * Prolapses out of the ostium into the **middle meatus** * Grows in the **nasal cavity** and then towards the **choana** > What are the Parts of the Antrochoanal Polyp? --- ### ๐Ÿ” Etiology of Antrochoanal Polyp **Age Group** ๐Ÿ‘‰ **Children and young adults** โญ The exact cause is not known. It has been hypothesized that **infection** plays a greater role than allergy. โญ In contrast, **ethmoidal polyp** is more associated with **allergy** than infection. --- #### Theories of Etiology 1- Proetz's Theory 2- Bernoulli's Phenomenon 3- Berg's Intramural Cyst Theory 4- Mill's Secretory Cyst Theory 5- Blocked Mucous Gland Theory 6- Jackson's Mucopolysaccharide (Ground Substance) Theory 7- Vasomotor Imbalance Theory 8- Infections > Describe the different theories of etiology of Antrochoanal Polyp in detail. --- ### ๐Ÿ”ฌ Pathology of Antrochoanal Polyp **Epithelium** * In **early stages**, covered by **ciliated columnar epithelium**, the same as normal nasal mucosa * Later may undergo **metaplastic change** to **transitional or squamous type**, especially on exposure to atmospheric irritation **Submucosa** * **Large intercellular spaces** filled with **serous fluid** * Infiltrated with **round cells** --- ### ๐Ÿ—ฃ๏ธ Clinical Features of Antrochoanal Polyp #### Symptoms of Antrochoanal Polyp - Unilateral Nasal Obstruction - Nasal Discharge - Post Nasal Drip - Headache - Rhinolalia Clausa - Mouth Breathing - Hyposmia or Anosmia - Blocked Ears and Reduced Hearing - Epistaxis > When can a patient of Antrochoanal Polyp have bilateral nasal obstruction? > Why does a patient of Antrochoanal Polyp complain of reduced hearing? > What is Rhinolalia Clausa and Rhinolalia Aperta? Give some examples for each. > What are the causes of Bleeding in an Antrochoanal Polyp? > Why does the Antrochoanal Polyp grow backwards? --- #### Signs of Antrochoanal Polyp **Anterior Rhinoscopy** A **solitary, unilateral, pale, glistening polypoidal mass** with a **smooth surface**, which is **mobile**. **On Probing** * **Soft** in consistency * โŒ Does **not** bleed on touch * โŒ **Insensitive** to touch * โœ… Probe can be passed **all around** โŒ Does **not shrink** on Vasoconstriction > Why is Antrochoanal polyp insensitive to touch? > How will you differentiate Antrochoanal polyp from Inferior Turbinate Hypertrophy? **[Posterior Rhinoscopy](https://www.theentresident.com/ent-notes-lectures/posterior-rhinoscopy.md)** โญ Must be performed, as the antrochoanal polyp notoriously grows backwards. * **Globular mass** filling the **choana and nasopharynx** * A very large polyp may **hang down behind the soft palate** and present in the oropharynx > What is the [differential diagnosis of a unilateral nasal mass](https://www.theentresident.com/ent-notes-lectures/differential-diagnosis-nasal-mass.md)? Mention the endoscopic findings of each one of them. --- ### ๐Ÿงช Investigations of Antrochoanal Polyp **1- Diagnostic Nasal Endoscopy** * Determines the **site of origin** of the polyp * Assesses the **extent** of the polyp * Identifies any **additional pathology** **2- X-ray Paranasal Sinuses** โญ Not commonly done nowadays, as CT is preferred. **3- X-ray Nasopharynx (Lateral View)** * **Globular swelling** in the post nasal space * **Crescentic air column** behind the polyp > What is [Dodd's sign](https://www.theentresident.com/ent-notes-lectures/double-density-sign-dodd-sign-furstenberg-sign.md)? What is the clinical significance of Dodd's sign? **4- CT Paranasal Sinuses** * **Hypodense mass** filling the maxillary antrum, extending into the nasal cavity and occupying the choana * Assesses the **origin and extent** of the polyp * Identifies any other **pathology or anatomical abnormality** --- ### ๐Ÿฉป Treatment of Antrochoanal Polyp โš ๏ธ **Surgery is the only treatment.** There is **no role of medical treatment**. #### Surgery of Choice ๐Ÿ‘‰ **Functional Endoscopic Sinus Surgery (FESS)** > What are the steps of FESS for Antrochoanal Polyp? > What is the indication for Caldwell Luc Operation for Antrochoanal Polyp? --- ### โญ Prognosis Prognosis is **very good**, and **recurrence is uncommon** with good surgery. > What is the Differential Diagnosis of Antrochoanal Polyp? --- ### ๐Ÿง  Viva Pearls * A nasal polyp is an inflammatory, non-neoplastic, hypertrophied edematous mucosa prolapsing from the nose or paranasal sinuses. * Antrochoanal polyp is also known as Killian's polyp. * It arises from the mucosa of the maxillary antrum near the accessory ostium. * Antrochoanal polyp is more associated with infection, while ethmoidal polyp is associated with allergy. * Epistaxis is extremely rare in antrochoanal polyp. * On anterior rhinoscopy it is a solitary, unilateral, pale, glistening, polypoidal mass with a smooth surface. * It is insensitive to touch and does not shrink on vasoconstriction. * Surgery is the only treatment; there is no role of medical management. * FESS is the surgery of choice. --- ## About This Note This free ENT note on Antrochoanal Polyp was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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