Nasal Polyp - Definition, Symptoms, Diagnosis and Treatment

Nose polyps

Nasal Polyp - Definition, Symptoms, Diagnosis and Treatment

What is a nasal polyp?

Nasal polyps or nose polyps are soft, painless, non-cancerous masses located within the nasal cavities. They usually grow like bunches of grapes and hang down. When a large number of nasal polyps are exist in the nasal cavity, it is called "nasal polyposis".

Nasal Polyps Filling Both Nasal Cavities

Causes and mechanism of nasal polyps

Nasal polyps are caused by chronic inflammation of mucosal surfaces caused by allergic asthma or rhinitis, recurrent infections, drug sensitivity, or various immune system diseases.

How does nasal polyp occur?

The causes of nasal polyps have not yet been clearly elucidated by scientists. Chronic mucosal inflammation or irritation are the most accused and thought to be the causes. On the basis of continuous infection, allergy, chronic irritation or immune system disease, a mucous membrane is formed that can produce fluid in the mucous membranes covering the nose and becomes polyp. It is argued that people with nasal polyps have a different immune system response that can cause polyp formation, unlike other people.

Risk factors for nasal polyps

The risk of nasal polyps increases in the following diseases and conditions that can trigger inflammation of the nasal mucosa:

• Asthma (general airway inflammation)
• Allergic fungal sinusitis
• Cystic fibrosis (abnormal, dark viscous and sticky secretions of nose and sinus secretions as a result of genetic disorder)
• Churg-Strauss syndrome (a rare disease that causes inflammation of blood vessels)
• Presence of chronic sinusitis or other masses that may cause nasal infection
• Family h'story of nasal polyps in the  (genetic predisposition)

Where are the most common nasal polyps in the nose?

Nasal polyps can be seen anywhere in the nose. They are most commonly seen in the nasal choking areas of the sinuses and at the starting points of the sinusitis (osteometal complex site). Sometimes even normal turbinates can become polyp.

At what age is nasal polyps most common?

Nasal polyps can occur at any age. It is most commonly seen in young and middle-aged adults.

Symptoms of nasal polyps

In patients with nasal polyps, chronic sinusitis (sinusitis lasting more than 12 weeks) is usually accompanied and the symptoms may overlap with chronic sinusitis. However, not every patient with chronic sinusitis should have a nasal polyp. When the nasal polyps are very large, they may obstruct the intranasal passage and cause severe respiratory distress.

Common symptoms of nasal polyps and chronic sinusitis

Symptoms of nasal polyps and common symptoms of chronic sinusitis include:

• Runny nose
• Permanent obstruction
• Postnasal drip
• Reduction or complete elimination of odor
• Loss of taste
• Facial pain or headache
• Pain in the upper teeth
• Feeling of pressure on forehead and face
• Snoring
• Itching around the eyes

When should patients with nasal polyps consult a doctor?

If the above symptoms persist for more than 10 days without interruption, it is advisable to consult a doctor. In this case, the patient will be evaluated for diseases that may cause nasal congestion such as colds and allergic rhinitis. In addition, if the above symptoms gradually increase and deteriorate, severe respiratory distress, double vision, pressure in the ears or a feeling of congestion (foreign sources have added fever, double vision increased headache, but these are among the risks of chronic sinusitis ...). It is appropriate for the patient to consult the ENT specialist.

Serious health problems due to nasal polyps

Because nasal polyps block fluid and air drainage within the nose, they may cause the following serious health problems:

• Obstructive sleep apnea syndrome
• Frequent asthma attacks (chronic sinusitis itself may increase asthma attacks)
• Sinus infections (nasal polyps may block the sinus drainage pathways and cause recurrent attacks of sinusitis.
• The spread of sinusitis to the eyes and visual changes (this information is often emphasized in foreign sources, but it is a very rare condition, mostly a risk factor for chronic sinusitis).
• Meningitis (this information is often emphasized in foreign sources, but it is a very rare case, a risk factor for chronic sinusitis).

How is nasal polyp diagnosed and what tests may be needed?

In patients with nasal polyps, the patient's complaints and careful ENT examination can be understood. Sometimes a simple intranasal light examination is sufficient. The following tests and methods can be used for the diagnosis of nasal polyps:

• Endoscopic nasal examination (nasal polyps are usually easily visible)
• Imaging studies (usually Paranasal Sinus Tomography is requested. Magnetic resonance imaging (MRI) is sometimes requested)
• Allergy tests (skin prick tests and blood tests for allergies may be requested to determine if they contribute to chronic inflammation)
• Tests for cystic fibrosis (especially in young patients with multiple polyps in the nose, may require tests for cystic fibrosis, a genetic disease affecting mucus production. Can be used for testing for tears, sweat, saliva and digestive juices) Non-invasive sweat test and chromosome analysis commonly used tests)

The following paranasal sinus tomography images show polyps filling the nasal cavity of the patient with "chronic rhinosinusitis with nasal polyps".

