Nazal Polipozis
Özet
Nazal polipozis, nazal mukoza ve paranazal sinüslerin kronik inflamasyonu ile karakterize, nazal kavitede lümene doğru genişleyen yarı saydam, ödemli ve lobuler kitlelerin oluştuğu çok faktörlü bir patolojidir. Toplumda görülme sıklığı yüzde 1-4 olan bu durum, sıklıkla kronik sinüzit, astım, aspirin intoleransı ve kistik fibrozis gibi sistemik veya lokal hastalıklarla ilişkilidir. Etyopatogenezinde genetik yatkınlık, anatomik varyasyonlar, mukozal temas, epitel rüptürü ve süperantijenlerin tetiklediği eozinofilik veya nötrofilik inflamatuar süreçler rol oynar. Hastalar en sık burun tıkanıklığı, koku kaybı (anosmi) ve burun akıntısı şikayetleriyle başvurur; altın standart tanı yöntemi endoskopik muayenedir. Tedavinin temel amacı semptomları hafifletmek, polip boyutunu küçültmek ve nüksleri önlemektir. Medikal yönetimde tuzlu su irrigasyonu, topikal ve sistemik kortikosteroidler, lökotrien antagonistleri ile dupilumab, omalizumab ve mepolizumab gibi güncel monoklonal antikorlar kullanılır. İlaç tedavisine dirençli vakalarda veya mukosel varlığında, sinüs ventilasyonunu ve drenajını yeniden sağlamak amacıyla en etkin cerrahi seçenek olan endoskopik sinüs cerrahisi uygulanır. Cerrahi sonrası erken nükslerin önlenmesi için uzun dönemli postoperatif bakım ve kortikosteroid takibi kritik öneme sahiptir.
Nasal polyposis is a multifactorial pathology characterized by chronic inflammation of the nasal mucosa and paranasal sinuses, resulting in translucent, edematous, and lobular masses protruding into the nasal cavity. Affecting 1-4 percent of the population, it is frequently associated with systemic or local conditions such as chronic sinusitis, asthma, aspirin intolerance, and cystic fibrosis. Its etiopathogenesis involves genetic predisposition, anatomical variations, mucosal contact, epithelial rupture, and eosinophilic or neutrophilic inflammatory cascades triggered by superantigens. Patients primarily present with nasal obstruction, loss of smell (anosmia), and rhinorrhea; endoscopic examination remains the gold standard for diagnosis. The primary goals of treatment are alleviating symptoms, reducing polyp size, and preventing recurrences. Medical management comprises saline irrigation, topical and systemic corticosteroids, leukotriene antagonists, and contemporary monoclonal antibodies like dupilumab, omalizumab, and mepolizumab. For cases refractory to medical therapy or complicated by mucoceles, functional endoscopic sinus surgery is utilized as the most effective surgical intervention to restore sinus ventilation and drainage. Postoperative care and long-term corticosteroid compliance are critical to ensuring proper mucosal healing and preventing early recurrence.
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