Nasal polyps: Causes, symptoms, and treatments (original) (raw)

Nasal polyps are fleshy swellings that develop in the lining of the nose and paranasal sinuses, the air-filled spaces that are linked to the nasal cavity. They are non-cancerous growths.

Polyps vary in size; they may be yellowish-brown or pink and are shaped like teardrops. As they grow, they eventually look like grapes on a stem.

Polyps may grow in one or both nostrils at the same time; they can grow on their own or in clusters.

Large polyps or clusters can cause breathing difficulties and can affect the patient’s sense of smell. They may block the sinuses and cause problems, such as regular infections.

Nasal polyps affect an estimated 4-40 percent of the general population, and they seem to be 2-4 times more common in males than females. People who develop them tend to do so as young or middle-aged adults.

Individuals with asthma, frequent sinus infections, and allergies are more likely to develop them. Some children with cystic fibrosis may develop nasal polyps.

Individuals with nasal polyps tend to have chronic inflammation of the lining of the nasal passages and sinuses (chronic sinusitis).

If there are clusters or large polyps, the patient’s nasal passages and sinuses may be obstructed.

Some people with small nasal polyps may have no signs or symptoms; however, the following are common:

• Runny nose – this may be chronic, with the patient feeling as if they always have a cold
• Persistent stuffy or blocked nose – in some cases, the patient may find it hard to breathe through the nose, causing sleeping problems
• Postnasal drip – a feeling of mucus continually running down the back of the throat
• Either no sense of smell or poor sense of smell – this may not improve after polyps are treated
• Poor sense of taste – this may not improve after polyps are treated
• Pain in the face
• Headache
• Snoring
• Itchiness around the eyes
• Obstructive sleep apnea (in severe cases) – this is a potentially serious condition where the patient stops breathing during sleep
• Double vision (in severe cases) – more likely to occur if the patient has allergic fungal sinusitis or cystic fibrosis

Risk factors include:

• Sensitivity to aspirin – people with an allergic response to aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) are more likely to develop polyps.
• Asthma.
• Allergic fungal sinusitis – an allergy to airborne fungi.
• Rhinitis/Rhinosinusitis – an inflammation of the nasal passage and sinuses, typically lasting 12 weeks or more. This condition includes hay fever.
• Cystic fibrosis – a chronic disease that affects organs such as the liver, lungs, pancreas, and intestines.
• Churg-Strauss syndrome – a disease that results in the inflammation of blood vessels.
• Age – Nasal polyps can occur at any age, but young and middle-aged adults are more at risk.
• Genetics – individuals whose parents have had nasal polyps have a higher risk of developing them.

The exact causes of nasal polyps are not known. Although a significant number of cases are linked to non-allergic asthma, in some cases, no respiratory or allergic trigger is found.

Nasal polyps have no relationship with colonic or uterine polyps found in the digestive system or uterus, respectively.

The exact mechanism of polyp formation is unknown, but most researchers agree that they are the result of swelling (inflammation) in the nose or sinuses – they are not a disease.

Some experts believe that inflammation causes an accumulation of fluid in the interstitial space (space between mucous-forming cells) of the nose and sinuses. Eventually, gravity pulls these heavy cells down, resulting in polyps. Scientists believe possible triggers are bacterial or viral infection, an allergy, or an immune response to a fungus.

Nasal polyps appear most frequently near the openings to the sinuses (in the nasal passage); however, they can develop anywhere throughout the nasal passages or sinuses.

A doctor will generally be able to make a diagnosis after asking about symptoms and examining the patient’s nose. Often polyps are visible with the aid of a lighted instrument.

The doctor may also order the following tests:

• Nasal endoscopy – a narrow tube with a small camera (or magnifying lens) is inserted into the patient’s nose.
• CT scan – this enables the doctor to locate nasal polyps and other abnormalities linked to chronic inflammation. The doctor will also be able to identify any other obstructions.
• Skin prick allergy test – if the doctor thinks that allergies may be contributing to polyp development, he or she may do an allergy test.
• Cystic fibrosis – if the patient is a young child, the doctor may order a cystic fibrosis test.

The following treatments are commonly used for nasal polyps:

1) Steroids

The doctor may prescribe a steroid spray or nose drops, which will shrink the polyps by reducing inflammation. This treatment is more common for patients with one or more small polyps. Side effects can include:

• sore throat
• headache
• nosebleeds

2) Steroid tablets

In cases of larger polyps or more severe inflammation, the patient may be prescribed steroid tablets; either on their own or to be taken along with a nasal spray. Although steroid tablets are very effective at shrinking polyps, there is a risk of more serious side effects, such as weight gain, and should be taken for a few weeks at the most.

3) Other medications

Other medications may be given to treat conditions that are making the inflammation worse. Examples include antihistamines for allergies, antibiotics for bacterial infections, and antifungal drugs for fungal allergies.

4) Surgery

Surgery is only used if the polyps are very large, or if the patient has not responded well to other treatments.

Polypectomy

This is the most common procedure for the removal of polyps. The patient is given either a local or general anesthetic. A long, thin tube with a video camera is inserted into the patient’s nose and sinuses.

Polyps are then cut out using micro-telescopes and surgical instruments. Sometimes, the surgeon may remove small pieces of bone from the nose to open up the nasal passageway.

After surgery, the patient will most likely be prescribed a corticosteroid nasal spray to help prevent recurrence. Some doctors recommend the use of a saline (saltwater) rinse to help post-surgical healing.

If the symptoms of nasal polyp seem to ba related to an allergic reaction, it will probably help to avoid the allergen that triggers the reaction.

Tea tree oil and other remedies have been proposed, but there appears to be little evidence to confirm their effectiveness.

Symptoms of congestion may be eased by using a steam bath.

Vitamin D may help reduce symptoms, but only in a high therapeutic dose. How this works, how it should be delivered, and how effective it may be has not been confirmed.

Sometimes, a large polyp, or cluster of polyps, can block the flow of air and draining of fluids from the sinuses or nasal cavity; this can lead to the following possible complications:

• Chronic or frequent sinus infections.
• Obstructive sleep apnea.
• The structure of the face may be altered, leading to double vision. Sometimes, the eyes may be set wider apart than normal (more common in patients with cystic fibrosis).

Hygiene – regular and thorough handwashing reduces the risk of having a bacterial or viral infection, resulting in fewer cases of inflammation of the sinuses and nasal passages.

Irritants – avoiding irritants, such as some allergens, chemicals, and airborne pollutants (which cause inflammation) may help some people reduce their risk of developing polyps.

Management of asthma and allergies – patients who follow their doctor’s recommendations regarding asthma and/or allergy treatment are less likely to develop nasal polyps.

Nasal lavage or nasal rinse – rinsing the nasal passages with a nasal lavage or saline spray will help improve the flow of mucus and remove irritants and allergens.