What are Nasal Polyps?
Nasal Polyps are abnormal, benign, drop-shaped growths of tissue that are formed from the mucous membrane inside the nose and sinuses, usually in the open nasal cavity. Mature nasal polyps are round in shape. A polyp can appear as one or develop a whole group.
Nasal polyps are often similar in their symptoms to allergies or asthma. In the early stages of the disease, there are no clinical signs.
Nasal polyps should not be confused with polyps of the large intestine or bladder. Unlike these types of polyps, they are rarely malignant. As a rule, they appear as a result of chronic inflammation or predisposition.
Also, there is no need to confuse polyps of the nose with cancerous tumors, since the latter is accompanied by pain syndrome.
Nasal polyps can appear at any age, in children they are rare, usually appear before the age of 10 years. When children develop polyps, they should be considered as a complication after cystic fibrosis (a systemic hereditary disease caused by a mutation of the gene of the transmembrane regulator of cystic fibrosis, which is characterized by the defeat of the glands of external secretion, severe impairment of the respiratory and gastrointestinal tract functions).
The causes Nasal Polyps:
In most cases, the causes of polyps in the nose are not known. They arise as a result of inflammation (redness and swelling) inside the mucous membrane of the nasal passages and sinuses (mucous membrane).
Some scientists believe that the appearance of nasal polyps is associated with:
- Asthma – A disease that causes inflammation of the respiratory tract and a general narrowing.
- Allergies – A reaction to aspirin, painkillers, plants, food, etc. Intolerance to aspirin by the body can cause allergic symptoms, such as a rash, itching, sneezing, and wheezing.
- Allergic fungal sinusitis.
- Allergic rhinitis.
- Cystic fibrosis – A genetic disorder that leads to the formation and secretion of abnormally thick, sticky nasal sinuses.
- Acute and chronic infections.
- Syndrome Cherdja-Strauss – A rare disease that causes inflammation of blood vessels.
- Hereditary predisposition – Analyzing the family history, the doctor can determine the genetic changes associated with the function of the immune system, which leads to the formation of polyps.
- The presence of foreign bodies in the nose.
- Cystic fibrosis.
- Previous development of sinusitis.
Some researchers suggest that allergy symptoms, including coryza (Irritation and swelling of the mucous membrane in the nose, caused especially by a cold or by hay fever), sneezing and itching, predispose to the development of polyps of the nose.
If the nasal polyps develop within or near the sinuses, it can lead to a sinus infection, causing the person to become painful and sensitive.
Incorrect metabolism of arachidonic acid, a syndrome of intolerance to salicylic acid, disruption of the paranasal sinuses and the entire nasal cavity provokes polyps in the nose.
What happens during Nasal Polyps?
Nasal Polyps are distinguished by their origin, size and color – they can be yellow, gray or pink. Polyps are teardrop shaped. As a rule, polyps occupy both nostrils. Polyps grow in the nasal passage, nasal sinuses and maxillary sinuses, which are under the eyes.
Polyps in the nose develop in several stages:
Stage 1: The polyps of the nose close only the upper part of the nasal septum.
Stage 2: Connective tissue greatly expands, as a result of which it covers most of the space in the nasal septum.
Stage 3: Polyps occupy the whole space.
The launched form of polyps can lead to serious consequences, as the nasal passages are closed, and the patient loses the sense of smell, the holes of his paranasal sinuses are blocked, which leads to ENT diseases. Therefore, it is so important to begin timely treatment.
Symptoms of Nasal Polyps:
Symptomatic picture of the polyps of the nose is manifested: nasal congestion, sneezing, runny nose, facial pain, decreased the perception of aromas, loss of smell ( anosmia ), loss of taste, itchiness around the eyes, the appearance and development of chronic infections, pressure in the forehead.
Many children have asthmatic symptoms such as shortness of breath, nasal sinus sensitivity to vapors, odors, dust, and chemicals. Rarely in children with nasal polyps, there is a strong allergy to medicines.
