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 for choke of
treatment line is the target of this study. We utilize C. T., endoscopic and
intraoperative findings. 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 IL 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 locol 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 1,11 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! and IL surgical treatment for patients with stage IV
and V to be followed by a course of steroids and for those with stage HI the treatment
started medically and the patients must kept under supervision that they might needs
surgery. |
