History of Nasal polyposis

Dr T Balasubramanian

Introduction

Nasal polypi first reported 4000 years ago Egyptians were pioneers in diagnosis & trt of

nasal polypi Egyptians were familiar with nasal anatomy as

they used this route to suck out the brain contents during mummification procedures

Samuel of Egypt described a large polyp hanging in the throat strangulating a patient

Contribution of Hippocrates

Father of Rhinology Coined the term

polyp This term was used

because they resembled sea polyp

First described the surgical procedure to remove nasal polypi

”Nasal polyps are sacs of phlegm that cause nasal obstruction and deranges the sense of smell” Hippocrates

Etiopathology

1st Century AD – Celsus documented nasal polypi enlarged in size during moist weather

Celsus hypothesized nasal polypi to be local manifestation of systemic disorder

Boerhaave hypothesized nasal polyp to be elongated nasal mucosa - 17th century

Mann & Heister – Nasal polypi are formed due to obstruction of mucosal glands

“A Nasal polyp shows itself by bad smell of the nose” Samuel

Billroth hypothesis

Billroth demonstrated that nasal polypi microscopically resembled nasal mucosa

He also postulated nasal infections somehow could play a role in the genesis of polypi

In his classic treatise published in1843 he concluded that nasal polypi could be nothing but hypertrophic nasal mucosa

Virchow's hypothesis

Considered nasal polyp to be primary tumors like fibroma / myxoma

Stressed on the relationship between the age of occurence and nasal deformity

Eggston's theory

Nasal polypi are formed due to vascular changes in the submucosal blood vessels

These changes are caused by inflammation and periphlebitis

The passive oedema of nasal mucous membrane is caused by venous stasis

Burn's theory

Also known as mucopolysaccharide theory Mucopolysaccharides present in the stroma could

somehow play a role in the pathogenesis of nasal polypi

Stromal mucopolysaccharides under go changes in response to allergy and nasal mucosal inflammation causing the mucosa to swell

Berden's theory

Nasal polypi could be caused due to allergic inflammation of nasal mucosa

He was able to demonstrate the reagin responsible for inflammation of nasal mucosa

Allergic reactions involving the nasal mucosa caused mucosal oedema

Syndromes associated with nasal polyp

Lurie described the association between nasal polypi and cystic fibrosis in 1959

Samter & Beer described the classic samter's triad in 1969.

Components of samter's triad include – nasal polypi, aspirin hypersensitivity and bronchial asthma

Instruments used to examine the nasal cavity

Hippocrates designed a tubular nasal speculum inspired by the speculum designed by Hindu surgeons of yesteryears

Hildanus designed the currently available nasal speculum. Hildanus speculum underwent different modifications to evolve into its present form

Morrel Mecenzie used mirrors to reflect sunlight to examine the nasal cavity

Medical Management

Hippocrates used tampoons dipped in honey and pepper

Celsus used caustic agents to treat nasal polypi Galen used oil of turpentine to treat nasal polyp Daniel Bovet used antihistamines in the treatment

of nasal polypi for the first time

Surgical management

Rolando of Italy used strings with knots to remove nasal polypi

Hippocrates described a method of removing the nasal polypi and delivering it via the post nasal space by using a large tampoon which can be pushed into the nasal cavity there by dislodging the polypi

Thank you