1. Epidemiology of nasal polyp Dr T Balasubramanian

2. Introduction Lots of development has taken place in the study of epidemiology of nasal polypi Still lots of questions remains unanswered It could best be described as a clinical manifestation of co existing multiple immunologic pathways

3. Epidemiological perspectives The prevalance of nasal polyp is 1-3% Links between nasal polyp and allergic rhinitis is rather weak There is a strong association between asthma & nasal polyp The incidence increases with age Incidence of aspirin hypersensitivity in patients with nasal polyp is high

4. Contd... Genetic predisposition is unclear Nasal polypi in children – Cystic fibrosis to be ruled out AFRS is commonly associated with nasal polyposis

5. Classification of chronic rhinosinusitis Chronic rhinosinusitis without nasal polypi Chronic rhinosinusitis with nasal polypi

6. Chronic rhinosinusitis without nasal polypi Commonly seen in TH1 mediated inflammation TH1 lymphocytes are potent inducers of inflammation If antrochoanal polyp is present should be differentiated from bilateral ethmoidal polypi

7. Chronic rhinosinusitis with nasal polypi This is caused by TH2 mediated inflammation This type of inflammation is seen in patients with bronchial asthma

8. TH1 & TH2 mediated inflammation TH1 & TH2 responses are T helper cell responses which are produced in response to infections / inflammation Both these responses should be optimal to enable the body to get rid of infection Disease tends to occur when either of them predomonates over the other

9. Contd. Cytokines secreted by T helper cells type I are proinflammatory cytokines Cytokines secreted by T helper cells type II are anti-inflammatory cytokines. These cytokines are seen during allergic response

10. Comorbid conditions associated with nasal polypi Allergic rhinitis General atopic status Bronchial asthma

11. Highlights No significant increase in the incidence of nasal polyposis in patients with nasal allergy Incidence of nasal polypi is 4 times more in patients with asthma Incidence of atopy was more in patients with nasal polypi than in normal population AFRS is commonly associated with nasal polypi

12. Pointers for diagnosis of AFRS Type I hypersensitivity to Demataceous fungi CT scan findings – Inspissated secretions with calcification Eosinophilic nasal secretions with the presence of Charcot Leyden crystals Positive isolation of fungal material from sinus contents

13. Thankyou