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. |