Chronic Rhinosinusitis With Nasal Polyps

Chronic Rhinosinusitis With Nasal Polyps

Chronic Rhinosinusitis With Nasal Polyps

Nasal Polyposis and Pansinusitis

Sinusitis, which does not improve with treatment, may occur in patients with polyps that have closed the intranasal cavity and sinus mouths for a long time, as the sinuses prevent physiological secretion and discharge. In the following 3 tomography images, it is seen that the sinuses of the patient with nasal polyposis who have not been treated for years and have not been under medical supervision (sinusitis).

Below are the photographs obtained during the nasal endoscopic examination of the patient, who has 3 tomography images above:

How is nasal polyp treatment?

Chronic sinusitis is already a health problem that is not easy to treat. In these patients, treatment in the presence of nasal polyps can be much more difficult and complex. Long-acting medical treatments with minimal side effects should be planned in the nasal polyps medication. The goal of latest treatment for nasal polyps is to reduce or eliminate the size of the polyps. Nasal polyps tend to recur despite all treatments (nasal polyps permanent treatment it is not always possible). Surgical treatment is preferred especially if the airways in the nose are completely obstructed or medical complaints no longer relieve.

Drug treatment for nasal polyps

The following groups of drugs can be used to medication for nose polyps:

• Corticosteroids: This group of drugs (best treatment for nasal polyps) can be used as spray, nasal drops, tablets or injection therapy. They reduce inflammation in the nose. They have been used as the most effective medical treatment tool for nasal polyp therapy for many years.
• Leukotriene receptor antagonists (montelukast sodium)
• Antihistamines
• Antibiotics (can also be used to treat chronic sinusitis)
• Aspirin desensitization treatments

Surgical treatment for nasal polyps

Surgical treatment is planned in patients who do not respond adequately with medical treatment and whose sinus openings are completely occluded. It is called "nasal polypectomy" by removing or removing nasal polyps only by other methods. In addition, the most commonly used surgical method is "functional endoscopic sinus surgery". Cortisone-containing drugs can be used before and after surgery.

Nasal Polyp - Tomography

Navigation Assisted Endoscopic Sinus Surgery is the most effective surgical treatment method currently known in which tomography sections are combined into 3-dimensional and 1 mm error margin during surgery is provided to the surgeon with excellent anatomical detail. In the above paranasal sinus tomography sections, the region originating from the left antrochoanal polyp and maxillary sinus is seen.

Recommendations to slow or prevent nasal polyp formation

It is important to take the following measures to reduce the formation of polyps in the nose:

• Preventive measures and treatments for allergies and asthma (avoidance of allergen contact, appropriate treatment during the allergy season, cleaning of allergens by washing the nose with saline water, measures to reduce allergens at home ...)

• Avoidance of chemical agents, cigarette smoke, dust that irritate or irritate the nose

• A small increase in ambient humidity in air-conditioned or dry air environments

• Regular nose wash with salty water

In some foreign sources, it is recommended that nasal wash water be boiled, cooled and filtered water or use sterile distilled water (source: http://www.mayoclinic.org/diseases-conditions/nasal-polyps/basics/prevention/con-20023206).

Nasal Polyp - Definition, Symptoms, Diagnosis and Treatment

The photos below show polyps removed (a handful) after endoscopic sinus surgery.

Why do nasal polyps occur despite treatment?

It is unclear why nasal polyps occur and it is not guaranteed that any of the nose polyps treatment will result. An article published in a reputable medical journal in 2004 argued that most of the patients who underwent endoscopic sinus surgery for nasal polyp therapy and who developed polyps again had asthma and similar allergic disease (source article link >> Recurrence rates after endoscopic sinus surgery for massive sinus polyposis)

In another study, there was no relationship between nasal polyp recurrence despite treatment and allergic disease (allergic rhinitis and asthma), age, sex, facial pain, inability to smell, nasal discharge, headache, and more clearly between disease staging performed using tomography and the risk of recurrence. It was emphasized that there is a relationship (ie, patients with excessive nasal polyps and excessive sinuses are affected have a higher risk of polyp re-formation after medical treatment or surgery) (link to article >> Factors associated with recurrent nasal polyps: a tertiary care experience) . In a different study, as in the previous two studies, 80% of patients who underwent nasal polyp surgery with endoscopic sinus surgery had recurrent polyps (ie, the risk of recurrence after nasal polyp surgery was greater in patients with nasal polyps with asthma). In the same article, aspirin intolerance increases the risk of recurrence of nasal polyps like asthma (source link >> Recurrent sinonasal polyposis after the endoscopic sinus surgery)

Antrochoanal polyp

Antrochoanal polyp

Among the nasal polyps, polyps that are usually "single" in the nose, obstructing a nostril, which can be seen in children and detected incidentally in careful endoscopic examinations or films, originating from the maxillary sinus and extending into the nasal cavity at the back are referred to as "Antrochoanal Polyp".

