Nasal polyps are non-cancerous outgrowths of the mucous membrane lining the nose and sinuses. They often grow to completely block the nose. While the exact cause of nasal polyps is not known, their presence usually signifies underlying chronic inflammation.
Inflammation causes waterlogging of cells in the lining membrane of the sinuses and gravity may cause them to prolapse into polyps.
These grapelike masses are often seen in association with some diseases. Allergy is one such common condition. Some people may suffer from a triad of nasal polyps, asthma and a hypersensitivity to aspirin. Longstanding sinusitis is another known and common cause, especially allergic fungal sinusitis where there is allergy to some environmental fungus. Some rare diseases like cystic fibrosis can cause polyps in the nose.
Problems Polyps Cause
In the initial stages polyps may cause no symptoms. As the polyps grow in size they can cause variable degrees of nasal obstruction often leading to mouth breathing and even snoring at night. When allergy is the cause, this may be accompanied by profuse sneezing and a watery nasal discharge. Large polyps can bring about a change in voice too, making it denasal. They can also block sinus openings in the nose resulting in frequent headaches. Polyps also affect one’s sense of smell as they block air currents in the nose.
Polyps give rise to a stuffy, runny nose just like a common cold. But colds clear in about a week’s time, and symptoms which persist longer may warrant seeking medical advice.
While large polyps are easily seen on examination, smaller ones may only be identified on nasal endoscopy. When allergy is the cause skin tests may be performed to identify the offending allergen. A CT scan may be recommended especially if surgery is being considered. The scan will reveal the extent of the polyps, the sinuses affected and any anatomical variations. In children with nasal polyps, sweat may be analysed to rule out cystic fibrosis.
Treatment
Polyps respond very well to corticosteroid therapy sometimes disappearing completely. Topical steroid therapy in the form of nasal sprays are known to be very effective, with little or no side effects even with long term use. This is because of their limited absorption into the bloodstream unlike oral steroids. Fluticasone, flunisolide, mometasone and budesonide are some of the steroids available as nasal sprays. Oral steroids are associated with many side effects and are therefore only recommended for short courses in some instances. Large polyps may regress with steroid therapy but not disappear completely.
Large and multiple polyps sometimes require surgery for their removal. Simple polypectomy or removal of polyps may be performed as an outpatient procedure. This procedure ensures relief from symptoms but does not prevent the recurrence of polyps. Endoscopic sinus surgery includes removing these polyps and at the same time enlarging the openings of some sinuses and clefts in the nasal wall, in an effort to reduce the recurrence rate. However, recurrence is common, especially in cases of multiple polyps. Large, single, one-sided polyps (called antrochoanal polyps) are less likely to recur after complete surgical removal.
Irrigation of the sinuses with warm saline may help prevent recurrence of polyps after surgery.
References
- e-Medicine – Nasal Polyps
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