Nasal polyps increase the possibility of the appearance of chronic sinusitis (sinus infection or rhinosinusitis). Large nasal polyps can shift nasal bones from each other and expand the nasal bridge, which can adversely affect the appearance.
The initial symptoms are similar to those of a common cold. Large polyps can cause headaches and snore.
The main sign is nasal congestion. But do not confuse it with cold and cold symptoms. Polyps produce pressure on blood vessels, which disrupt the blood supply of tissues, which become more susceptible to infection and viruses, resulting in frequent inflammation of the pharyngeal and palatine tonsils, inflammation in the middle ear.
Disorders in the form of loss of smell occur due to the fact that the polyp blocks the proportion of the mucous membrane of the nose, which is responsible for the sense of smell, and if you let the disease go into a chronic form, then even the operation will not be able to regain the former sense of smell.
Large polyps affect the voice, as the holes of the auditory tubes are closed, which leads to a disruption in the pronunciation of the speech and a decrease in hearing.
In children, polyps in the nose are easy to identify because they have open mouth, drooping lower jaw and smoothed nasolabial folds (“smile lines” or “laugh lines”, are facial features), their breathing is difficult, the shape of the face and the dento-alveolar system change, which even leads to abnormal development of the thorax.
The greatest danger is the presence of polyps in infants, as their sleep and sucking are disturbed, which causes inflammation of the bronchi, lungs, children are malnourished, become weak and lose weight.
Older children complain of a headache, the cause of which is a violation of blood circulation, a disorder of the gastrointestinal tract, a weak appetite, fast fatigue, and discharge from the nose, vomiting, diarrhea.
Diagnosis of Nasal Polyps:
In, as a rule, diagnoses on complaints of the patient, having studied a nose with the help of an endoscope and a rhinoscope, and also palpation with a fingernail of a nasopharynx. In some cases, the doctor may prescribe additional tests or perform a biopsy of the polyp in order to establish whether it is a tumor.
Nasal polyps located near the nostril opening can be seen, so the diagnosis is easy to put. If the polyps grow in the nasal passages deeply, then a number of tests will be required to diagnose them:
1. CT or MRI – It is used for more detailed testing. Helps determine the size and location of polyps in deeper areas of the sinuses and assess the degree of inflammation. These studies can also help the doctor to differentiate polyps from other possible diseases in the nasal cavity, such as structural anomalies, cancer or non-malignant neoplasms.
2. Radiography – It allows you to see the degree of damage in the paranasal sinuses.
General and biochemical analysis of blood.
3. Allergic tests – Such as skin tests, which determine the allergic reaction to drugs. To do this, minimum allergens are injected into your body. The injection is done in the forearm. Allergen remains under the skin for 15 minutes, after which either there is an allergic reaction, or is absent.
4. Test for cystic fibrosis – If the family has a predisposition to the disease, then the child must definitely be tested.
Treatment of Nasal Polyps:
Treatment of nasal polyps is divided into conservative (drug therapy) and operational.
Conservative or Drug Therapy
In the treatment, doctors are first applying medication. In many cases, such therapy is effective, it reduces and eliminates the polyps of the nose. In most cases, the polyps of the nose respond well to medication. Polyps can appear even after successful treatment, then the treatment course is repeated.
It is very important to establish the root cause of the disease and eliminate it (for example, infectious diseases of the nose and paranasal sinuses).
Treatment and elimination of the factors that provoked the disease consists in the exclusion of contact with domestic, pollen, medicinal, epidermal and occupational allergens; fungal and infectious agents; during treatment, all non-steroidal anti-inflammatory drugs, foods containing natural salicylates, food additives and colorants are excluded.
Unfortunately, the nasal polyps, as a rule, are renewed, if there is no root cause, which provoked the disease.
In medical therapy, physicians can use antihistamines and decongestants to monitor the development of allergies, a course of antibiotics to control chronic infection, corticosteroids (fluticasone, budesonide, mometasone flunisolide, triamcinolone, and beclomethasone).
