NBE CME programme for DNB consultants - National Board Of ...

NBE CME programme for DNB consultantsmiddle ear protruding through a perforation in the tympanic membrane. Polyp is pedunculatedwhile granulations are multiple and sessile. They usually arise from attic, Posterior superiormargin of the tympanic membrane, Promontory, Eustachian tube orifice, Aditus ad antrum.Granulation tissue polyps in the forming stage are soft, red and bleed readily when touched. Laterpolyps become more fibrous and the surface may be covered with metaplastic squamousepithelium. Clinical examination may or may not give evidence of cholesteatoma / CSOM.Inflammatory polyps are soft while neoplastic polyps are firm.Probing- A probe can not be passed all around the polyp, if the polyp arises from the externalauditory canal. The probe can be passed all around the polyp arising from the middle ear.Investigaions- Discharge is sent for bacteriological and histological examination, Audiometry mayshow conductive deafness; Radiographs of the mastoid are normal in cases having polyps arisingfrom the external auditory canal. A polyp associated with benign chronic otitis media may show asclerotic mastoid while a polyp due to dangerous chronic otitis media shows a sclerotic mastoidbone with translucent areas of erosion caused by cholesteatoma. Patient having a neoplasticpolyp may reveal erosion of the temporal bone; CT Scan of the ear will show better detail than theradiodgraph; Biopsy can settle the diagnosis.Differential diagnosis- Granulomatous diseases or fungal infections, Neoplastic proliferation(Jugulo-tympanic paraganglioma), Glomus tumour, Langerhan’s Cell histiocytosis (LHC), Foreignbodies of external auditory canal, Exostosis, CeruminomaNon-surgical management- Antibiotics given systemically and locally may help early inflammatorypolyps. In elderly individuals and who refuses operations, there is some place for conservativetreatment like suction clearance and attic irrigation with white venigar solution and cauterization ofgranulations with 10% Silver Nitrate or with Trichloro Acetic Acid.Surgical management- Polypectomy is performed with the help of an aural snare or a punchforceps. Polyps arising from the middle ear should not be avulsed to prevent damaged to themiddle ear structures. Polypectomy helps the drainage of the middle ear and permits visualizationof the ear drum for proper diagnosis. Causative factors should be treated like modified radicalmastoidectomy for cholesteatoma, tympanoplasties for hearing, Radiotherapy / Chemotherapy /Radical operations for neoplasm.Any other- AIDS, Tuberulosis.Fibroius dysplasiaHistory- Benign Fibroosseous Lesion; Slowly Progressive Disorder; Site of Involvement inDecreasing Order-Maxila, Mandible, Frontal Bone; Types Monostotic 70%; Polyostotic 27%;Involvement of Bones of Skull 10% in Monostotic; Involvement of Cranio Facial Bones 50% inPolyostotic; Condition Diagnosed Before The Age of 20 Years; Lesion Burns Out After Puberty;Malignant Transformation Uncommon (