Nasal Polyposis

What is nasal polyposis?

It is the growth of a soft painless and noncancerous mass lining the nasal cavity and paranasal sinuses. They result from chronic inflammation caused by conditions such as allergies, asthma, recurrent infectious, hypersensitivity to certain drugs and or certain immunologic diseases.

Before continuing, a little history…

Nasal polyposis was first reported by the Egyptians over 4000 years ago. They are considered the pioneers in the diagnosis and treatment of this condition as they were thoroughly familiar with the nasal anatomy and due to the mummification approach take took place in that time. Samuel of Egypt, was first described as a patient. It is said that he had a polyp so great that it hung down the back of his nasopharynx and “strangled” the patient!

However, it was Hippocrates who coined the term polyp considering that it resembled a “marine polyp” (has a flat base, are soft and the body is shaped like a tube). Hippocrates was even the first to describe the surgical procedure for resection of the polyps or the “polypectomy”

What are the symptoms of nasal polyposis?

They come in different sizes. When they are small they may not cause any symptoms. However, when they are large or even giant, they can give very severe symptoms such as difficulty in breathing, changes in smell and taste, nasal congestion, nasal voice or permanent, postnasal discharge, presence of abundant hyaline mucus, pain in the upper dental arch, tightness in the forehead and malar region (also known as the cheek), snoring and recurrent infections.

When should you visit the otolaryngologist (physician in charge of looking at diseases of the Ears, Nose and Throat (ENT))?

You must go to your doctor if symptoms persist for more than 10 days. Symptoms of chronic sinusitis and nasal polyposis are very similar to those of many other conditions or diseases, including the common cold. It is advisable that you go to see your doctor if you feel that you have one or more of the above symptoms.

Who is affected by polyps?

Polyps can occur at any age but are by far more common in people over 40 years and tend to be more common in men than in women. In rare causes they are also know to affect children under the age of 10 years. They can form anywhere in the nose but typically occur first in the ethmoid cedillas but are most common in the area where the sinuses are “drained”, this place is better known as osteomeatal complex.

What are the risk factors?

The risk factors for developing polyps in the nose could be from any situation that involves the chronic inflammation of the nasal mucosa, such as allergy.

The diseases associated with nasal polyposis frequently are: Asthma, Allergy to aspirin (acetylsalicylic acid) or nonsteroidal antiinflammatory drugs, better known as NSAIDs (ibuprofen, naproxen), allergic fungal sinusitis, cystic fibrosis (a genetic disorder resulting from the production and secretion of abnormally thick, sticky mucus) and Churg-Strauss syndrome (a disease that causes inflammation of blood vessels). There are also hereditary genetic diseases that can make us more likely to develop nasal polyposis.

However, in many cases, nasal polyposis is of an unknown cause but cases are known of nasal polyp formation preceding the development of asthma or sinusitis.

What are the potential complications?

They are varied and can range from sinusitis to obstructive sleep apnea, to asthma exacerbations, dissemination of the infectious process to the eye or even to the development of meningitis.

How are they diagnosed?

The nasofibroendoscopa is a very useful tool to the otolaryngologists that is easy and painlessly and allows direct and detailed visualization of the nose and sinuses with a camera.

Similarly, the CT scan of the nose and paranasal sinuses may help assess more accurately the location and extent of the polyps in deeper areas of the sinuses and allowing the extent of mucosal inflammation to be assessed. Also it allows us to know if there is obstruction of either side within the nasal cavity and thus it is best option to decide and plan treatment for the patient.

There may also be other diagnoses studies that can be used such as allergy tests, and if polyps are found in the nasalesen of a child then a specific diagnostic test for cystic fibrosis should be carried out. It is important that treatment is multidisciplinary, i.e. several specialists should be consulted with in order to offer the best treatment and the gain best result for the patient.

Normally, depending on the size of polyps, our first approach is to treat the polyps with medication. Corticosteroids (nasal sprays) are the first line treatment because they help us to reduce inflammation. This treatment can reduce the size of polyps and sometimes even eliminate them altogether. Other times, we can accompany oral and injectable corticosteroids if they do not get the desired effect with the nasal spray. Also, occasionally we have to prescribe antihistamines to control the allergic process as well as antibiotics to treat chronic or recurrent infections.

Surgical treatment for nasal polyposis

The surgery is performed when despite medical treatment, polyps do not get smaller or disappear. The type of surgery depends on the size, the number and location of polyps.

There are 2 surgeries that can be performed. The first of them is the polypectomy (Hippocrates, the father of Rhinology, was the first to do it), which is used in small or isolated polyps that can be completely removed with a suction device or a microdebrider. The second is endoscopic sinus surgery (which uses a camera that magnifies the nasal structures). It is reserved to remove large polyps and to correct sinus problems that promote inflammation and the development thereof of polyps.

Although surgery is associated with a significant improvement in most patients it may be less effective in those with a combination of polyps and asthma or those with polyps, asthma and hypersensitivity to aspirin ( Triad Sampter described this in 1969 in Sampter and Beer).

Reoccurrence

Unfortunately, nasal polyps tend to recur if the underlying cause is not treated or controlled. Therefore, both the otolaryngologist and allergist and sometimes even the inmunologist must maintain tight control of the patient because they must address the factors mentioned above in order to offer the patient a better quality of life.