Corticosteroids can be prescribed as a short course of tablets or in the form of drops or a spray in the nose (budesonide, fluticasone, mometasone, and triamcinolone.). The drops are prescribed for 7-14 days, and anti-inflammatory drugs, mast cell membrane stabilizers or antibacterial agents are also included in the therapy.
In drug treatment, immunocorrective therapy is very important, it is carried out by specific non-bacterial or bacterial allergens.
Operational or Surgical Treatment:
Sometimes, nasal polyps are so large and obstructive that corticosteroids are ineffective. In such cases, doctors resort to surgical methods. Indications for surgery: gross violations of the function of breathing through the nose, purulent-inflammatory processes of the nose and paranasal sinuses.
Before the operation, the parents of the sick child should inform the doctor about the existing chronic diseases of the child, about all medications are taken before treatment, about the presence of allergies to drugs, food, plants, if any.
1. Polypectomy Surgery – Removal of polyps with the help of surgical instruments. The operation is performed through the nostrils. For surgery, a local anesthetic or general anesthesia is used. The type of anesthesia can depend on the number and size of polyps, their location. The operation consists in excising the polyp by means of surgical instruments or a laser.
2. Endoscopic Removal – This procedure is performed endoscopically, using a small bow telescope, which removes nasal polyps, while retaining normal tissue. Endoscopic surgery is done with general anesthesia. This method is used when the polyps are very large and numerous, or they seriously block the sinuses. Most often, these procedures are performed in an outpatient setting, the surgery takes a little time, and a few hours after the operation the patient can go home.
During operations, the paranasal sinuses are washed, which is the prevention of the re-formation of nasal polyps.
After the operative removal of nasal polyps, the patient is prescribed antibiotics for preventive purposes in order to avoid the appearance of complications, which include:
- Spikes and fusion in the nasal passages.
- Obstructive sleep apnea.
- Infectious complications (nasal polyps can make a patient more susceptible to infection, which can go into a chronic form).
- Repeated formation of polyps of the nose.
- Outbreaks of asthma.
- Spreading the infection on the orbit (this can cause swelling or bulging of the eye, the inability of the eye to move, reduced visual acuity, even blindness, which can become permanent).
- Aneurysms or thrombi.
- Diseases of the circulatory system.
Prevention of Nasal Polyps:
After the course of treatment, it is necessary to undergo an examination with an otolaryngologist (medical specialist of ears, nose, and throat) several times a year, this is necessary to detect the reappearance of polyps.
For preventive purposes, it is necessary to do a nose wash for a long time.
Prevention includes the proper work of the digestive system, regular cleansing of the intestine, liver, so doctors recommend switching to separate meals, excluding salt and spicy food, tonic drinks from the diet.
Reduce the likelihood of relapse in the following ways:
- Control of allergies and asthma. To do this, follow the recommendations of the attending physician. If the symptoms do not disappear, then you need to change the course of treatment.
- Elimination of nasal irritants. As far as possible, avoid inhaling allergens (tobacco smoke, chemical vapors, dust and small debris), which can provoke inflammation or irritation of the nose and sinuses, such as allergens.
- Compliance with hygiene. Careful and regular hand washing.
- Humidifying the house. If the house has dry air, then you must use a humidifier. This can help moisturize your airways, improve the flow of mucus from the sinuses, and prevent inflammation.
- Rinsing of the nose. The saline solution is well suited to rinse your nasal passages. This procedure helps to improve the flow of mucus and remove allergens and other irritants.
Which doctors should be consulted if you have Nasal Polyps?
Featured Image Credit: Healthline
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Overview of Nasal Polyps: Cause, Symptoms & Treatment
Nasal Polyps are abnormal, benign, drop-shaped growths of tissue that are formed from the mucous membrane inside the nose and sinuses.
A. R. Choudhury, M.Sc Biochemistry