Nasal polyps


Nasal polyps

Description, Causes and Risk Factors:

Nasal polyps are soft fleshy swellings that grow inside the nose. They may be yellowish, grey or pink in colour. They are benign and are not cancerous. Nasal polyps can vary greatly in size. There may be only one but sometimes several grow like a small bunch of grapes on a stem.

In most cases the cause is not known. It is thought that ongoing (chronic) inflammation in the nose causes swelling (edema) of the lining of the nostril. Due to gravity, this swelling hangs down (dependent edema), forming the polyp. Polyps usually affect both nostrils and can gradually enlarge, blocking the nose.

Polyps can also grow in the sinuses. The sinuses are air-filled spaces in the skull which drain into the nose. The biggest sinuses are called the maxillary sinuses. They are found under the eyes, behind the cheeks. The lining of the sinuses is the same as the lining of the nose, so this is why polyps can also form in the sinuses.

Rhinosinusitis is the name for this inflammation of the nose and sinuses. Often the cause is unknown but it can be due, in part, to infection. Nasal polyps can be a part of this condition.

Certain conditions make nose inflammation and polyps more likely. These include: asthma, an allergy, cystic fibrosis, and some rare conditions of the nose (such as allergic fungal sinusitis and Churg-Strauss syndrome).

Symptoms:

• The main symptom is a blocked feeling in the nose. You may find it difficult to breathe through your nose. You may then have to breathe through your mouth for much of the time. This is especially troublesome at night and your sleep may be affected.

• Watering from the nose (rhinorrhea) is common.

• A postnasal drip may occur. This is the sensation of something continually running down the back of your throat. It is due to mucus coming from the back of the nose because of large polyps.

• Your sense of smell and taste may be dulled or lost.

• A blocked nose may make your voice sound different.

• Larger polyps may cause headaches and snoring.

• Sometimes polyps block the drainage channel of the sinuses into the nose. This can make you more prone to sinusitis (infection of the sinuses).

• Large polyps sometimes interfere with breathing at night and cause obstructive sleep apnoea. (See separate leaflet called 'Sleep Apnoea' for more information.)

• Very large untreated polyps can make your nose and front of your face enlarge. This is rare. In extremely rare cases, double vision can occur due to huge polyps changing the structure of the face and pressing on the nerves that send vision signals from the eyes to the brain.

Diagnosis:

Your PCP might suspect that you have nasal polyps from your symptoms. A PCP can examine the lower part of the nostrils, so might be able to see a large polyp. It is usual for you to be referred to an ear, nose, and throat (ENT) specialist the first time you have symptoms of nasal polyps.

An ENT surgeon can usually diagnose nasal polyps based on your symptoms and on examination of your nose (and perhaps your sinuses).

Large polyps may be easily visible through your nostrils. Smaller polyps, and polyps in the sinuses are not visible via the nostrils. In such cases, the ENT specialist will pass a small flexible telescope with a camera on it (an endoscope), into your nose. This procedure is called nasendoscopy. It allows the extent and location of the polyps to be assessed.

Occasionally a CT or MRI scan may be needed. These scans may show more detail about where the polyps are and what effects they might have had on other parts of the face, sinuses and skull.

Treatment:

Everyone with nasal polyps should try treatment with medicines, before considering surgery (unless there is any doubt about whether there is a more serious problem, such as tumour).

Medicines for nasal polyps might be topical (for example, drops and sprays), or tablets.

Steroid nose drops are the usual first-line treatment for nasal polyps. Nose drops that contain steroid medicines reduce inflammation in the nose. Gradually, nasal stuffiness reduces, and the polyps shrink. Drops may take a week or two to make any obvious difference to your symptoms. You will probably be advised to use them for at least 4-6 weeks.

It is important to use the drops exactly as prescribed everyday for the best chance of success.

Surgery: An operation may be advised if polyps are large, or if steroid nose drops or tablets have not worked. Polypectomy involves removing the polyps with a surgical instrument. It can be done through the nostrils, either with local anaesthetic (awake), or under general anaesthetic. The type of anaesthetic might depend on the number and size of the polyps, where they are, and how fit you are for an operation. Endoscopic sinus surgery is done with a general anaesthetic. It might be done where the polyps are very large and numerous, or where they are seriously blocking your sinuses. The endoscope allows the surgeon to see into the sinuses with a camera, and to do the operation in a place that is difficult to reach with normal surgical instruments.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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