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Schwannomas of the sinonasal tract are rare, accounting for

Background: Nasal polyps (NPs) are inflammatory outgrowths of paranasal sinus mucosa that occur in one to four percent of the population and most commonly cause congestion, obstruction, or hyposmia. Intranasal corticosteroids, along with short courses of oral corticosteroids, are most often recommended for symptomatic nasal polyposis, prior to consideration of surgical intervention. We present the first reported case of spontaneous nasal polypectomy, occurring after use of fluticasone propionate (XHANCE®) and zileuton (Xyflo®). Methods: A 43-year-old Asian-Indian male with history of allergic rhinitis, asthma, and nasal polyposis had been prescribed subcutaneous immunotherapy for five years without effectiveness before another polypectomy was scheduled. After the polyps resurfaced, the patient was prescribed prednisone and underwent another polypectomy. He later presented with persistent NPs and congestion, as well as diffuse lymphadenopathy and pruritic eyes and ears. Fluticasone Propionate was continued as maintenance therapy and Zileuton was prescribed in place of Montelukast (Singulair®). Results: After several weeks of the new treatment regimen, the patient reported polyp irritation and movement, as well as influenza-like symptoms. Epistaxis soon occurred, followed by a spontaneous polypectomy. Three more polyps were expelled with bloody discharge. The patient reported resolved hyposmia and reduced symptoms thereafter. The treatment regimen was continued without change or further episodes of epistaxis and polypectomy. Conclusion: Few case reports in the literature describe polyp autoamputation. We report the first instance of spontaneous nasal polypectomy in the literature, induced by Fluticasone Propionate and Zileuton.

Introduction : la polypose naso-sinusienne (PNS) est une pathologie invalidante dont le traitement de première intention est médical, associant rhinocorticoïdes et corticothérapie systémique en cures courtes. En cas d’échec, une chirurgie sous anesthésie générale est classiquement proposée au patient. Au cours des dernières années, la chirurgie sur patient éveillé (CPE) s’est développée et constitue un nouvel outil dans l’arsenal thérapeutique de la PNS. L’objectif principal de ce travail était de préciser les indications et la durée d’efficacité de la CPE dans notre population de patients porteurs d’une PNS. Les objectifs secondaires étaient d’évaluer la qualité de vie des patients par l’analyse des Patient-Reported Outcome Measures (PROMs) et des Patient-Reported Expérience Measures (PREMs) et les complications de cette procédure.Matériels et méthodes : tous les patients majeurs opérés dans notre centre d’une PNS sur patient éveillé entre février 2018 et mars 2021 (3 ans) étaient inclus. Le recueil de données était fait par consultation de leur dossier médical et lors de consultations de suivi. La durée d’efficacité correspondait à la durée de non-récidive. Nous avons recueilli le score endoscopique de PNS, l’EVA (Echelle Visuelle Analogique) concernant l’anosmie et l’obstruction nasale, en pré- et post-opératoire. Le questionnaire APSS (Awake Patient Surgery Score) que nous avons créé nous a permis d’évaluer l’expérience-patient lié à cette procédure. Les complications post opératoires ont été recueillies.Résultats : soixante-quinze patients ont été inclus dans l’étude (SR=3,1). La majorité d’entre eux avaient déjà été opérés de la PNS (60%) et l’âge moyen était de 60,92±12,3 ans. Quatre-vingt-dix pourcent des patients souffraient d’une PNS de stade IV et plus de 60% avaient une surconsommation de corticoïdes systémiques (recours à plus de deux semaines par an à une posologie d’un milligramme par kilo par jour) avant la CPE. La durée de suivi moyenne était de 15,56±9,18 mois. La moyenne du délai de non-récidive était de 31,3±2,38 mois. Nous avons retrouvé une amélioration significative du score endoscopique pré- vs post-opératoire à 1 mois (3,87±0,45 vs 1,59±0,66 respectivement, p

