Nazal polipler

KOÇ, Can; Atasoy, Pınar; BAYAR MULUK, NURAY; KİTAPÇI, Fatma

Nazal polipler

Fatma KİTAPÇI, (Kırıkkale Üniversitesi, Tıp Fakültesi, Kulak Burun Boğaz Hastalıkları Anabilim Dalı, Kırıkkale, Türkiye)

NURAY BAYAR MULUK, (Kırıkkale Üniversitesi, Tıp Fakültesi, Kulak Burun Boğaz Hastalıkları Anabilim Dalı, Kırıkkale, Türkiye)

Pınar ATASOY, (Kırıkkale Üniversitesi, Tıp Fakültesi, Patoloji Anabilim Dalı, Kırıkkale, Türkiye)

Can KOÇ (Kırıkkale Üniversitesi, Tıp Fakültesi, Kulak Burun Boğaz Hastalıkları Anabilim Dalı, Kırıkkale, Türkiye)

Van Tıp Dergisi

44 2

Yıl: 2005 Cilt: 12 Sayı: 3 Sayfa Aralığı: 212 - 222 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Nazal polipler

Öz:

Nazal polipozis, burun tıkanıklığı durumunda ayırıcı tanısı yapılması gereken önemli bir antitedir. Hastalarda burun tıkanıklığı yanında, postnazal akıntı, burun akıntısı, koku/tad hissinde kayıp ve yüz ağrısı gibi şikayetler de bulunabilir. Nazal polipler özellikle endoskopik muayene ile kolaylıkla tanınabilir. Poliplerin oluşumu ile ilgili çok sayıda teori ileri sürülmüştür. Polip patogenezinde tüm teoriler mukoza ödemi üzerine kurulmuştur. Alerji, burun inflamasyonu, mukozal yüzeylerin teması, kronik enfeksiyonlar, burun mukozasının vazomotor bozukluğu gibi patolojilere sekonder olarak ödem gelişir ve bu ödemli mukoza yerçekiminin etkisiyle nazal kaviteye doğru bombeleşir. Özellikle paradoksal orta konka, aşırı pnömatize etmoid bulla gibi ostiomeatal bölgeyi daraltan anatomik varyasyonlar da nazal polip gelişimine neden olmaktadır. Nazal polip patogenezini anlamaya yönelik çok sayıda çalışma yapılmıştır. Eozinofilik infiltrasyon ve mast hücrelerin degranülasyonu polip histopatolojisinin en yaygın bulgularıdır. Bunun dışında lenfositler, bazofiller ve makrofajlar gibi inflamatuar hücrelerden oluşan infiltrasyon mevcuttur. Bu hücrelerden salgılanan kimyasal mediatörlerin de etkisiyle polip dokularında, skuamöz metaplazi, sekretuar hiperplazi ve epitelyal hücre proliferasyonunu içeren mukozal değişiklikler görülmektedir. Nazal polipozis tedavisi nıedikal ve/veya cerrahi olarak yapılır. Medikal tedavide antiinflamatuar etkilerinden dolayı yaygın olarak kullanılan ilaçlar kortikosteroidlerdir. Steroidler topikal ve/veya sistemik olarak kullanılarak poliplerin küçülmesi, ödemin azalması, semptomların hafiflemesi ve postoperatif rekürrenslerin azalması gibi olumlu etkiler gösterirler. Konvansiyonel medikal tedavi başarısız olduğunda, cerrahi tedavi planlanır. Endoskopik sinüs cerrahisi günümüzde en etkili ve sık uygulanan tekniktir. Bu yöntemle hastalıklı sinüsler açılarak polip dokularıyla birlikte tüm patolojik mukozalar çıkarılmaktadır. Nazal polipoziste rekürrens sıktır. Bu nedenle postoperatif medikal tedaviye yeterli süre devam edilmelidir.

