Antrochoanal Polyp

AUTHORS:
Noah Kondamudi, MD, and Ayush Gupta, MBBS
The Brooklyn Hospital Center

CITATION:
Kondamudi N, Gupta A. Antrochoanal polyp. Consultant for Pediatricians. 2013;12(11):523.

An 11-year-old boy presented to the pediatric emergency department with a concern of a possible foreign body in the left nostril, with blockage of the left nasal cavity, for the past 2 weeks. He also had a sensation of a mass being present on the same side.

He did not complain of runny nose, mouth-breathing, or a decreased sense of smell. He had no history of recent fever, shortness of breath, chronic sinusitis, allergy, or long-term aspirin use.

On physical examination of the nose, a pinkish-gray, grapelike growth was visualized in the left nasal cavity. It was nontender, had a fleshy feel, and did not bleed upon being touched with forceps. The other nasal cavity was normal, and there were no other significant findings on physical examination. The patient was referred to otorhinolaryngology for further management.

The patient subsequently was treated with topical fluticasone and systemic prednisone for 2 weeks without improvement. Surgical polypectomy was done, and biopsy results confirmed the diagnosis of antrochoanal polyp.

Antrochoanal polyps are more common in children and young adults than in other age groups, with a higher prevalence in children. They are more common in males than in females. They nearly always are unilateral, solitary, benign polyps arising from the maxillary antrum, and they represent 4% to 6% of nasal polyps in the general population.¹

Although the etiology of antrochoanal polyps remains unknown, some authors have implicated allergic or inflammatory causes.² Chronic sinusitis and cystic fibrosis also have been implicated.

While unilateral nasal obstruction is the most common symptom, other symptoms can include rhinorrhea, epistaxis, postnasal drip, and snoring.

The differential diagnosis includes foreign body in the nostril and other masses that have a maxillary antral component, such as mucocele, mucopyocele, inverted papilloma, and allergic fungal sinusitis.³ Apart from causing the characteristic symptoms, antrochoanal polyps can cause additional health hazards ranging from obstructive sleep apnea syndrome to swallowing disorders and cachexia.⁴ Thus, early diagnosis of a nasal polyp becomes greatly important. Recommended imaging studies for suspected nasal masses of unknown etiology in teenagers and young adults include computed tomography with contrast enhancement in axial and coronal planes.⁵

Oral corticosteroids are considered to be the most effective medical treatment for nasal polyposis.⁶ Generally, children are treated with prednisone 1 mg/kg/d for 5 to 7 days, and then tapered over 1 to 3 weeks. Response to corticosteroids is notable among patients with polyps and allergic rhinitis or asthma. Topical nasal corticosteroids have been advocated either as primary treatment or as a continual secondary treatment following oral corticosteroids or surgery.⁷

Patients with antrochoanal polyps who fail to respond to medical therapy require complete surgical removal via functional endoscopic surgery through the middle meatus. It is recommended that endoscopic middle meatal surgery be combined with transcanine sinuscopy to ensure the complete removal of antrochoanal polyps. Endoscopic treatment of antrochoanal polyp in children is safe and effective. Early diagnosis and treatment of antrochoanal polyps is important, because secondary rhinosinusitis can complicate the disease and make surgery more difficult.⁸

References:

1.Jmeian S. Bilateral antrochoanal polyps in a child: an extremely rare case. Jordan R Med Serv. 2006;13(2):57-58.

2.Maldonado M, Martínez A, Alobid I, Mullol J. The antrochoanal polyp. Rhinology. 2004;42(4):178-182.

3.Aktaş D, Yetişer S, Gerek M, Kurnaz A, Can C, Kahramanyol M. Antrochoanal polyps: analysis of 16 cases. Rhinology. 1998;36(2):81-85.

4.Weder S, Landis BN, Banz Y, Caversaccio M, Dubach P. Paediatric traffic accident and obstructive sleep apnoea by antrochoanal polyps: case report and literature review. Int J Pediatr Otorhinolaryngol. 2011;75(11):1359-1363.

5.Harnsberger HR, Wiggins RH, Hudgins PA, Davidson C. Sinonasal solitary polyps. In: Harnsberger HR, Wiggins RH, Hudgins PA, eds. Diagnostic Imaging: Head and Neck. Salt Lake City, UT: Amirsys; 2004:50.

6.Kirtsreesakul V, Wongsritrang K, Ruttanaphol S. Clinical efficacy of a short course of systemic steroids in nasal polyposis. Rhinology. 2011; 49(5):525-532.

7.Rudmik L, Schlosser RJ, Smith TL, Soler ZM. Impact of topical nasal steroid therapy on symptoms of nasal polyposis: a meta-analysis. Laryngoscope. 2012;122(7):1431-1437. 

8.Cetinkaya EA. Giant antrochoanal polyp in an elderly patient: case report. Acta Otorhinolaryngol Ital. 2008;28(3):147-149.