A síndrome de Kounis, também conhecida como síndrome da angina alérgica, foi descrita em 1991 por Kounis e Zafras como a “ocorrência coincidente de dor torácica e reação alérgica acompanhadas de achados clínicos e labo-ratoriais de angina pectoris clássica, causada por mediadores inflamatórios libertados durante o estímulo alérgico”. Os autores apresentam o caso de um doente de 57 anos, diagnosticado com síndrome de Kounis, submetido a poli-pectomia nasal, meatotomia média e etmoidectomia ântero-posterior.Com esta publicação pretende-se fazer uma revisão teórica acerca da abordagem anestésica direcionada para esta síndrome dado que se trata de um tema re-cente, pouco conhecido e com envolvimento multidisciplinar (Anestesiologia, Cardiologia e Medicina Intensiva).

The necessity to routinely carry out histopathologic examinations of surgically removed polyps in patients with chronic rhinosinusitis with bilateral nasal polyps (CRSwNP) is uncertain. The aim of this study was to describe the histopathology of polyps from a large series of patients who underwent endoscopic sinus surgery for CRSwNP and the rate of neoplasms. This is a retrospective study of the histopathological result of all patients with CRSwNP who underwent functional endoscopic nasal surgery and in whom histologic examination was performed, from 2006 to 2015, in a tertiary medical center. Data on demographics and whether a nasal lesion was suspected for neoplasm prior to surgery were analyzed. Two hundred thirty-five patients underwent bilateral nasal polypectomy and histopathologic examinations of the surgical specimens. The rate of neoplasms in nonsuspicious cases was 2.3% (5 cases) and all were inverted papilloma. To conclude, inverted papilloma and other neoplasms are considered rare incidental findings in patients presenting with bilateral nasal polyps. This study demonstrated a higher rate of the latter than that reported in the literature. Our study further emphasizes that despite the low incidence of these pathologies, a histopathologic examination of every nasal polypectomy is warranted so as not to miss potential serious pathologies. We stress that a routine histopathological examination should be practiced at least in the elderly population.

Von-Willebrand disease (VWD) is one of the platelet dysfunction disorders that results from a deficiency of Von-Willebrand factor, which is essential for hemostasis. VWD patients typically have normal laboratory results on screening for bleeding disorders. To suspect and diagnose VWD, a careful review of past medical history and laboratory tests is critical. A 59-year-old male patient presented with intractable nasal bleeding after nasal polypectomy. The bleeding was controlled by platelet transfusion, and he was later diagnosed with VWD.

BACKGROUND: Nasal polyposis can lead to olfactory dysfunction, either due to physical obstruction of the olfactory cleft or physiological disruption of the olfactory neuroepithelium. Where medical therapy has failed to relieve symptoms of nasal polyposis, surgical excision can be considered. However, removal of polyps medial to the middle turbinate is controversial: some believe this will relieve physical obstruction to odourants, others state that removal here risks excising olfactory neuroepithelium. METHODS: We stained 25 nasal polypectomy samples from the area medial to the middle turbinate with olfactory marker protein. RESULTS: We confirmed that our staining method worked on normal olfactory tissue. However, no positive staining of nasal polyps was demonstrated. CONCLUSION: We conclude that nasal polyps medial to the middle turbinate do not contain olfactory neurons, and surgical excision is not contraindicated.

