Polyps of the nasal cavity and paranasal sinuses (nasal polyposis)

Polyps are benign growths arising from the mucous membrane.

Author:

• Galkin Alexey Vladimirovich

  ENT pathology expert

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Prevention

Polyps are benign growths of the mucous membrane. Nasal polyps are the result of long-term inflammation in the nose or paranasal sinuses due to prolonged infection, allergens, and certain immune disorders.

Polyps of the nasal cavity and sinuses can appear in both adults and children, but they are more often observed in adults. Drug therapy helps polyps regress in size or slow their growth, but sometimes surgery is performed to relieve the symptoms of the disease. Despite successful treatment, polyps tend to re-grow.

Symptoms of the disease

Often small polyps do not cause discomfort to patients. But, large or multiple, they can block the nasal passages, leading to breathing problems, decreased sense of smell, and recurring respiratory infections.

Most common symptoms:

• chronic runny nose;
• persistent deterioration in breathing through the nose;
• decreased or absent sense of smell;
• violation of taste sensitivity;
• facial pain, pain in other parts of the head;
• a feeling of heaviness, discomfort in the eyes, facial walls of the sinuses, head;
• snore.

Symptoms of polyps in the nasopharynx

The polyp clinically manifests itself when the nasal passage is limited and the drainage of the nasal passages is impaired.

A polyp sometimes develops as a result of a sinus infection, and sometimes, on the contrary, a large polyp that causes airway obstruction itself contributes to the development of a sinus infection.

Clinically identified nasal polyps are characterized by wheezing, nasal congestion, loss of taste and smell, headache, toothache, pressure on the forehead and face, sneezing, and frequent nosebleeds. The patient constantly feels like he has a cold. Contact your doctor if the above symptoms persist for more than 7-10 days.

Nasal congestion

Call 911 immediately if you have severe respiratory distress, blurred or blurred vision, limited eye movement, severe swelling around the eyes, severe headaches, sudden worsening of symptoms: fever, neck stiffness.

Causes

Scientists do not fully understand the reasons for the appearance and growth of polyps. It is not entirely clear why ongoing inflammation triggers the development of polyposis in some people and not in others.

There is some evidence that people who develop polyps have a different immune response and distinctive mucosal chemical markers.

Conditions often associated with polyposis:

• bronchial asthma is accompanied by prolonged inflammation of all airways;
• aspirin sensitivity, intolerance to certain non-steroidal anti-inflammatory drugs causes the development of an inflammatory reaction in the mucous membrane of the respiratory tract in response to medication;
• allergic fungal sinusitis, sensitization of the nasal mucosa and paranasal sinuses to microscopic fungi and their spores;
• cystic fibrosis (cystic fibrosis), a genetic disease that leads to the formation of a very viscous secretion on the mucous membrane of the upper and lower respiratory tract;
• eosinophilic granulomatosis (Charge-Strauss), a rare pathology accompanied by inflammation of blood vessels.

Complications

Nasal polyps can lead to complications because they interfere with the free passage of air and the drainage of mucous secretions from the sinuses.

Possible complications with nasal polyposis:

• Obstructive sleep apnea. In this condition, prolonged pauses in breathing occur during sleep, which increases the risk of cardiovascular disease and sudden cardiac death.
• Progression of bronchial asthma. Polyposis can aggravate the course of bronchial asthma.
• Sinus infection or infectious complications of chronic sinusitis. Nasal polyps increase the frequency of exacerbations of sinusitis and can lead to serious complications (for example, meningitis, orbital phlegmon, sepsis).

Diagnosis of the disease

Your doctor can determine the condition based on your answers to questions about your symptoms, a physical examination, and rhinoscopy (a visual inspection of the nasal cavity using a light and a nasal speculum). But additional examination may be required to determine treatment tactics.

Additional diagnostic tests for polyposis:

• Endoscopic examination. Using an endoscope, the doctor can conduct a thorough examination of the nasal cavity.
• X-ray tomography. Images obtained by X-ray computed tomography (CT) provide information about the extent of polyposis involvement in the nasal cavity or sinuses. These tests can also help the doctor detect the presence of other abnormalities, such as a deformed nasal septum or enlarged nasal turbinates. Based on RCT images, the doctor may suspect a tumor growth other than polyposis (malignant or benign).
• Allergy detection. The doctor may prescribe an additional test to identify allergies: rhinocytogram, blood test for IgE, eosinophilic cationic protein, scarification tests. This is necessary in order to identify the presence of allergic pathology, which contributes to the development of polyposis.
• Test for cystic fibrosis (cystic fibrosis). A child diagnosed with chronic polypous sinusitis should be evaluated for cystic fibrosis. This is a hereditary disease that disrupts the secretion of glands, which leads to chronic inflammation of the respiratory tract and the development of polyposis.

What it is?

Nasal polyps are soft tissue, painless growths that hang into the nasal or sinus cavity like clusters or drops.

IMPORTANT! Information from the article cannot be used for self-diagnosis and self-medication! Only a doctor can prescribe the necessary examinations, establish a diagnosis and draw up a treatment plan during a consultation!

Typically, nasal polyps result from chronic inflammation of the nasal cavity and/or are associated with asthma, recurrent infection, allergies, drug sensitivities, or immune system disorders.

Medicines can reduce their size or completely rid the nose of polyps, but sometimes surgery is required to remove them. Even after successful treatment, nasal polyps often return.

Treatment of nasal polyposis

Treatment of chronic inflammation of the sinuses (with or without polyps) is a difficult task that requires complex treatment.

A team of doctors (therapist, allergist-immunologist, otolaryngologist) must participate in the treatment of the disease in order to determine an effective treatment regimen.

