A Rare Case of Nasal Inferior Meatus Polyps

A nasal polyp is considered as an inflammatory condition in nasal and paranasal sinus cavities and is frequently seen in all ENT clinics. The two usual types of polyps are the ethmoid polyps which are usually bilateral and the AC polyp which is often unilateral, both from the middle meatus. Polyps of the inferior meatus are not described.

Our patient, a 34-year-old lady presented to our department with complaints of mild discharge coming from Right side of the nose of 6 months duration. She was not having any other symptoms related to nose like bleeding, headache, foul smell, or nasal obstruction. She never had any surgery inside her nose, or trauma, or foreign body inside the nose or history of packing the nose in the past.

Figure 1:

Her nasal cavity of Right side showed minimal discharge, and on endoscopy, an irregular bulge was seen on the under surface of inferior turbinate. There were no polyps in other areas like middle meatus or surroundings (Figure 1). CT scan showed a large inferior turbinate on the right side, maxillary sinusitis, and bilateral concha bullosa (Figure 2). Because of this atypical picture, she was taken up for surgery of excision biopsy of the mass (Figure 3). The histopathological examination revealed polypoid mucosa, lined by respiratory epithelium, sub epithelium showing marked oedema, and chronic inflammatory cell infiltration of lymphocytes and plasma cells.

Figure 2:

Figure 3:

Many pathogenic theories are proposed as etiology like adenoma and fibroma theory, glandular cyst theory, mucosal exudation block theory, glandular hyperplasia, gand new formation, ion transport theory, and likewise [1] most polyps originated from the clefts of the ostiomeatal complex region and the adjacent area. [2]. It is very rare to have polyp of inferior meatus. A Chinese author had described this in 2013 [3]. It was a female patient, 24 years old with a history of mass coming from the nose. On examination it was found out that the mass was coming from inferior meatus and going back. This is an apt description of nasal rhinosporidiosis. The rest of the cases reported were about choanal polyps arising from the inferior turbinate [4]. The literature doesn’t contain much about this rare condition.

This is a very rare condition and probably the 2^nd case in world literature.

1. Dagli M, Eryilmaz A, Besler T, Akmansu H, Acar A, et al. (2004) Role of free radicals and antioxidants in nasal polyps. The Laryngoscope 114(7): 1200-1203.
2. Virat MD (2005) Update on nasal polyps: Etiopathogenesis. Journal Medical Association of Thailand 88(12): 1966-1972.
3. Lei PS, Zheng Chunquan (2013) A case of inferior nasal polyps from the inferior turbinate. Chinese Journal of Otorhinolaryngology Head and Neck Surgery 48 (4): 299-299.
4. Tuz M, Yasan H (2006) Choanal polyp originated from the inferior turbinate presenting as nasal polyposis. Kulak Burun BogazIhtis Derg 16(1): 37-40.
5. Aydil U, Karadeniz H, Sahin C (2008) Choanal polyp originated from the inferior nasal concha. European Archives of Oto Rhino Laryngology 265(4): 477-479.