Introduction: The efficacy of sinus surgery for the treatment of ethmoidal polyp continues to be an issue of debate among otolaryngologists. A study was undertaken to compare the efficacy of Functional Endoscopic Sinus Surgery (FESS) over intra nasal polypectomy in treatment of ethmoidal polyp. Methods: Sixty patients of either sex above 18 years of age suffering from ethmoidal polyp were included in the study. The patients were discharged after surgery and were called for endoscopic examination during subsequent follow up. Results: Final results were recorded 6 months after the operative procedure. The results suggest that FESS is highly effective for the treatment of ethmoidal polyp with the recurrence rate being as low as 10% and with no major complications. Conclusion: This study will help in evaluation of FESS as better surgical option for the management of ethmoidal polyp DOI: http://dx.doi.org/10.3329/bjo.v18i2.12008 Bangladesh J Otorhinolaryngol 2012; 18(2): 161-165

Summary The clinical problems of patients with cystic fibrosis who require anaesthesia are reviewed. The management and the complications of anaesthesia in 77 patients over a 3-year period are presented. The long term effects of anaesthesia are analysed by a study of the lung function tests of these patients. The results suggest that even multiple procedures, as for instance nasal polypectomy, are not harmful. A method for safe peroperative management is presented.

Objectives: This study summarises the results of a National Audit of sino-nasal surgery carried out in England and Wales. It describes patient and operative characteristics as well as patient outcomes up to 36 months after surgery. Design: Prospective cohort study. Setting: NHS hospitals in England and Wales. Participants: Consecutive patients undergoing surgery for nasal polyposis and/or chronic rhinosinusitis. Main outcome measure: The total score derived from a 22-item version of the Sino-Nasal Outcome Test (SNOT-22). Lower scores represent better health-related quality of life. Results: A total of 3128 consecutive patients at 87 NHS hospitals were enrolled. There is a large improvement in SNOT-22 scores from the pre-operative period (mean = 42.0) to 3 months after surgery (mean = 25.5). The scores for patients undergoing nasal polypectomy improved from 41.0 before surgery to 23.1 at 3 months after surgery, while the scores for patients undergoing surgery for chronic rhinosinusitis alone improved from 44.2 to 31.2. The SNOT-22 scores reported at 12 and 36 months after surgery were similar to those reported at 3 months. Excessive bleeding occurred in 5% of patients during the operation and in 1% of patients after the operation. Intra-orbital complications were reported in 0.2%. Of those patients undergoing primary surgery for bilateral grade I or II polyposis, 18% had not received a pre-operative course of steroid treatment. At the 36-month follow-up, 11.4% of patients had undergone revision surgery. Conclusions: The audit confirms that sino-nasal surgery is generally safe and effective. There is some evidence that patient selection for surgery could be improved.

Objectives:Long-term follow-up of 1045 patients with chronic rhinosinusitis with nasal polyposis (CRSwNPs) in the national Sinonasal Audit demonstrated that at 5 years 20.6% of patients had undergone revision surgery. The aim of this study was to see if the Chronic Rhinosinusitis Epidemiology Study (CRES) data reflected a continued burden of revision surgery in patients with CRSwNPs.Methods:A prospective questionnaire-based study at 30 sites around the UK of patients with CRS presenting to secondary care between October 2007 and September 2013. This paper presents a specific analysis of patients with CRS who reported undergoing sinus surgery.Results:A total of 651 patients with CRSwNPs, 553 with CRSsNPs, and 45 with AFRS were included in the CRES. 365 (57%) of patients with CRSwNPs/AFRS reported undergoing endoscopic nasal polypectomy (ENP) in which 175 (25% or 48% of surgical cases) reported having received more than one ENP. The mean number of ENPs per patient in the revision group was 3.3 with a range ...

Patients with nasal obstruction often have associated snoring. It is uncertain whether surgery, which relieves the nasal obstruction, will also relieve the snoring. We have reviewed 96 patients who complain of both nasal obstruction and snoring and who underwent nasal surgery. Snoring was completely relieved in 48 patients (50%), was less loud in a further 38 patients (40%), unchanged in 8 patients, and louder in 2. Patients who had nasal polypectomy as part of their nasal surgery obtained the greatest snoring relief. The relationship between nasal obstruction and snoring is complex and the alteration of airflow patterns after nasal surgery is postulated to be important in influencing snoring relief. This study suggests that, when snoring and nasal obstruction coexist, nasal surgery should be considered as the first line of surgical treatment.