Anahtar Kelime: Nazal polipler

Konular: Kulak, Burun, Boğaz

Nasal polyps

Öz:

Nasal polyposis is an important entity that differencial diagnosis must be done in case of nasal blockage. Beside nasal blockage complains 'like post nasal drip, rhinorrhea, loss of sense of smell and taste and fascial pain can be found at the patients. Polyps can easily be diagnosed with endoscopic examination. There have been many number of theories put forward for the pathogenesis of polyp formation. All theories about nasal polyp pathogenesis are depend on mucosal eudema. Mucosal eudema occurs seconderaly to the pathologies like allergy, inflammation of nose, contact of mucosal surfaces, chronic infections, vasomotor imbalance of nasal mucosa and this eudematous mucosa prolapse to the nasal cavity by the effect of gravity. Especially anatomical variations like paradoxical middle turbinate, over-pneumatized ethmoid bulla that obstruct ostiomeatal region cause nasal polyps. Many studies on nasal polyp pathogenesis have been described. The common findings of polyp histopathology are infiltration of eosinophils and mast cells degranulation. However there is an infiltration of lymphocytes, basophils and macrophages. Mucosal changes like squamous methaplasia, secrefuar hyperplasia and epithelial cell proliferation can be seen by the effect of chemical mediators released from inflammatory cells. Treatment of nasal polyposis is medical and/or surgical management. The common drugs are corticosteroids by their antiinflammatory effects. Systemic and topical corticosteroids have positive effects like decreasing size of polyps, decreasing eudema, relieving the symptoms and decreasing postoperative recurrences. When conventional medical therapy fails, surgical treatment of nasal polyposis can be envisioned. Endoscopic sinus surgery is most common and effective technique in recent years. In this technique all diseased sinuses are opened and all pathologic mucosas with polyp tissues are removed. Recurrences of nasal polyps are common. For this reason, postoperative medical treatment must be continued adequate time.

