Nasal polyps

What are nasal polyps?

Nasal polyps are soft, non-cancerous growths that develop in the lining of the nose or sinuses. They result from chronic inflammation in the lining. What triggers the inflammation is not always clear. Nasal polyps can affect anyone, they are more common in adults older than 40 and in adults and children with conditions such as asthma, chronic sinus infections (chronic sinusitis), hay fever (chronic rhinitis) and cystic fibrosis — a serious, inherited disorder that causes respiratory, digestive and reproductive problems.

What are the causes?

Nasal polyps are not a disease. They are the end product of the ongoing inflammation that may result from viral or bacterial infections, from allergies or from an immune system response to fungus. Chronic inflammation causes the blood vessels in the lining of the nose and sinuses to become more permeable, allowing water to accumulate in the cells. Over time, as gravity pulls on these waterlogged tissues, they may develop into polyps.

What are the symptoms?

A person suffering from nasal polyps may feel difficulty in breathing; there is constant dripping from the nose and loss of one’s sense of smell. A person may have just one nasal polyp or have several, clustered together like grapes on a stem. Single or multiple polyps, which are very small in size, may not cause any problem, but larger ones are likely to obstruct the airways in the nose, making it difficult to breathe.

Other signs and symptoms include:

• Running nose
  
• Persistent stuffiness
  
• Chronic sinus infections
  
• Loss or reduced sense of smell
  
• Dull headaches
  
• Snoring

What is the diagnosis?

The doctor examines the patient’s nasal passages. A computerized tomography (CT) scan will be done to help determine the size and exact location of the polyps, including any polyps in the sinuses.
For a young child, the doctor might suggest a test for cystic fibrosis, an inherited condition affecting the glands that produce mucus, tears, sweat, saliva and digestive juices. Children who have both nasal polyps and hay fever may have allergy skin tests, which can provide important information about allergic sensitivities.

What is the treatment?

Inhaled or oral steroid medications are the most common treatment for small nasal polyps. Surgery might be required to remove larger polyps. Although this eliminates symptoms, polyps frequently return, requiring further operations. For one or more small polyps, corticosteroid nasal sprays are prescribed. These medications relieve inflammation, increase nasal airflow and may help shrink polyps. Although they cause fewer side effects than oral steroids, long-term use can lead to nasal bleeding or perforation of the septum and an increased risk of glaucoma. Nasal corticosteroids may also reduce growth rates by as much as one-half inch in some children.

Other treatments for nasal polyps include:

Oral corticosteroids: An oral corticosteroid pill can be taken either alone or in combination with a nasal spray.

Other medications: Medications to control allergies or infection may also be prescribed. Antihistamines, for instance, counteract histamine, an inflammatory substance released when the immune system encounters an allergen. The doctor may also prescribe antibiotics for an acute sinus infection.

Surgery: Polyps can be removed surgically. This is often the only option for people with cystic fibrosis who usually don't respond to steroids. The type of operation depends on the size, number and location of the polyps. Small or isolated polyps can often be completely removed using a small mechanical suction device. The procedure, called a polypectomy, is performed on an outpatient basis.

Endoscopic sinus surgery: It is a more extensive procedure that not only removes polyps, but also opens the part of the sinus cavity where polyps usually form. The surgeon uses a thin, rigid tube and a camera called a video endoscope. In this surgery the polyps may heal more quickly with less discomfort than with other types of surgery. Full recovery may take several weeks, and polyps may return. This surgery carries serious potential risks, including leakage of cerebrospinal fluid, injury to the optic nerve or eye muscles, and haemorrhage.