drtbalu's otolaryngology resources: History of nasal polypi

Introduction:

Nasal polypi were first described about 4000 years ago. Egyptians were pioneers in identification and treatment of nasal polyposis. They were more familiar with the anatomy of the nose because they used intranasal route to suck out the brain during mummification procedures. It was Hippocrates who is considered to be the father of Rhinology who coined the term polyp. He used this term because these intranasal polypi resembled sea polypi.

“Nasal polyps are sacs of phlegm that cause nasal obstruction and deranges the sense of smell”

Hippocrates.

“ A Nasal polyp shows itself by bad smell of the nose”

Samuel of Egypt

“Large polyp from the nose can dangle into the throat stangling a person to death”

Celsus

Etiopathology:

During early first century A.D. Celsus documented that nasal polypi enlarged in size during moist weather. He also hypothesized that nasal polypi were local manifestation of a systemic disorder.

Boerhaave during the 17^th century hypothesized that polypi was elongation of nasal mucosa. At about the same time Manne and Heister suggested that polypi are caused by obstruction to nasal mucosal glands. Billroth in 1843 demonstrated that the lining mucosa of nasal polypi resembled normal nasal mucosa and went to the extent of suggesting that nasal polypi could be due to hypertrophy of nasal mucosa.

During 19^th century Virchow taught his students that nasal polypi were primary tumors like myxomas and fibromas. Eggston & Wolff came close to suggesting that nasal polypi could be caused by passive oedema involving the nasal mucosa.

Relationship of nasal polypi with that of allergy: Kern & Shenck in 1933 demonstrated that allergy was common in patients with nasal polypi. It was 25% more common in this group when compared to that of normal individuals. They also suggested that ethmoidal sinus commonly gave rise to these polypi due to their complex anatomy.

Eggston's theory of etiology of nasal polypi:

Eggston suggested that nasal polypi could result due to basic vascular changes involving the submucosal vessels of nasal mucous membrane due to inflammation leading on to periphlebitis which obstructed venous return causing congestion of the nasal mucous membrane. He considered this oedema to be passive in nature.

Acid mucopolysaccharide theory of Burn: According to Burn the stroma of nasal polyp contains acid mucopolysaccharides. He attributed that the presence of mucopolysaccharides in the stroma could play some role in the pathophysiology of nasal polyposis.

Berden opined that the accumulation of reagin and edema in the stroma of nasal polypi could be features suggestive of allergic inflammation.

The association between nasal polypi and cystic fibrosis was demonstrated by Lurie in 1959.

Samter and Beer in 1969 reported the classic “Samter's triad” which comprise of aspirin sensitivity, nasal polypi and bronchial asthma.

History of nasal instruments:

Introduction of nasal speculum facilitated examination of nasal cavity in a big way. Hippocrates introduced a tubular nasal speculum which was designed from a protype speculum used by Hindu surgeons. It was Fabricious Hildanous who designed an aural speculum in 1560 which closely resembled the currently available nasal speculum. This Hildanous speculum has undergone minor modifications to evolve into a nasal speculum.

Morrel Mekenzie utilized mirror to reflect sunlight into the nasal cavity to visualize its contents. Kirstein designed the modern head light used in otolaryngological practice.

Development of X-rays is considered to be a turning point in many ways in the diagnosis of nasal polyp. Various views were evolved to visualize the paranasal sinuses.

Historic medical management of nasal polypi:

Hippocrates used a variety of nasal packs / tampoons dipped in pepper and honey in managing patients with nasal polypi. According to him repeated sneezing induced by exposure to pepper caused some relief.

Celsus treated nasal polypi with application of caustic agents.

Galen used oil / and irritants like turpentine local application used to treat nasal polypi.

Daniel Bovet was the first to use antihistamines in the management of nasal polypi.

Historic surgical management of nasal polypi:

Italian physician Rolando used string with knots to remove polypi. He managed topass this knotted thread into the nasal cavity. Knots were tied to the thread 1 cm apart. When the threat is pulled out it dislodges the polyp and brings it along with it.

Hippocrates described a method of dislodging the polyp from the nasal cavity and delivering it via the post nasal space. He introduced a wire loop into the nasal cavity to snare the polyp lying within the nasal cavity.