Anahtar Kelime: Nasal Polyps

Konular: Kulak, Burun, Boğaz

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Koç C. Nazal Polip. In: Koç C (Ed.). Kulak Burun Boğaz Hastalıkları ve Baş-Boyun Cerrahisi. Ankara, Güneş Kitabevi, 2004, p 609-624.
2. Dingsör G, Kramer J, Olshot R. Flunisolide Nasal Spray 0,025 % in the Prophylactice Treatment of Nasal Polyposis after Polypectomy. Rhinology; 23: 49-59,1985.
3. Bateman ND, Fahy C, Woolford TJ. Nasal polyps: still more questions than answers. J Laryngol Otol.; 117 (1):1-9,2003.
4. Stammberger H. Rhinoscopic Surgery. Settipane GA, Lund VJ, Bernstein JM, Tos M. Nasal Polyps: Epidemiology, Pathogenesis and Treatment. Rhode Island: Ocean Side Pub, 1997, p 7-15.
5. Vancil ME. A Historical Survey of Treatments for Nasal Polyposis. Laryngoscope: 435-445,1979.
6. Tos M, Larsen PL. Nasal Polyps: Origin, Etiology, Pathogenesis, and Structure. Kennedy DW, Bolger WE, Zinreich SJ. Diseases of the Sinuses, Diagnoses and Management. Hamilton: B.C. Decker, 2001, p 57-68
7. Kaytaz A. Nazal Polip. Çelik O. Kulak Burun Boğaz Hastalıkları ve Baş Boyun Cerrahisi. İstanbul: Turgut Yayıncılık, 2002, p 475-485.
8. Settipane GA. Epidemiology of nasal polyps. Allergy Asthma Proc.; 17 (5): 231-6,1996.
9. Larsen PL, Tos M. Anatomic Site of Origin of Nasal Polyps. Endoscopic Nasal and Paranasal Sinüs Surgery as a Screening Method for Nasal Polyps in an Authopsy Material. Am J Rhinol; 10: 211-216,1996.
10. Burger R, Escudier E, Coste A, Dao-Pick T: Relation of Epidermal Growth Factor Receptor Expression to Goblet Cell Hyperplasia in Nasal Polyps. J. Allergy Clinical Immunology: 705-712,2000.
11. Drake-Lee AB. Medical Treatment of Nasal Polyps. Rhinology; 32: 1-4,1994.
12. Ni G, Chen W, Zhu Y, Zhao H. The recurrent nasal polyp analysed by mRNA difference to demonstrate. Lin Chuang Er Bi Yan Hou Ke Za Zhi.;18 (10): 602- 3, 2004.
13. Stammberger H. Functional Endoscopic Sinus Surgery: The Messerklinger Technique. Phidelphia: BC Decker, 1991.
14. Larsen PL, Tos M. Origin of Nasal Polyps: An Endoscopic Autopsy Study. The Laryngoscope; 114: 710-719,2004.
15. Larsen PL, Tos M. Goblet Cell Density in Nasal Polyps. Ann Otol Rhinol Laryngol; 99: 310- 315,1990.
16. Önerci M. Yaygın Nazal Polipozis. Endoskopik Sinüs Cerrahisi, İkinci Baskı. Ankara: Kutsan Ofset, 1999; p 66-70.
17. Benson M. Pathophysiological effects of glucocorticoids on nasal polyps: an update. Cur Opin Allergy Clin Immunol.; 5 (1): 31-35,2005.
18. Pata YS, Bicik E, Aygenç E, Koç C, Özdem C. Endoskopik sinüs cerrahisinin geç dönem sonuçları. Türkiye Klinikleri KBB Dergisi;3: 9-15,2003.
19. Değer K, Keleş N, Savaş I, Çilingiroğlu T, Hafizali B. Nazal polipoziste allerji ve fonksiyonel endoskopik sinüs cerrahisi. Türk Otolaringoloji Arşivi; 32: 196- 9,1994.
20. Drake-Lee AB. Nasal Polyps. Kerr AG, Stephens D. Scott-Brown’s Otolaryngology. Sixth ed. Great Britain: Butterworth&Co. Ltd, 1997; 3: 4/10/1-16.
21. Bernstein JM, Kansal R. Superantigen Hypotesis for the Early Development of Chronic Hyperplastic Sinusitis with Massive Nasal Polyposis. Curr Opin Otolaryngol Head Neck Surg.;13 (1): 39-44,2005.
22. Van Zele T, Gevaert P, Watelet JB, Claeys G, Holtappels G, Claeys C, Bachert C. Staphylococcus aureus colonization andI g E antibody formation to enterotoxins is increased in nasal polyposis. J Allergy Clin Immunol.; 114 (4):981-3,2004.
23. Conley DB, Tripathi A, Ditto AM, Reid K, Gramer LC, Kern RC. Chronic sinusitis with nasal polyps: staphylococcal exotoxin Ig E and cellular inflammation. Am J Rhinol.; 18(5): 273-8,2004.
24. Gevaert P, Holtappels G, Johanson SG, Cuvelier C, Bachert C. Organization of secondary lymphoid tissue and local Ig e formation to Staphylococcus aureus enterotoxins in nasal polyp tissue. Allergy.;60 (1):71-9,2005.
25. Pitzurra L, Bellocchio S, Nocentini A, Bonifazi P, Scardazza R, Gallucci L, Stracci F, Simonelli C, Romani L. Antifungal immune reactivity in nasal polyposis. Infect Immun.;72 (12): 7275-81,2004.
26. Benoliel P. Treatment of sino-nasal polyposis by Candida albicans immunotherapy: apropos of 4 cases. Allergy Immunol;33 (10):388-94,2001.
27. Weschta M, Rimek D, Formanek M, Polzehl D, Podbielski A, Riechelmann H. Topical antifungal treatment of chronic rhinosinusitis with nasal polyps: a randomized, double-blind clinical trial. J Allergy Clin Immunol.; 113 (6): 1122-8,2004.
28. Richetti A, Landis BN, Maffioli A, Giger R, Zeng C. Effect of antifungal nasal lavage with amphotericin B on nasal polyposis. J Laryngol Otol; 116 (4): 261- 3,2002.
29. Koc C, Arikan OK, Atasoy P, Aksoy A. Prevalence of Helicobacter pylori in patients with nasal polyps: a preliminary report. Laryngoscope.; 114 (11):1941- 4,2004.
