Nasal polyps were first described more than 3000 years ago and comprise the most common group of mass lesions encountered in the nose [1].

Nasal polyps have been recognized and treated since ancient times. Nasal polyp is not a disease, but a physical finding with a number of causes and associated conditions. A polyp is a pedunculated, soft, elongated structure attached to the nasal mucosa by a slim stalk or a broad base. Polyps are usually soft, mobile, have a smooth shiny surface and are of bluish - gray or pink translucent appearance [2].

Nasal polyps are essentially rounded projections of oedematous mucous membrane with inflammatory cells. They may develop in association with chronic hypertrophic rhinitis, chronic sinusitis and allergic diseases of nose. They are solitary or multiple, unilateral or bilateral [3].

The main symptom of the patient is blockage of nose and watery discharge. Nasal stuffiness leading to total nasal obstruction may be the presenting symptom. Partial or total loss of sense of smell, headache due to associated sinusitis, mass protruding from the nostril and sneezing are other symptoms. Asthma, Cystic fibrosis, Kartagener syndrome, Young syndrome, Churg-Strauss syndrome, Fungal sinusitis are other diseases associated with nasal polyposis which may significantly increase the morbidity [2-3].

Relatively little research has been published with respect to socio-demographic and clinical profile of nasal polyposis in Himachal Pradesh. Therefore, this study aimed to evaluate the socio-demographic and clinical profile of Patients suffering from Sinonasal Polyposis attending routine ENT OPD in Dr. RPGMC Tanda.

Objectives of the Study

To evaluate the socio-demographic and clinical profile of Patients suffering from Sinonasal Polyposis attending routine ENT OPD in Dr. RPGMC Tanda.

Source of Data

Patients suffering from Sinonasal Polyposis attending routine ENT OPD in Dr. RPGMC Tanda.

Methods of Collection of Data

• Study Area: Department of ENT, Head and Neck Surgery in Dr. RPGMC Tanda

• Study Population: 30 patients of Chronic Rhinosinusitis with Nasal Polyposis

• Study Design: Hospital based cross sectional study

• Study Period: One Year, i.e. from June 2018 to June 2019

Inclusion criteria

Study population included adult population (>18 years) suffering from CRSwNP who were not taking any treatment at least for the last 1-2 weeks, diagnosis being made on basis of history and clinical examination.

Clinically patient having following symptom was included: 

• Sneezing 

• Itching in nose, eyes, ears and palate

• Nasal discharge

• Nasal obstruction

• Loss of smell

• Facial Pain or pressure

• Headache

• Nasal polyposis

• Patients not on medication for the past 2 week.

• All patients willing to give consent.

Exclusion Criteria

• Patients didn’t willing to give consent.

• Patients aged <18 years.

• Patients suffering from diseases like

• DNS

• Adenoid hypertrophy

• History of Sinonasal surgeries (for recurrent nasal polyp)

• Patients with cystic fibrosis

• Patients suffering from fungal sinusitis

• Patients with immunotherapy

• Pregnancy

• Nasal neoplasm 

• Patients who have used nasal, inhaled or systemic steroids within 2 months

• Chronic bronchitis

• Bronchial asthma

Methodology and Type of Data Collected

Present study was conducted in the Department of ENT in Dr RPGMC Tanda, after obtaining clearance and approval from the institutional ethical committee; patients fulfilling the inclusion/exclusion criteria were included in the study after obtaining informed consent. A Pretest semi structured questionnaire containing questions regarding Socio-demographic characteristics and other correlates was created and used for data collection. Data regarding Socio-demographic and clinical characteristics was retrieved. 

Statistical Analysis

The data entry and analysis was done in Microsoft Office Excel 2007 and Epi Info software. Descriptive analysis was done using frequency, percentages and Mean (+/-S.D.). 

The present study was entitled “Socio-demographic and clinical profile of Patients suffering from Sinonasal Polyposis attending tertiary care Hospital”. It was carried out in the Department of ENT, Head and Neck Surgery at Dr. RPGMC Tanda (Himachal Pradesh) from June 2018 to June 2019. A total of 30 patients were enrolled into the study. The results of which are as below:

There were a total of 30 patients out of which there were 16 males and 14 females with male to female ratio of 1.14:1. The mean age of all patients was 42.47±13.68 ranging from 21 to 79 years. The mean age of males was 45.88±13.3 and mean age of females was 38.57±13.53 which was less than that of males (Table 1).

Table 1: Age and Gender wise Distribution of Patients

Figure 1: Distribution of Patients as Per Duration of Disease

Figure 2: Percentage of Sinus Involvement in Cases of CRSwNP

The most common symptom observed was nasal obstruction in all patients followed by rhinorrhoea present in 21 (70%) of patients. Excessive sneezing, discomfort in activity and cough was observed in 17 (56.6%), 15 (50%) and 14 (46.67%) patients respectively (Table 2).

