---
title: "Ethmoidal Polyp"
description: "ENT notes on Ethmoidal Polyp - Theories of etiology, Pathology, Symptoms & signs, Management."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/ethmoidal-polyp-symptoms-treatment-causes"
categories: ["Rhinology"]
video: "https://www.youtube.com/watch?v=EeRVamzAryw"
image: "https://media.theentresident.com/og-images/ethmoidal-polyp-symptoms-treatment-causes.png"
---

# Ethmoidal Polyp

ENT notes on Ethmoidal Polyp - Theories of etiology, Pathology, Symptoms & signs, Management. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=EeRVamzAryw

## 👃 Ethmoidal Polyp

Ethmoidal polyp is a common OPD case and an important [**long case or short case** in practical exams](https://www.theentresident.com/ent-notes-lectures/ethmoidal-polyp-case-presentation.md).

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### 📝 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- Ethmoidal polyp

> [What is Antrochoanal Polyp?](https://www.theentresident.com/ent-notes-lectures/antrochoanal-polyp-symptoms-treatment-causes.md)

---

### 🔍 Origin of the Ethmoidal Polyp

Arises from **multiple air cells of the ethmoidal labyrinth**.

⭐ Ethmoidal polyps are **bilateral and multiple**, whereas the antrochoanal polyp is **solitary and unilateral**.

> What are the common sites of origin of the Ethmoidal Polyp?

> [What are the differences between Antrochoanal Polyp and Ethmoidal Polyp?](https://www.theentresident.com/ent-notes-lectures/antrochoanal-vs-ethmoidal-polyp.md)

---

### 🔍 Etiology of Ethmoidal Polyp

⭐ The etiology is **complex and not well understood**.

It has been hypothesized that ethmoidal polyps arise from:

* Inflammatory conditions of the nasal mucosa
* Disorders of ciliary motility
* Abnormal composition of the nasal mucus

---

#### Diseases Associated with Nasal Polyposis

| Disease | Association |
| --- | --- |
| **Chronic rhinosinusitis** | Both allergic and non-allergic origin |
| **Asthma** | 7% of asthma patients develop nasal polyp |
| **Aspirin Exacerbated Respiratory Disease** | 36% of patients with aspirin sensitivity develop nasal polyp |
| **Cystic fibrosis** | 20% of patients develop polyp |
| **Allergic fungal rhinosinusitis** | Almost all cases develop polyp |
| **Primary ciliary dyskinesia** | 27% of patients exhibit nasal polyp |
| **Young's syndrome** | Rare; obstructive azoospermia, bronchiectasis and sinusitis with polyp |
| **Churg-Strauss syndrome** (now called Eosinophilic Granulomatosis with Polyangiitis) | 50% of patients develop nasal polyp |
| **Nasal mastocytosis** |  |

⭐ In a **child with bilateral ethmoidal polyp**, screen for **cystic fibrosis**.

> What is Samter's Triad?

> What is Kartagener's Syndrome? What are the features seen in Kartagener's Syndrome?

---

#### Theories of Etiology

- Bernoulli's Phenomenon
- Vasomotor Imbalance Theory
- Jackson's Mucopolysaccharide (Ground Substance) Theory
- Polypeptide Theory
- Allergy

> Describe the different theories of etiology of Ethmoidal Polyp in detail.

---

### 🔬 Pathology of Ethmoidal Polyp

**Epithelium**

* Covered by **ciliated columnar epithelium**, the normal nasal mucosa
* May undergo **metaplastic change** to **transitional or squamous type** on exposure to atmospheric irritation

**Submucosa**

* **Large intercellular spaces** filled with **serous fluid**
* Infiltration with **round cells** and **abundant eosinophils**
* **IgE is raised**, especially in polyps of allergic origin

---

### 🗣️ Clinical Features of Ethmoidal Polyp

**Age Group** - Adults

> Which age group is more common for Antrochoanal Polyp?

