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A girl, aged 15, was brought to me by her mother. They were under the treatment of a local practitioner, who diagnosed the case as nasal polyp. Even after taking several years treatment, the polyp was not disappearing completely. They decided to go for surgery as a last resort. As a family friend, they contacted me only for the sake of my opinion on the scope and complications of polypectomy. So what they need is my opinion, not medicine.

 

On examination with a nasal speculum, I could not see the nasal polyp! When I told the mother that there is no polyp visible, she shouted at me (family friends often take more freedom), and asked me to look properly to see the polyp inside the left nostril. Eureka!!!!! I noticed the swollen nasal turbinate, which is not large enough for surgical reduction. Their doctor had misdiagnosed hypertrophied nasal turbinate as nasal polyp! These people were under lot of stress due to a wrong diagnosis. But, they were not fully satisfied with my observation. The word “POLYP” is very deeply recorded in their minds. So, I suggested them to consult an ENT surgeon who can convince them better.  

 

Differentiating the nasal polyp and hypertrophied nasal turbinate is very easy. Polyp is usually grayish in color; where as the nasal turbinate is having the same color of the nasal mucosa.

Nasal polyp (Courtesy: emedicine.medscape.com)

 

 

 

Hypertrophied nasal turbinate (courtesy: entusa.com)

Views: 4902

Tags: nasal-polyp, nasal-polyp-diagnosis, nasal-turbinate

Comment by Debby Bruck on September 8, 2011 at 9:38am

Thank you for sharing your story. What lessons may be learned? Always get a second, or even third opinion when making a major life decision regarding surgery. Now that this family has recognized the troubles with turbinate rather than nasal polyp, what choices for care are available? 

  • Concha Bullosa is an air pocket in the middle tubrinate. Turbinates are the part of your nose that warms and humidifies the air you breathe. Concha bullosa is a very common anatomical deviation. While it does not necessarily predispose you to sinus problems, persons with enlarged turbinates and concha bullosa may have a blockage which prevents their sinuses from draining properly resulting in frequent sinus infections. This condition may require surgical intervention
  • Connection between deviated septum and concha bullosa:  American Journal of Neuroradiology. The Incidence of Concha Bullosa and it's Relationship to Nasal Septal Deviation and Paranasal Sinus Disease. Accessed: August 12, 2010 from AJNR.ORG

What were the symptoms that lead to the original diagnosis? What homeopathic remedies address this issue?

 

Comment by Dr. Wequar Ali Khan on September 9, 2011 at 9:32am
Dr Rafeeque and Debby,thank you both for the valuable information. The photographs explains a lot;
Comment by Dr. Md Arafat Hossian Molla on September 10, 2011 at 2:21am
Thank you for sharing the misdiagnosed case. It gives us the lesson that not to depend up on the othes diagnosis, but we have to diagnose each and every case before us.
Comment by Dr Muhammed Rafeeque on September 11, 2011 at 7:12am
Thank you all for the comments. Homeopathy has great scope in ENT diseases. A swelling can be removed temporarily by the scalpel, but the allergy and the tendency to swellings cant be removed by the surgeon. We often get cases of DNS treated by SMR operation; all their complaints remain same even after surgery. True that when the obstruction is complete, surgical intervention is needed.
Comment by Farrukh Zeeshan on September 12, 2011 at 3:59am
Thanks for sharing good information. Homeopathic treatment ?
Comment by Dr Muhammed Rafeeque on September 12, 2011 at 6:40am
for this case? the case was reffered to an ENT surgeon just for their satisfaction. I am sure one day they will come back!!!
Comment by Pavalan R D on September 18, 2011 at 1:04am

This is the usual pitfall in the Diagnosis of Nasal Polyp. Another test which helps to conform is PROBE TEST. 

take a sterile probe and touch the swelling, TURNINATES are Very Sensitive, Polyps are insensitive, Polyps - easily bleeds on touch, where as turbinates do not. 

Comment by Dr Muhammed Rafeeque on September 19, 2011 at 12:27am
Thans for the comments.

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