Variable Presentations of Sinonasal Polypoid Masses: A Tertiary Institution Experience

Background Lesions of the sinonasal area are varied, but they mostly present as polypoid masses which require meticulous work-up to reach at the most probable diagnosis. Objective Analysis of polypoid sinonasal masses in terms of etiology, clinical presentations, brief demographic profile, clinico-histologic correlate where possible, and follow-up results. Method In this descriptive, longitudinal study, 198 patients with polypoid sinonasal masses attending the otolaryngology clinic of a tertiary teaching institute were selected using proper selection criteria and analyzed through a pre-set proforma and algorithm for a diagnostic work-up (that included histopathology where necessary). Result Common presentations were nasal obstruction (~89%), discharge (~70%) and hyposmia (~22%). Though nearly 87% was clinically benign and 8% indeterminate, therapeutic and diagnostic interventions (including histopathology) showed 91% truly benign, of which polyposis formed the bulk. Sensitivity of clinical detection was 75% for benign lesions and 62% for malignancies. Diagnosis depended on histopathology in 52.52% cases, including the clinically malignant, the "grey zone", and more than 40% of the clinically benign lesions. There was male predilection (2.16 for benign lesions and 1.57 for malignant), rural preponderance, and above 60% of the patients were within 50-70 years. There was ~26% recurrence in the follow-up period of a minimum of one year, predominantly in polyposis (29.55%) and malignancies (~39%). Conclusion Presentations of polypoid sinonasal masses are variable, etiology of which is mostly benign. Proper clinico-histologic correlate is necessary for correct diagnosis. A low threshold of suspicion is required because of this variability, necessitating follow-up for further evaluation.