Nasal polyps

 

What is a nasal polyp?

A polyp is a swelling of the lining of the nose, which is usually due to inflammation of the lining of the nose. Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.

Nasal polyps aren’t painful to the touch.

Causes

Nasal polyps come from the lining of the nose and often originate from the ethmoid sinuses, which drain into the side wall of the nasal cavity. Nasal polyps contain inflammatory fluid and, while they can be associated with allergy and infection, the exact reason why some people get them and not others is not known.

Nasal polyps are linked to allergic rhinitis, asthma, aspirin allergy, sinus infections, acute and chronicinfections, something stuck in the nose, and cystic fibrosis. But many times the cause is unknown. Sometimes, people get them before they develop asthma or sinusitis.

Unlike polyps that form in the colon or bladder, nasal ones are rarely cancer. Experts think that long-term inflammation causes them or that they run in families.

Conditions associated with polyps

They commonly occur in more general diseases such as late onset asthma in an adult patient, aspirin intolerance or cystic fibrosis.

Late onset asthma rather than childhood asthma is associated with nasal polyps. Of the patients with polyps 20% to 40% will have coexisting asthma. Although nasal allergy is present in some cases, more than two thirds of the patients show no evidence of systemic allergic disease. However, 90% of nasal polyps have eosinophilia (inflammatory cells present which are associated with allergy).

Aspirin hypersensitivity is not an allergic reaction but an alteration in prostaglandin production. Asthma, aspirin sensitivity and nasal polyps together are a well-recognised subgroup in 8% of polyp patients. These polyps tend to recur more than in other conditions.

Nasal polyps are rare in children between the ages of two and 10 years. If found in children cystic fibrosis should be excluded

Symptoms

 

Most people with nasal polyps have a runny nose, sneezing, and postnasal drip. About 75% have problems with their sense of smell.

Many people also have wheezing, sinus infections, and sensitivity to fumes, odors, dusts, and chemicals. It’s less common, but some people with nasal polyps also have a severe allergy to aspirin and reaction to yellow dyes. If you know you have that allergy, ask your doctor to check for nasal polyps.

Nasal polyps make you more likely to have long-term (chronic) sinusitis. Large ones can even change the shape of your nose.

Who Gets Them?

Anyone can, but they’re most common in adults over age 40 and are twice as likely to affect men as women. Children under age 10 rarely get them. If they do, a doctor will check for signs of cystic fibrosis.

Nasal polyps are linked to allergic rhinitisasthmaaspirin allergy, sinus infections, acute and chronic infections, something stuck in the nose, and cystic fibrosis. But many times the cause is unknown. Sometimes, people get them before they develop asthma or sinusitis.

Some experts think that symptoms of allergies — including runny nose, sneezing, and itching — make some people more likely to get nasal polyps. But the allergy connection is controversial. Other researchers think that sinus infections are to blame.

Treatment

The first step to determining the appropriate nasal polyps treatment is to be evaluated by an experienced sinus surgeon. The Doctor will examine you and may recommend that you have a CT scan of your sinuses taken. This will allow to visualize the extent of sinuses involved, and also if there are any structural abnormalities (such as a deviated septum) or another condition (such as chronic sinusitis) that’s aggravating your nasal polyps.

Conservative treatment options are always tried first and may include the following:

  • Nasal steroid sprays– used to shrink polyps, help clear blocked nasal passages and temporarily alleviate runny nose symptoms
  • Antihistamines– used to help reduce symptoms like runny nose while decreasing inflammation, particularly if inflammation is caused by allergies
  • Antibiotics– used to help treat polyps caused by a bacterial sinus infection
  • Oral steroid pills– used to reduce swelling and other symptoms, but they shouldn’t be taken long-term because of possible side effects

 

Nasal polyps are known to shrink when nasal sprays or drops containing nasal steroids are used. Stronger steroids in drop form can be used but should only be used with care and limited to short courses because some is absorbed into the body.

Polyps respond and shrink using drops or sprays in up to 80% of people. New nasal steroid sprays can be taken to control symptoms for many years as very little is absorbed into the body and they can work well, but many take up to six weeks of treatment before their full effect can be felt.

Steroids in tablet form can provide good relief of symptoms but the effects are short-lived and they are used sparingly because of concerns about side effects. If medicines don’t work then surgery is needed.

Nasal washes can be done to reduce the mucus build up inside the nasal cavity.They improve the quality of life for the patient but do not shrink the polyps.

What does nasal polyp removal surgery involve?

In cases where conservative treatments don’t provide effective relief, nasal polyps removal surgery may be considered.

Functional Endoscopic Sinus Surgery (FESS) is performed using an endoscope – a tube with a tiny camera that gives your doctor a detailed view inside your nose and sinuses. During this procedure, the polyps and any other problematic tissue can be precisely removed. Special instruments are passed through your nostrils to perform the corrections, so no incisions will need to be made to your face. This surgery enlarges the drainage pathways of your sinuses and fixes any other issues interfering with drainage, thus preventing a future build-up of mucus.

Balloon Sinuplasty: A tiny balloon catheter is inserted through your nostril and inflated in your sinus passageway. The passageway is gently opened and widened to restore normal sinus drainage and function, and the balloon is then deflated and carefully removed. This surgery is done along with FESS to open the sinuses atraumatically.

How successful are surgical options?

In many cases, nasal polyps removal can be very successful and lead to a great reduction in symptoms. However, if your nasal polyps are caused by a genetic or allergic issue, the polyps may re-emerge and require repeat treatments. Under these circumstances, nasal polyp surgery can provide relief, but it may not be permanent without additional treatment in the future.

Local medical treatment is often still needed using anti-inflammatory sprays or drops.

The Role of allergy Testing and Immunotherapy

Considering that the main cause for Polyp formation is Allergy, it would be helpful to get a complete Allergy Test done following polyp surgery. This is best done by SKIN PRICK TEST which is recommended by World Allergy Organisation, World Health Organisation to be the GOLD Standard of Allergy Testing.

At ALLERGYDOC, we do an allergy test for 110 allergens and help identify your allergies. Allergic foods can be avoided from the diet, Immunotherapy is started for inhaled allergens.

Subcutaneous immunotherapy or allergy vaccinations have been in vogue for more than 100 years. This is the only way known to change the course of Allergic disease and have a long term impact.

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