Nasal polyps are common and benign (non-tumoral) formations: they are teardrop-shaped outgrowths of the nasal mucosa that form in the nose or paranasal sinuses.
Nasal polyps are mainly seen near the opening to the paranasal sinuses (nasal passages), in front of the area where they enter the nasal cavities. However, they can develop in any part of the nasal mucosa.
Usually these formations occur on both sides, if they are unilateral or unilateral, it must be examined whether they are malignant formations.
If nasal polyps are small, they do not cause any symptoms in the patient. In such a case, no therapy is required.
If they become larger, they block the normal flow of secretions from the paranasal sinuses: The increased congestion of mucus in the sinuses leads to infection, which explains the viscous and bright secretions in the nose and throat in many people with nasal polyps.
Nasal polyps should not be confused with polyps that form in the urinary bladder, uterus or colon: unlike these types of polyps, nasal polyps are rarely malignant. The cause of the formation of nasal polyps is chronic inflammation or a family predisposition.
Often, nasal polyps occur together with other disorders, for example, with an allergy or asthma, which also causes coughing.
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What are risk factors for nasal polyps?
Every person who suffers from chronic inflammation of the nasal mucosa, chronic sinusitis or allergy has a significantly higher risk of developing nasal polyps.
Other risk factors include:
- Hypersensitivity to aspirin – Patients with an allergic reaction to aspirin or to other NSAIDs (non-steroidal anti-inflammatory drugs) are more likely to develop nasal polyps.
- Asthma – those who suffer from asthma tend to develop nasal polyps.
- Allergic fungal sinusitis – an allergy to airborne fungi.
- Rhinitis (cold) – this also includes hay fever.
- Cystic fibrosis – a chronic disease that affects organs such as the liver, lungs, pancreas and intestines. It changes the water-salt balance in the organism, whereby too little salt and water remains outside the cells and thickens and sticks the thin layer of mucus that normally protects the lungs from germs, i.e. the so-called surfactant. This mucus is difficult to excrete: it causes disability and lesions on the lungs and respiratory tract, and also increases the risk of infection.
- Churg-Strauss syndrome – a condition that causes inflammation of the blood vessels or vasculitis
- Age – Nasal polyps are more common in adults over the age of 40.
- Genetic – Research shows that the likelihood of developing nasal polyps is greater if the parents have already suffered from this disorder.
What are the causes of nasal polyps?
Nasal polyps are caused by inflammation of the nose or paranasal sinuses: this inflammation leads to the accumulation of fluids in the cells of the nasal mucosa, which are shifted downwards by gravity with the result that nasal polyps form. Despite this, the exact pathogenesis of nasal polyps is unknown; the exact chain of events that lead to this disease is not known.
Nasal polyps can be caused by:
- an allergy,
- an inflammatory response to a fungus or bacterial or viral infection,
- less often due to a disease such as cystic fibrosis,
- a sizable number of cases are associated with non-allergic asthma, while other times no respiratory or allergic “trigger factor” was found.
Symptoms of nasal polyps
Nasal polyps are delicate and soft growths of the nasal mucosa. If they are small, the patient has no knowledge of them, but if they are large or multiple, they can obstruct the airways and nasal passages and are the cause of a corresponding symptomatology.
Nasal polyps often occur together with inflammation of the mucous membrane lining the nasal cavity and sinuses and persist for more than 12 weeks, with rhinosinusitis or chronic sinusitis. However, it is possible and also likely to have chronic sinusitis without nasal polyps.
The most common signs and symptoms of chronic sinusitis with nasal polyps are:
- Nasal secretion
- Persistent nasal obstruction due to inflammation of the nasal mucosa and polyp
- Reduced or absent sense of smell, i.e. the perception of smells changes
- Loss of taste
- Facial pain or headache
- Pain in the upper arch of the tooth
- Nocturnal snoring
- Itching around the eyes
How to recognize nasal polyps? Diagnosis
If the nasal polyps are located near the nostrils, you can see them clearly when you shine a simple light into the nose.
However, further investigations are required to find the polyps deeper inside the nasal cavities or paranasal sinuses.
The diagnostic imaging examinations are carried out with an endoscope in a clinical ear, nose and throat department.