30. Kowalski ML, Lewandowska A, Wozniak J, Makowska J, Jankowski A. Inhibition of nasal polyp mast cell and eosinophil activation by desloratidine. Allergy.; 60 (1):80-85,2005.
31. Hartnell A, Heinemann A, Conroy DM, Wait R, Sturm GJ, Jose PJ, Williams TJ. Identification of selective basophil chemoattractants in human nasal polyps as insulin-like growth factor-1 and insulin-like growth factor-2. J Immunol.; 173 (10):6448-57,2004.
32. Caye-Thomasen P, Larsen K, Tingsgaard P, Tos M. Immunohistochemical demonstration and semiquantitation of vascular endothelial growth factor in recurrent versus non-recurrent nasal polyps. Acta Otolaryngol.; 124(6): 706-11,2004.
33. Zhou B, Li H, Han D, Liu Z. Role of ICAM-1 in eosinophilia and prognosis of nasal polyps. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2004; 18 (2): 72- 3.
34. Seto H, Suzaki H, Shioda S. Immunohistochemical localization of eotaxin immunoreactivity in nasal polyps. Acta Otolaryngol Suppl.; 553:99-104,2004.
35. Young Kim J, Kim CH, Kim KS, Choi YS, Lee JG, Yoon JH. Extracellular signal-regulated kinase is involved in tumor necrosis factor-alpha-induced MUC5AC gene expression in cultured human nasal polyp epithelial cells. Acta Otolaryngol.; 124(8): 953- 7,2004.
36. Dağlı M, Eryılmaz A, Besler T, Akmansu H, Acar A, Korkmaz H. Role of free radicals and antioxidants in nasal polyps. Laryngoscope; 114 (7): 1200-3,2004.
37. Kang BH, Huang NC, Wang HW. Possible involvement of nitric oxide and peroxynitrite in nasal polyposis. Am J Rhinol.; 18 (4): 191-6,2004.
38. Prieto L, Seijas T, Gutierrez V, Uixera S, Bruno L, Lopez R. Exhaled nitric oxide levels and airway responsiveness to adenosine 5-monophosphate in subjects with nasal polyposis. Int Arch Allergy Immunol.; 134 (4): 303-9,2004.
39. Li MH, Yang ZQ, Yin WZ. The influence of protein kinase C inhibitor in eosinophil apoptosis of nasal polyps. Zhonghua Er Bi Yan Hou Ke Za Zhi.; 39 (6): 353-5,2004.
40. Gosepath J, Brieger J, Gletsou E, Mann WJ. Expression and localization of COX-1 and COX-2 in nasal respiratory mucosa. Does COX-2 play a key role in the immunology of nasal polyps? J Investig Allergy Clin Immunol.; 14 (2) 114-8,2004.
41. Saseki Y. Distribution of the Degranulated and Nondegranulated Mast Cells in Nasal Polyps. Acta Otolaryngol; 430: 34-38,1986.
42. Muluk NB, Koç C, Atasoy P. Localization of Tcells and Subtypes in Paranazal Sinüs and Turbinate Mucosa in Patients with Chronic Sinüsitis. Journal of Otolaryngol 2003 (Yayınlanmak üzere kabul edildi).
43. Woodworth BA, Joseph K, Kaplan AP, Schlosser RJ. Alterations in eotaxin, monocyte chemoattractant protein-4, interleukin-5, and interleukin-13 after systemic steroid treatment for nasal polyps. Otolaryngol Head Neck Surg.; 131 (5):585-9,2004.
44. Brausewetter F, Hecht M, Pirsing W. Antrochoanal polyp and obstructive sleep apnea in children. J Laryngol Otol.; 118 (6): 453-8,2004.
45. Gillespie MB, Osguthorpe JD. Pharmalogic management of chronic rhinosinusitis, alone or with nasal polyposis. Curr Allergy Asthma Rep.; 4(6): 478-85,2004.
46. Sarıoğlu T, Bayar N, Kanbur B, Gündüz M. Rekürren Nazal Poliplerde Tedavi Yöntemleri. İlaç ve Tedavi Dergisi; 6: 12-14,1993.
47. Delbrouck C, Gabius HJ, Vandenhoven G, Kiss R, Hassid S. Budesonide-dependent modulation of expression of macrophage migration inhibitory factor in a polyposis model: evidence for differential regulation in surface and glandular epithelia. Ann Otol Rhinol Laryngol.; 113 (7): 544-51,2004.
48. Watanabe K, Shirasaki H, Kanaizumi E, Himi T. Effects of glucocorticoids on infiltrating cells and epithelial cells of nasal polyps. Ann Otol Rhinol Laryngol.; 113 (6): 465-73,2004.
49. Wang J, Yang B. Effects of dexamethasone on mucin gene expression in human nasal polyps. Lin Chuang Er Bi Yan Hou Ke Za Zhi.; 18 (2): 74-6,2004.
50. Majima Y. Clinical implications of the immunomodulatory effects of macrolides on sinusitis. Am J Med. 2004; 117 Suppl 9:20-25.
51. Triglia JM, Nicollas R. Nasal and Sinüs Polyposis in Children. Laryngoscope; 107: 963-966,1997.
52. Krouse JH, Christmas DA. Powered Nasal Polypectomy in the Office Setting. Ear Nose Throat J; 75: 608-610,1996.
53. Tong YF, Sun XZ, Li DW. Observation of maxillary mucosa restoration after the endoscopic sinus surgery operation of chronic sinusitis and nasal polyps. Zhonghua Er Bi Yan Hou Ke Za Zhi.; 39 (7):402- 6,2004.
54. Vaughan WC. Medical and Surgical Management of Polypoid Rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg; 8: 11-17,2000.
55. Batra PS, Kern RC, Tripathi A, Conley DB, Ditto AM, Haines GK, Yarnold PR, Grammar L. Outcome Analysis of Endoscopic Sinus Surgery in Patients with Nasal Polyps and Asthma. The Laryngoscope; 113: 1703-1706,2003.
56. Farrell BP. Endoscopic Sinüs Surgery: Sinonasal Poliposis and Allergy. Ear Nose Throat J; 72: 544- 559,1993.