#### Symptoms of Ethmoidal Polyp

- Bilateral Nasal Obstruction
- Nasal Discharge
- Hyposmia or Anosmia
- Features of Associated Sinusitis

    * Post nasal drip
    * Hawking
    * Headache

- Rhinolalia Clausa
- Features of Nasal Allergy
- Mass Protruding Out of the Nostril
- Snoring and Mouth Breathing
- Broadening of the Nose

> Which deformity of face is seen in long standing cases of Ethmoidal Polyp?

> What is Rhinolalia Clausa?

> What is Rhinolalia Aperta?

---

#### Signs of Ethmoidal Polyp

**External Nose (Inspection)**

* Broadening of the nose
* Widening of the intercanthal distance

**Anterior Rhinoscopy**

**Bilateral, multiple, pale or greyish, smooth, glistening masses**, appearing like a **bunch of grapes**.

* **Mobile**
* May be **sessile or pedunculated**

**On Probing**

* **Soft** in consistency
* ❌ Does **not** bleed on touch, as it is not a vascular mass
* ❌ **Insensitive** to touch, as there are no nerve fibres
* ✅ Probe can be passed **all around**

**On Vasoconstriction** - ❌ Does **not shrink**

> Why is Ethmoidal polyp insensitive to touch?

> [How will you differentiate Ethmoidal polyp from Inferior Turbinate Hypertrophy?](https://www.theentresident.com/ent-notes-lectures/differential-diagnosis-nasal-mass.md)

**Posterior Rhinoscopy**

- Usually **no abnormality**.

---

### 🧪 Investigations of Ethmoidal Polyp

**1- Diagnostic Nasal Endoscopy**

* Site of **origin** of the polyp
* **Extent** of the polyp
* Any **additional pathology** or **anatomical variations**

**2- CT Paranasal Sinuses**

* Shows **hypodensity** in the ethmoidal region
* Assesses the **origin and extent** of the polyp
* Identifies invasion of surrounding structures

**3- Allergic Testing**

---

### 🩻 Treatment of Ethmoidal Polyp

#### 💊 Medical Treatment

⭐ Every patient can undergo a **trial of medical therapy**.

**1- Intranasal Corticosteroids**

> What is the role of Intranasal corticosteroids in Treatment of Ethmoidal Polyp?

**2- Systemic Steroids**

* Used only in **severe cases** or **very large polyps**

**3- Antihistamines**

* For cases of **allergy**

**4- Leukotriene Inhibitors**

* Particularly helpful in patients with **aspirin sensitivity**

**5- Nasal Douching and Saline Nasal Spray**

* Clears mucus and removes allergens
* Gives symptomatic relief

---

#### ✂️ Surgical Treatment

**📌 Indication**

Patients **not responding to medical treatment**.

#### Surgery of Choice

👉 **Functional Endoscopic Sinus Surgery (FESS)**

> What are the steps of FESS for Ethmoidal Polyp?

#### External Ethmoidectomy

⭐ Done only for **very large polyps** where FESS is not possible.

---

### ⭐ Prognosis

⚠️ **High chance of recurrence**, because of:

* The **allergic etiology**
* **Incomplete removal**

> What is the Differential Diagnosis of Ethmoidal Polyp?

---

### 🧠 Viva Pearls

* A nasal polyp is an inflammatory, non-neoplastic, hypertrophied edematous mucosa prolapsing from the nose or paranasal sinuses.
* Ethmoidal polyps arise from multiple air cells of the ethmoidal labyrinth.
* Ethmoidal polyps are bilateral and multiple; antrochoanal polyp is solitary and unilateral.
* Ethmoidal polyp is associated with allergy, antrochoanal polyp with infection.
* A child with bilateral ethmoidal polyp should be screened for cystic fibrosis.
* Almost all cases of allergic fungal rhinosinusitis develop polyps.
* Submucosa shows abundant eosinophils, and IgE is raised in allergic polyps.
* Most common symptom is bilateral nasal obstruction of slow onset.
* Anterior rhinoscopy shows bilateral, multiple, pale greyish, smooth glistening masses like a bunch of grapes.
* Posterior rhinoscopy usually shows no abnormality.
* FESS is the surgery of choice.
* Ethmoidal polyp has a high rate of recurrence.

---

## About This Note

This free ENT note on Ethmoidal Polyp was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/ethmoidal-polyp-symptoms-treatment-causes

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