In this article, we present a 75-year-old male with worsened nasal obstruction on the left side. Nasal endoscopy revealed bilateral grade 2 nasal polyps and a large polyp in the left posterior choana. postnasal space could not be viewed. Urgent computed tomography and magnetic resonance imaging revealed a lesion in the postnasal space. The patient was scheduled for endoscopic excision of the postnasal space lesion and bilateral nasal polypectomy. Histopathological examination of the samples revealed benign nature of polyps and plasmacytoma for postnasal space lesion. The patient is still on radiotherapy. A thorough endoscopic examination of the nasal cavities including the postnasal space is essential in all cases of nasal polyps to avoid postnasal space lesions to be overlooked.

Objective: Assess patient satisfaction with endoscopic nasal polypectomy carried out under local anesthesia. Patient consultation allows us to review and amend practice and is a fundamental aspect of clinical governance, hence ensuring good medical practice.Method: A 16-point questionnaire was sent to all patients who underwent the procedure over a 2-year period. They were asked about previous operative history, quality of operative information given, level of pain and how well it was managed, effectiveness of procedure on their symptoms, and overall perception of the experience.Results: Of 32 patients the response rate was 81%. Half of the patients had previously had nasal polypectomy under general anesthetic. Ninety-four percent felt their pain was dealt with appropriately, and all patients were discharged uneventfully within 6 hours. Ninety-two percent reported symptomatic improvement and were happy with the procedure. All but one of the patients preferred avoiding a general anesthetic, and 88% would h...

Nasal polypectomy is a common operation. There is debate about whether all nasal polyps removed at operation should be sent for histopathological examination. To investigate this, a prospective study was performed to check the correlation of clinical and histopathological examination. Three hundred and forty-four nasal polypectomy specimens during the period from September 1997 to September 1999 were sent for histopathological diagnosis, with the clinical diagnosis documented on the pathology form. The clinical diagnosis was then correlated with the histological diagnosis. Three hundred and twenty-eight specimens were diagnosed as inflammatory polyps and 16 as tumours, of which seven were malignant. There was a good correlation between the clinical and histological findings in 340 cases. There was disagreement between the forms and reports in four cases. When the notes were consulted, three cases had forms that were incorrectly filled in. There was only one unsuspected case of inverted papilloma in a polyp specimen, which looked like a benign inflammatory polyp. This study indicates there is a 99.7% correlation between clinical and histopathological diagnosis.

In a controlled prospective study, patients who had nasal polypectomy were compared with patients who required other nasal surgery. Patients with and without asthma were identified. Both polyposis and asthma were independently associated with increased blood absolute eosinophil counts. Absolute eosinophil counts were: neither disease 0.199 × 106 cell/mL ± 0.025, polyposis alone 0.249 × 106 cell/mL ± 0.017, asthma alone 0.318 × 106 cell/mL ± 0.092, and both 0.375 × 106 cell/mL ± 0.076. In contrast, we were unable to show a difference between polyp patients and the controls in the serum IgE concentration or allergy skin test reactivity. Atopy was not a predictive factor for asthma in polyp patients. We conclude that nasal polyposis, like asthma, is highly associated with eosinophilia.

Forty-seven patients undergoing nasal polypectomy and 27 adult tonsillectomy patients were studied regarding history of allergy, duration of symptoms, and previous polypectomies. At surgery, samples of serum, tissues, and nasal washes were obtained for evaluation of total and allergen-specific IgE. Serum IgE levels were not significantly higher in polypectomy patients. The IgE/mg of protein was significantly greater in polyp than tonsil tissue. Allergen-specific IgE levels did not differ in polyp and tonsil patients, nor was bacterial specific IgE detected in polyp patients. Allergen-specific IgG4 levels and the ratios of specific IgG4 to specific IgE did not differ between the patient groups.

