<unk>  appearing in the middle meatus.<unk> s can be seen on physical examination inside of the nose and are often detected during the evaluation of symptoms. On examination, a<unk>  will appear as a visible mass in the nostril. Some<unk> s may be seen with anterior rhinoscopy (looking in the nose with a nasal speculum and a light), but frequently, they are farther back in the nose and must be seen by nasal endoscopy. Nasal endoscopy involves passing a small, rigid camera with a light source into the nose. An image is projected onto a screen in the office so the doctor can examine the nasal passages and sinuses in greater detail. The procedure is not generally painful, but the person can be given a spray decongestant and local anesthetic to minimize discomfort. Attempts have been made to develop scoring systems to determine the severity of<unk> s. Proposed staging systems take into account the extent of<unk> s seen on endoscopic exam and the number of sinuses affected on CT imaging. This staging system is only partially validated, but in the future, may be useful for communicating the severity of disease, assessing treatment response, and planning treatment. Types There are two primary types of<unk> s: ethmoidal and antrochoanal. Ethmoidal<unk> s arise from the ethmoid sinuses and extend through the middle meatus into the nasal cavity. Antrochoanal<unk> s usually arise in the maxillary sinus and extend into the nasopharynx and represent only 4–6% of all<unk> s. However, antrochoanal<unk> s are more common in children comprising one-third of all<unk> s in this population. Ethmoidal<unk> s are usually smaller and multiple while antrochoanal<unk> s are usually single and larger. CT scan CT scan can show the full extent of the<unk> , which may not be fully appreciated with physical examination alone. Imaging is also required for planning surgical treatment. On a CT scan, a<unk>  generally has an attenuation of 10–18 Hounsfield units, which is similar to that of mucus.<unk> s may have calcification. Histology Histology of<unk> , magnification 25x (H&E stain) On histologic examination,<unk> s consist of hyperplastic edematous (excess fluid) connective tissue with some seromucous glands and cells representing inflammation (mostly neutrophils and eosinophils).<unk> s have virtually no neurons. Therefore, the tissue that makes up the<unk>  does not have any tissue sensation and the<unk>  itself will not be painful. In early stages, the surface of the<unk>  is covered by normal respiratory epithelium, but later it undergoes metaplastic change to squamous type epithelium with the constant irritation and inflammation. The submucosa shows large intercellular spaces filled with serous fluid. Differential diagnosis Other disorders can mimic the appearance of<unk> s and should be considered if a mass is seen on exam. Examples include encephalocele, glioma, inverted papilloma, and cancer. Early biopsy is recommended for unilateral<unk> s to rule out more serious conditions such as cancer, inverted papilloma, or fungal sinusitis.
Nasal polyp
Nasal septal abscess
Nasal vestibulitis
Trachoma
Nasal septum perforation
Aerosinusitis
Adenoiditis
Rhinosinusitis