The goal of treatment for nasal polyposis is to reduce the size of the polyps or eliminate them. The first step begins with drug therapy. If the effectiveness of drug therapy is low, surgical treatment is resorted to. It does not provide complete recovery, but significantly improves the course of the disease. Therefore, it is necessary to continue conservative treatment in the postoperative period.

Use of medications for nasal polyposis

Treatment begins with drug therapy, which helps to reduce or disappear even large polyps.

Drug treatment usually includes:

• Nasal corticosteroids

Nasal corticosteroids have a predominantly local anti-inflammatory effect. They are used in the form of nasal sprays (with mometasone, beclomethasone) and help reduce nasal polyps.

• Systemic corticosteroids

If the administration of nasal medications is not effective, then systemic corticosteroids (dexamethasone, prednisolone, etc.) are prescribed orally or by injection. Because corticosteroids taken by mouth or by injection carry a risk of serious side effects, these drugs are not prescribed for long periods.

• Other medicines

The doctor may also prescribe other medications that affect inflammation of the mucous membrane. They may include various drugs for the treatment of allergic pathology (leukotriene receptor blockers, antihistamines, cromoglycates), antibacterial drugs for the treatment of prolonged or recurring infections.

Polyp surgery

If drug treatment does not shrink or eliminate polyps, endoscopic surgery may be required to remove them and correct sinus problems.

In the endoscopic technique, the surgeon uses a special optical tube that magnifies and displays an image of the operated area on a screen. Under visual control, the surgeon, using specialized micro-instruments, removes polyps and other obstructions from the nasal cavity and paranasal sinuses that interfere with the outflow of fluid from the sinuses.

The surgeon may also enlarge the openings connecting the sinuses to the nasal cavity.

After surgery, it is recommended to use a corticosteroid nasal spray, as well as regular rinsing with prepared saline solutions, to help prevent recurrence of nasal polyposis.

Can polyps be cured?

Treatment has two goals: to make the polyps disappear or shrink. Since symptoms appear when the polyp narrows the airways, when it contracts, the passage of air is restored and the condition improves, so shrinking the polyp is already an excellent result.

Treatment for nasal polyps begins with medication. Medicines help relieve symptoms and, in rare cases, even get rid of polyps.

• The first step is to prescribe a nasal spray containing steroids. Steroids cause polyps to shrink and sometimes even disappear. This helps clear the airways and relieve symptoms, although symptoms will return after stopping treatment.
• Corticosteroid tablets and injections have the same effect. Their effects usually last several months, but oral steroids also have serious side effects, so they are prescribed only when nasal steroids are ineffective, even for a short course.
• If the cause of the polyp is an allergy, naturally the doctor will prescribe an antiallergic drug.
• In the case of a bacterial sinus infection, the antibiotic of choice is the drug of choice. Here we remind you once again that antibiotics cannot cure a viral disease, so they are not prescribed to treat polyps resulting from such an infection.
• When the cause of the polyp is hypersensitivity to aspirin, desensitization is needed: The patient is given increasing doses of aspirin. Desensitization is carried out in a hospital under the supervision of a doctor.

Nasal spray
If drug treatment is ineffective or the polyps are too large, the question of surgical treatment arises. Polyps are removed endoscopically. The doctor inserts a thin endoscope tube into the nostrils and inserts it into the insides. An instrument is attached to the tube to cut the polyp. The surgery is usually performed on an outpatient basis and the patient returns home the same day.

Nasal breathing often improves after surgery, but sometimes the polyps grow back. If the factors that contributed to their development are not eliminated, the appearance of new polyps will not come as a surprise.

After surgery, a nasal spray containing corticosteroids is prescribed to prevent recurrence. It is also recommended to rinse the nasal cavity with salt water, which promotes healing. By the way, rinsing with saline solution can remove allergens and other irritants from the nasal mucosa, as well as relieve swelling.

It should also be noted that the sense of smell and taste cannot be restored even with medical or surgical treatment.

Scientists are studying the role of biologic drugs used to treat severe asthma in treating polyps. These medications target specific cells and proteins to reduce inflammation and irritation. Early results from the study suggest that biologics may be an alternative treatment for people for whom steroids and surgery are ineffective.

Prevention

You can reduce your chances of polyps appearing or returning after treatment by following these strategies:

1. Monitor allergy symptoms. Follow your doctor's recommendations to monitor the course of your allergic disease. If symptoms do not improve, consult your doctor about changing your treatment.
2. Avoid irritants to the nasal mucosa. Avoid contact with substances that can cause inflammation or irritation of the mucous membranes (smoke, a suspension of small particles, caustic chemicals, allergens, dust, animal hair).
3. Maintain good hygiene. Wash your hands thoroughly and regularly. This is one of the best ways to prevent infections that can cause inflammation of the mucous membranes of the nasal cavity and sinuses.
4. Control the humidity in your home. When humidity levels are low, use humidifiers. This will moisturize the airways and improve self-cleaning of the sinuses and nasal cavity.
5. Use nasal cleansers. Use a nasal douche (aerosol) with isotonic sodium chloride solution to clean the cavity. This will reduce the concentration of irritating agents on the nasal mucosa (allergens, dust, germs) and reduce inflammation. If you prepare your own saline solution, use distilled or boiled water.

How to prevent it?

To reduce the likelihood of polyps appearing, including recurrence (after treatment):

• Control exacerbations of asthma and allergies. To do this, you must follow the recommendations of your doctor;
• try not to inhale substances that cause inflammation of the nasal passages and sinuses (pollen, dust, chemical fumes, tobacco smoke...);
• reduce the likelihood of infections - for example, wash your hands more often;
• If you often have sinusitis, humidify the air in your home and rinse your nose properly.