Objective: To investigate a possible contribution of Helicobacter pylori (H. Pylori) in the etiopathogenesis of simple nasal polyps. Study Design: Prospective clinical trial. Methods: Twenty five patients with simple nasal polyps underwent nasal polypectomy were studied. Helicobacter pylori DNA was investigated for specimens removed from those patients by using polymerase chain reaction (PCR). Results: Helicobacter pylori DNA was detected in 2 (8%) of total 25 specimens. Conclusion: We could not find strong indicator that H. pylori played a role at the tissue level in the pathogenesis of nasal polyp. Keywords : Nasal polyp - Helicobacter pylori –Polymerase chain reaction. Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 95-98

A prospective study was carried out to compare blood loss from various types of nasal surgery, to investigate how accurately this loss was estimated during surgery and to find out how soon any losses were replenished. Blood loss during surgery was estimated, and by serial blood tests actual blood loss and continuing changes in haematological parameters were recorded. It was found that blood loss was highest when a nasal polypectomy and submucous resection were performed together and over the whole range of nasal surgery studied the actual blood loss was more than double the estimate during surgery. Although the blood volume recovers soon after surgery it was found that even after 6 weeks many patients had still not made up their loss of haemoglobin.

Nasal surgery includes short procedures such as reduction of nasal fractures and antral washouts, or longer procedures such as septoplasty, turbinate surgery, functional endoscopic sinus surgery and nasal polypectomy.

Pneumocephalus is a rare complication of craniofacial surgeries.1,2 A 48-year-old man presented with severe left frontal headaches, confusion, and right-sided myoclonic seizures 8 days after mucoperichondrial repair of CSF leak following left nasal polypectomy. Imaging studies demonstrated …

The use of powered instrumentation has revolutionized the practice of functional endoscopic sinus surgery. We have expanded the role of the instrument to the treatment of polypoid disease of the nose within the office setting. We have found the technique to be both safe and effective, and to allow thorough exenteration of nasal polyps with minimal bleeding and discomfort. We recommend the use of the powered device as the primary tool in the surgical treatment of nasal polyps in the office.

Background: Sino - nasal surgery poses a great challenge to practicing ear, nose and throat surgeons in the sub- Saharan Africa where facilities are inadequate and most patients are distantly located from the few hospitals available in this region. Method: A retrospective study of 79 patients who had nasal and paranasal sinuses surgery at the university of Maiduguri teaching hospital (UMTH) between January 1997 to December 2001. Results: The most common indication for surgery was infection/allergy in 49 (62%) patients, followed by tumours in 16 (22.3%) patients. In the infection/allergy subgroup, intranasal antrostomy and nasal polypectomy were the most common procedures done constituting 63.3% and 32.7% respectively. Nasal surgeries as a result of trauma and congenital anomalies were quite few. Conclusion: This rather low figure is unexpected considering the few available services in this region. Therefore health education and community awareness on health matters should be stressed. Key Words: Nasal surgery, intranasal antrostomy, nasal polypectomy Annals of African Medicine Vol.3(2) 2004: 66-68

Sphenoid sinus mucoceles behave as mass lesions producing erosion of adjacent bone and cranial nerve palsies. The probable cause is obstruction of the ostia of the sinus. We describe a case which was 'cured' inadvertently by a nasal polypectomy.

We describe the case of a patient with a known myeloproliferative disorder who presented with epistaxis and what clinically appeared to be a nasal polyp. The mass was resected and proved to represent a focus of extramedullary hematopoiesis. The patient subsequently developed extramedullary hematopoiesis of the skin and the stomach wall. Following nasal polypectomy, he did well for a time, but he eventually died as a result of other complications of his disease. This unique case serves as a reminder that common rhinologic complaints can be a sign of significant and life-threatening pathology.