APA	KİTAPÇI F, BAYAR MULUK N, Atasoy P, KOÇ C (2005). Nazal polipler. , 212 - 222.
Chicago	KİTAPÇI Fatma,BAYAR MULUK NURAY,Atasoy Pınar,KOÇ Can Nazal polipler. (2005): 212 - 222.
MLA	KİTAPÇI Fatma,BAYAR MULUK NURAY,Atasoy Pınar,KOÇ Can Nazal polipler. , 2005, ss.212 - 222.
AMA	KİTAPÇI F,BAYAR MULUK N,Atasoy P,KOÇ C Nazal polipler. . 2005; 212 - 222.
Vancouver	KİTAPÇI F,BAYAR MULUK N,Atasoy P,KOÇ C Nazal polipler. . 2005; 212 - 222.
IEEE	KİTAPÇI F,BAYAR MULUK N,Atasoy P,KOÇ C "Nazal polipler." , ss.212 - 222, 2005.
ISNAD	KİTAPÇI, Fatma vd. "Nazal polipler". (2005), 212-222.

APA	KİTAPÇI F, BAYAR MULUK N, Atasoy P, KOÇ C (2005). Nazal polipler. Van Tıp Dergisi, 12(3), 212 - 222.
Chicago	KİTAPÇI Fatma,BAYAR MULUK NURAY,Atasoy Pınar,KOÇ Can Nazal polipler. Van Tıp Dergisi 12, no.3 (2005): 212 - 222.
MLA	KİTAPÇI Fatma,BAYAR MULUK NURAY,Atasoy Pınar,KOÇ Can Nazal polipler. Van Tıp Dergisi, vol.12, no.3, 2005, ss.212 - 222.
AMA	KİTAPÇI F,BAYAR MULUK N,Atasoy P,KOÇ C Nazal polipler. Van Tıp Dergisi. 2005; 12(3): 212 - 222.
Vancouver	KİTAPÇI F,BAYAR MULUK N,Atasoy P,KOÇ C Nazal polipler. Van Tıp Dergisi. 2005; 12(3): 212 - 222.
IEEE	KİTAPÇI F,BAYAR MULUK N,Atasoy P,KOÇ C "Nazal polipler." Van Tıp Dergisi, 12, ss.212 - 222, 2005.
ISNAD	KİTAPÇI, Fatma vd. "Nazal polipler". Van Tıp Dergisi 12/3 (2005), 212-222.