Nasal Polyps – Presentation and Management

Nasal polyps are common benign growths of the nose and paranasal sinuses. They have the appearance of peeled grapes, and they are sometimes associated with allergies or asthma. When small they are asymptomatic and require no treatment.

But the larger lesions are symptomatic with nasal obstruction and rhinorrhea the predominant symptoms. Medication and/or surgery are the main forms of treatment. Because they can recur after successful treatment, however, continued medical therapy is often necessary.

CAUSES

The causes of nasal polyps are not known. It’s also not clear why chronic inflammation triggers polyp formation in some people and not in others. There’s evidence that people who develop polyps have a different immune system response and unique chemical markers on their mucous membranes to those who don’t. They can develop at any age, but most commonly occur in the young and middle-aged adults.

RISK FACTORS

Any pathology that causes chronic inflammation in your nose or sinuses, e.g. infections or allergies, heightens the risk of developing nasal polyps. Medical conditions that are sometimes associated with them include:

• Asthma

• Aspirin sensitivity

• Allergic fungal sinusitis-allergy to airborne fungi.

• Cystic fibrosis-a genetic disorder that results in the production of abnormally thick and sticky secretions in nasal and sinus mucous membranes.

• Family or genetic predisposition may also lead to nasal polyps.

SYMPTOMS

• Running nose

• Nasal stuffiness

• Postnasal drip

• Decreased or absent sense of smell

• Facial pain or headache

• Pain in your upper teeth

• Pressure over your forehead and face

• Snoring

DIAGNOSIS

Nasal polyps are easily seen in the nose using a nasal speculum. Radiology, particularly CT SCAN, is excellent in displaying the extent of the disease.

TREATMENT

Treatment is often long term. Its objective is to reduce the size of the polyps and to eliminate the inflammation. Medication is usually is used initially. Surgery may sometimes be needed, but it may not provide a permanent solution since nasal polyps notoriously recur.

MEDICATION

Treatment of nasal polyps usually involves drugs, which can make even large lesions shrink or disappear. It often includes:

• Nasal corticosteroid sprays. These are very effective in reducing the size of the polyps and in dealing with the inflammation.

• Oral and injectable corticosteroids. These are effective for resistant symptoms, and because of side-effects, they are often used for a short period.

• Other medication-includes antihistamines, and antibiotics to treat chronic or recurring infections.

Aspirin desensitization (immunotherapy) may benefit some patients.

SURGERY

This is done endescopically and its indications are:

  • failed medical treatment ï�§
  • absence of smell (anosmia) ï�§
  • persistent sinusitis

CONCLUSION

Nasal polyps are fleshy non-cancerous growths of variable sizes that develop in the lining of the nose and paranasal sinuses. They are often bilateral. They commonly cause nasal obstruction, but may lead to serious complications such as sinusitis. Treatment may be medical or surgical, and is often long term.