DOI: http://dx.doi.org/10.4038/slja.v20i1.3305 Sri Lankan Journal of Anaesthesiology 20(1): 56-57 (2012)

We undertook a study to determine the usefulness and effectiveness of a relatively new, portable 980-nm wavelength diode laser with a fiberoptic delivery system. We tested the laser in several clinical situations, both in the operating room and in the office. We used it while performing 14 turbinate reduction procedures, one nasal polypectomy, one ablation of an oral papilloma, and one photocoagulation of nasal telangiectasias. Our preliminary findings indicate that the use of this laser was helpful in alleviating nasal congestion in the patients with turbinate dysfunction and in controlling epistaxis in the patient with telangiectasias. It was also effective in treating the polyp and papilloma patients. We did not experience any intra- or postoperative complications. The laser's flexible fiber delivery system is compatible with hollow instruments, allows for coaxial vision, and is ideally suited for intranasal use. Its portability and functional diversity make it an attractive alternative to the conventional carbon dioxide, argon, and neodymium:yttrium-aluminum-garnet lasers.

Patients with nasal obstruction may also complain of snoring. It is uncertain whether surgery which relieves the nasal obstruction will also relieve the snoring. We have reviewed 126 patients who complained of both nasal obstruction and snoring and who underwent nasal surgery. Snoring was completely relieved in 39 patients (31%), was less loud in a further 72 patients (57%), unchanged in 11 and louder in 4. It occurred on fewer nights post-operatively in 61, on the same number in 24 and more frequently in 2. Patients who had nasal polypectomy as part of their nasal surgery obtained the greatest snoring relief. This study suggests that when snoring and nasal obstruction coexist nasal surgery should be considered as the first line of surgical treatment.

This study aims to assess the indications for histological examination of polypoid lesions removed from the nose. To achieve this we have performed a national survey of consultant ENT surgeons and reviewed 2866 nasal polypectomy operations. The operations were performed between 1982 and 1988 in the Radcliffe Infirmary, Oxford and the Freeman Hospital, Newcastle. One hundred and fifty questionnaires were sent to randomly selected ENT consultants in the United Kingdom. One hundred and seventeen were returned completed (return rate 78%). The questionnaire asked whether or not the surgeon sent all polyps for examination and, if not, what his indications were for so doing. A retrospective review of all nasal polypectomy operations at the two hospitals was performed. The questionnaire revealed that 38% of the surgeons who replied sent all nasal polyps for examination and 62% did not. The commonest indications for requesting histology were unilateral polyps, abnormal appearance and a history of bleeding. The review of polypectomies showed that 74% of cases in Oxford were examined histologically and 33% in Newcastle. Two per cent of polyps were tumours, of which half were malignant. There were no cases in this study in which unsuspected malignancy was found. All cases of nasal tumours, benign or malignant, were diagnosed clinically either in the Outpatient clinic or in the operating theatre. The results of this survey suggest that it is unnecessary to send all nasal polyps for histological examination.

A 61 year old woman undergoing nasal polypectomy developed hypotension and ST elevation in the inferior leads on ECG. She was previously well with no risk factors for …

Seventy patients with nasal polyps were studied. Forty-seven of these had pre-operative sinusradiographs and all seventy patients had antral washouts at the time of nasal polypectomy. One hundred and seventeen antral aspirates were sent for culture and microscopy. The naked eyeappearance of aspirates were turbid in 34 patients. Bacteria were cultured from 15 of the specimens in 10 patients.It was concluded that antral washout should be recommended in all patients who have nasal polypectomy and that there is no need for sinus radiographs in those patients who have uncomplicated nasal polyps.