With anterior rhinoscopy, visible nasal polyps are detected, for the deeper polyps, a CT scan is required.
In this examination, the nasal polyps are imaged as an opaque or non-transparent area between the walls of the paranasal sinuses and nasal passages.
The prick test is used to detect a possible allergy that could explain the patient’s symptoms: small amounts of substances known for the most common allergies are inserted into the skin. The test is positive if the patient’s skin reacts to one or more of these substances.
Nasal polyps do not usually occur in children, except in children who suffer from cystic fibrosis, i.e. in which the lungs or digestive system become clogged with thickened and sticky mucus. Therefore, if a child is diagnosed with nasal polyps, a test for cystic fibrosis should be performed.
What should you do? How are nasal polyps treated?
Medication is the preferred therapeutic choice.
Chronic sinusitis, with or without polyps, is very difficult to heal. The doctor treats the risk factors (such as allergies) that lead to chronic inflammation.
The therapy of nasal polyps begins with medication that shrinks or eliminates even large polyps.
The doctor may prescribe the following means:
Cortisone spray – Applying it in the form of a spray reduces the inflammation and size of the polyps, and sometimes completely eliminates them. Nasal corticosteroids include fluticasone (Flutide and Avamys), budesonide (Aquacort), flunisolid, mometasone (Nasonex), triamcinolone (Nasacort), and beclometasone (Beconase).
Oral and parenteral corticosteroids – If the nasal corticosteroid is ineffective, an oral corticosteroid such as prednisone is used, either alone or in combination with a nasal spray. Because oral corticosteroids can cause severe side effects, they are only used short-term, while parenterally administered corticosteroids are used when there are serious cases of nasal polyps.
Other medications – The doctor will also prescribe medications to treat the condition that causes the chronic inflammation in the nose or sinuses, such as antihistamines for allergies or antibiotics to treat a chronic or recurrent infection.
Women who are pregnant should talk to their doctor before taking any medication.
Constant treatment with nasal spray or oral corticosteroids reduces resistance to infections in the nasal mucosa.
When should surgery be performed?
If drug therapy does not reduce or eliminate the nasal polyps, intervention by means of surgical endoscopy is required: surgical therapy removes the polyps and corrects the diseases that predispose the patient to inflammation and nasal polyps.
Surgery is not a permanent solution, as recurrences often occur.
Surgery
The surgeon inserts a tube with a magnifying lens or a small video camera through the nostrils and guides it to the paranasal sinuses, where, with appropriate instruments, the polyps and other obstructions that block the outflow of fluids are removed.
This operation is performed under local or general anesthesia.
As a rule, the operation is performed on an outpatient basis.
To eliminate the polyps, the surgeon performs a laser-assisted endonasal polypectomy, in which selective removal of the polyps is performed using a special laser device.
This operation is performed under local anesthesia with sedation.
Alternatively, the surgeon may enlarge the openings leading from the sinuses into the patient’s nasal cavity.
Natural remedies
Among the natural treatments, acupuncture is considered a useful treatment, as it can improve nasal congestion and air circulation.
What is the prognosis for nasal polyps?
Recovery times with surgical therapy range from 1 to 3 weeks.
Most symptoms improve considerably, but occasionally there may be a partial loss of sense of smell.
Patients may complain of nasal congestion and nosebleeds in the first 2-3 days after surgery.
The doctor may prescribe painkillers and antibiotics to relieve postoperative pain and reduce the risk of infection.
The effect of the anesthetics persists for about a day, so one should observe certain precautions:
- Do not drive for 24-48 hours after surgery
- Don’t blow your nose
- Do not smoke
- Do not drink alcohol
After the surgical procedure, the bleeding nasal cavities are tamponed with gauze bandages and cotton wool. This medication should be changed regularly.
After the bandage is removed, the nasal cavities are rinsed with a physiological solution: this helps to remove blood residues or coagulations that have accumulated on the surface of the mucous membrane, reduces the risk of infection and promotes the healing of surgical wounds.
The internal nasal tissues are swollen in the first few weeks, but this is not a cause for concern, because it is a normal reaction of the body.
Bleeding is one of the more serious complications of this surgical procedure: if it occurs, a doctor should be consulted immediately.
Nasal polyps can grow again in 10% of patients with chronic nasal disease despite surgical therapy.
