There is an on going dilemma concerning the pathogenesis of both antrochoanal polyps (ACP)
and bilateral nasal polyps (BNP) as regards etiology as well as causes of recurrence and ideal
methods of treatment. The data gathered through the investigations on the pathogenesis reveal
the need to further evaluate the differences and similarities of the two pathological conditions.
Aim of this study : To find laboratory , light microscopic and transmission electron microscopic
(TEM) differences between both types of nasal polypi in the primary as well as in recurrent
disease.
Patients and methods : This study includes sixty patients , divided into 4 groups , two groups with
primary polyps and another two with recurrent polyps , group 1 ten patients with primary ACP,
group 2 twenty patients with primary BNP, group 3 ten patients with recurrent ACP and group 4
twenty patients with recurrent BNP. These patients are subjected to full history , clinical and
endoscopic examination , CT study , laboratory examination in the form of nasal smear , blood
IgE , blood esinophils and polyp IgE. Surgery is done using endoscopic surgery and biopsy is
taken for light microscope and 5 cases only of each group for TEM examination.
Results : We found in the primary groups 1 & 2 significant differences as regards symptoms and
signs of allergy and also significant differences as regards degree of edema and degree of
degranulating esinophils on light and E/M microscopic examination. These parameters are non
significant in both recurrent groups (3&4) where we found allergy in 50% of cases with recurrent
ACP from history , laboratory and microscopic examination. With significant differences between
both groups of ACP (1&3) and non significant differences between both groups of BNP(2&4).
Conclusion :
1-Nasal smears are useful to differentiate allergic from nonallergic rhinitis. It may be possible to
treat antrochoanal polyps safely by the use of antiallergic regimens if investigations showed
allergy.
2-TEM has been performed as a complementary technique besides light microscopy for
evaluation of the epithelial lining and stroma of nasal polyps.