• Nasal polypectomy is safe in patients with asthma and intolerance to aspirin. Asthma should be controlled before polypectomy. Patency of the nasal airway after the operation and the effect of polypectomy on asthma are independent of severity of the asthma, history of atopy, and administration of steroids. We reviewed retrospectively the courses of 101 patients with the asthma triad who had nasal polypectomies between 1970 and 1974. Before polypectomy, 39 patients were hospitalized to control active asthma; during the postoperative hospitalization, 19 had wheezing, mostly mild. Of the 62 patients with inactive asthma, three had wheezing postoperatively. Asthmatic condition at one year after polypectomy, compared with the condition at one year before, was improved in 30 patients, worse in 14, and unchanged in the rest. Nasal airways remained good for at least one year in 60% of the patients. ( Arch Otolaryngol 105:413-416, 1979)

Chitin extracted from the shells of Japanese pink crab accelerates wound healing. The usefulness of gauze coated on both sides with chitin after endonasal operation was evaluated in clinical trials at six hospitals. Coated gauze tampons were used in 37 patients after repairs of deviated septum, conchotomy, nasal polypectomy, etc. Although insertion was difficult, chitin-gauze tampons were more useful than conventional gauzetampons with respect to extractability and manageability.

— In 33 patients undergoing nasal polypectomy, severely dysplastic or intraepithelial malignancy was observed focally in the surface Lining of these polyps. Follow-up on 29 of these patients showed that the changes did not recur or progress to invasive tumor, and that local excision was curative. Investigations as to the possible causation of such changes failed to provide any answers. Other hypotheses in relation to the pathogenesis and significance of these changes are put forward.

Aspirin idiosyncrasy in patients admitted for nasal polypectomy Investigation of 100 consecutive patients admitted for nasal polypectomy revealed only 3 patients with aspirin idiosyncrasy and asthma. It is important that this combination be recognized but fortunately this can be done by the history. Incidental findings were that nasal polypi are much commoner in men and that the incidence of atopy was the same as that in the general population.

Subdural tension pneumocephalus in a 80-year-old man following nasal polypectomy, presenting clinically with progressive weakness of both legs, is reported and the pathogenesis is discussed. The diagnosis of tension pneumocephalus and the options of management are considered.

In a retrospective study of 445 patients with nasal polyps, 95 (21 per cent) had asthma. Forty-two (44 per cent) of the patients with asthma had been skin tested and 27 (60 per cent) had positive reactions. Nasal polyps were twice as common in men as women, though a woman with nasal polyps was twice as likely to have asthma as a man. The average age of onset of polyps was 39 years and of asthma was 38 years. No significant difference was found in the age of onset of polyps or asthma in various groups of patients. Two per cent of all the patients in the series had nasal polyps, asthma and hypersensitivity to aspirin (the ASA triad). Ten per cent of those with polyps and asthma were hypersensitive to aspirin and thus had the full triad. Overall, 6 per cent of all the patients in the series were recorded as being allergic to aspirin. Asthma developed more commonly before polypectomy than after in the ratio of 2.5:1. Around 1 per cent of first polypectomies and 0.5 per cent of all polypectomies were followed by the development of asthma within a few months. The onset of asthma was found to occur most frequently just before or just after the first polypectomy. Those who developed asthma after polypectomy had significantly more polypectomies than both non-asthmatics and those whose asthma preceded their polyps. Though it is possible polypectomy may on rare occasions precipitate asthma, it is felt that it does not cause it.

In this study, the cases of patients under age 18 who had been admitted to the hospital over a five-year period for nasal polypectomy were reviewed for evidence of allergy or other possible predisposing conditions. Two of the children had cystic fibrosis and one had Kartagener's syndrome. Of the remaining 21 patients, 12 (57%) had four or more positive criteria for allergic disease, out of eight criteria considered. It is concluded that in the majority of children with nasal polyposis, allergy can be implicated as a causative factor.

A case of traumatic aneurysm of the ICa following an attempted hypophysectomy is reported, and the management of the case is discussed. Extensive review of the English literature and personal communications (Angell-James, Bateman, Symon, Richards) have revealed only four other proven cases of intracranial aneurysms following operations on the ear and nose, one each following nasal polypectomy and partial intra-nasal ethmoidectomy, trans-antral ethmoidectomy, hypophysectomy, and mastoidectomy.