Table 2: List of Symptoms and Distribution of Cases According to Symptoms

Most of the patients 70% (n = 21) had symptoms for more than 12 months followed by 20% patients (n = 6) with symptoms for duration less than 6 months. 10% patients (n = 3) had symptoms for 6-12 months (Figure 1).

The 30 patients who were enrolled for the study were taking some medication for the symptoms. Out of them 18 patients were on anti-histaminic and intra nasal steroids, 8 were on anti-histaminic only and 2 were taking intra nasal steroids only (Table 3).

Table 3: Division of Cases as Per Premedication before Surgery

Maximum of patients (n = 18) enrolled had involvement of all sinuses (60%). The most common single sinus involved was maxillary sinus in 10 (33.3%) cases and maxillary and ethmoid sinuses were involved in 2 (6.6%) patients. Hence maxillary sinus was involved in all patients (Figure 2).

The prevalence rate of nasal polyposis is around 2 percent and in CRSwNP the male to female ratio is about 2:1. [3] The typical age of diagnosis of CRS range from 40–60 years [1-2]. 

In our study the mean age observed was 42.47±13.68 years similar to the study by Wang ET et al [4] where the mean age of patients was 46.93±12.35 years and 40.27±13.47 years in eosinophilic and non eosinophilic CRSwNP groups respectively.

In our study there were 16 (53.3%) males and 14 (46.7%) females with male to female ratio of 1.14:1 which is similar to the observation by Fokkens WJ et al [5] that males are more likely to suffer from CRS than females while in a study by Wang ET et al [4] there were 44 (73.3%) males and 16 (26.7%) females with male to female ratio as 2.75:1 which is much higher than our study.

By definition, patients with CRSwNP must report the presence of anterior or posterior rhinorrhoea, nasal congestion, hyposmia and/or facial pressure or pain lasting for greater than 12 weeks duration. However these subjective findings are neither sensitive nor specific for CRSwNP alone and are used to also characterize patients who have chronic rhinosinusitis without nasal polyps (CRSsNP) [5].

In our study 70 % patients (n = 21) were symptomatic for more than 12 months followed by 20% patients (n = 6) having symptoms for less than 6 months while in study by Hu Y et al⁶ and Wang ET et al [4] the mean duration of symptoms was 3.5 and 5 years and 5.50±3.92 and 8.55±6.93 in the two groups of eosinophilic and non eosinophilic CRSwNP respectively.

The most common symptom observed by us in the present study was nasal obstruction in 100% patients (n = 30) followed by rhinorrhoea in 70% (n = 21) and excessive sneezing in 56.67% (n = 17). Discomfort in activity, cough and headache were seen in 50 % (n = 15), 46.67% (n = 14) and 43.33% (n = 13) patients respectively while in a study by Nair S et al [7] nasal obstruction was seen in 23.7% of patients and nasal discharge was present in 52.6% patients. Headache and facial pain combined were observed in 76.3% of patients. Another study by Hu Y et al [6] observed nasal obstruction, rhinorrhoea, headache and facial pain in 34/155 (21.9%) each.

Present study concluded that most of the patients suffering from Sinonasal Polyposis were males, presenting with complaints of patients were nasal obstruction, rhinorrhea and excessive sneezing, had symptoms for more than 12 months, had premedication history of anti-histamine and intra nasal steroids use and had involvement of was maxillary sinus.

1. Slavin, R.G. “Nasal polyps and sinusitis.” In: Allergy: Principle and Practice, Middleton, E. et al. (Eds.), Mosby, New York, 1993, pp. 1455–1459.

2. Stamm, A.C. Microendoscopic Surgery of Paranasal Sinuses and the Skull Base. 1st ed., Springer-Verlag, New York, 2000.

3. Friedmann, I., and Wst Symmers. “Inflammatory conditions of the nose.” Nose Throat and Ears: Systemic Pathology, 3rd ed., Churchill Livingstone, New York, 1982, pp. 19–127.

4. Wang, E.T., et al. “Eosinophilic chronic rhinosinusitis in East Asians.” World Journal of Clinical Cases, vol. 2, no. 12, 2014, pp. 873–882.

5. Fokkens, W.J., et al. “European position paper on rhinosinusitis and nasal polyps 2012: A summary for otorhinolaryngologists.” Rhinology, vol. 50, no. 1, 2012, pp. 1–12.

6. Hu, Y., et al. “Diagnostic significance of blood eosinophil count in eosinophilic chronic rhinosinusitis with nasal polyps in Chinese adults.” Laryngoscope, vol. 122, 2012, pp. 498–503.

7. Nair, S., et al. “Endoscopic sinus surgery in chronic rhinosinusitis and nasal polyposis: A comparative study.” Indian Journal of Otolaryngology and Head & Neck Surgery, vol. 63, no. 1, 2011, pp. 50–55.