An overlooked cause of nasal congestion: Antrochoanal polyp

In patients with nasal obstruction, single nasal polyps originating from the sinuses behind the cheek (extending from the antrum to the koa) may be detected, except for simple allergic rhinitis, nasal flesh growth, nasal septum deviation, upper respiratory tract infection. It is defined as antrochoanal polyp.

Sometimes they can reach large dimensions and when viewed through the mouth, they may be liquid-like bubbles extending from top to bottom. It can move with head movements, repeating sinusitis attacks, nasal discharge, decrease in smell (anosmia) can be added to the table by disrupting sinus aeration. Antrochoanal polyps are usually seen in children and are unilateral.

Treatment consists of endoscopic sinus surgery and removal of this polyp. The sinus orifice from which the polyp originates is already enlarged by the polyp. Endoscopic simultaneous aspiration of the sinus content from which the polyp originates is performed in order to reduce the risk of polyp development. Patients sometimes confuse these polyps with simple nasal congestion reasons that may have different symptoms such as having nasal congestion that does not pass despite the use of a nasal opener spray, bleeding when forced by the nose, no water entering and exiting the single nostril while sinus rinse is used and the head movements feel inside the nose; nasal and then down to the pharynx can consult a doctor.

Risks of nasal polyp surgery

Functional Endoscopic Sinus Surgery (FESS) is generally used for surgical treatment of nasal polyps. In addition, the changing nasal anatomy due to diffuse polyps can be used in the "Navigation System", which provides excellent anatomical detail to the surgeon by superimposing the patient's skull with tomography images in order to minimize the errors that may arise due to difficulty in orientation during surgery. The following risks are particularly high in patients who have undergone polyp surgery and re-polyp, patients with common polyps, and patients with uncontrolled polyps who have not received medical treatment. Many surgeons prefer Navigation Assisted Functional Endoscopic Sinus Surgery in patients with extensive polyps and who do not benefit from medical treatment (although cure nasal polyps are permanently not always possible; navigation assisted endoscopic sinus surgery can be performed after medical treatment to ensure that patients remain asymptomatic for as long as possible after treatment.).

Risks of polyp removal can be summarized as the below:

Nasal polyp removal in office can sometimes be done. The following risks should not be overlooked whether they are performed in operating room conditions or in the office:

• Adhesion in the nose
• Cerebrospinal fluid leakage (usually caused by damage to the membranes when removing polyps in front of the sinuses in the base of the skull. Meningitis and risk of brain inflammation may also occur)
• Eye injury (damage to the eye muscles, spread of infection into the eye, bleeding into the eye, and rarely nerve damage)
• Infection and bleeding

Source links: Complications of surgery for nasal polyposis and chronic rhinosinusitis: the results of a national audit in England and Wales / Complications of endonasal endoscopic sinus surgery for management of nasal polyp and chronic sinusitis

Why is navigation-guided endoscopic sinus surgery the longest-acting treatment tool?

Considering the fact that unknown underlying etiology and medical therapies related to nasal polyps do not have a lasting effect, the risks have been reduced and surgical procedures have been focused on the best treatment for nose polyps. In patients with excessive polyps in the nose, navigation systems have been developed in order to restore the anatomical dominance of the surgeon and to present a 3-dimensional image to the physician during surgery. Three-dimensional computer-assisted sinus surgery is performed by matching the skull bones of the patient to the axial plane with thin section (at least 1 mm or less if possible) paranasal sinus tomography images. In this way, the surgeon can remove the areas of polyps within the nose within the widest range and can easily recognize structures such as the base of the head, the inner bone wall of the eye and stay away.

Source links: Computer-aided endoscopic sinus surgery: A retrospective comparative study / Functional endoscopic sinus surgery assisted by navigation system ...

The most effective medical treatment, albeit temporarily, in the treatment of nasal polyps: Cortisone

Nowadays, cortisone group drugs are the most effective drugs for non-surgical treatment of nasal polyps. Although the effects are temporary, it can slow down the patient's process until the surgery if given by the physician under regular control. The article "Nonsurgical Treatment of Nasal Polyps Treatment & Management" is summarized very well and I suggest you read it. In the treatment of nasal polyps, it is emphasized that intranasal cortisone spray and drop applications should be made with priority, especially systemic transmission is very low and that auxiliary products (antibiotics, antihistaminic drugs, topical diuretic treatment and intranasal lysine – acetylsalicylic acid ...) can be given. Unfortunately, cortisone, like all other treatment tools, has a temporary effect as nasal polyp removal without surgery. Especially in patients with uncontrolled, uncontrolled nasal plip, the effect of intranasal drug administration decreases after intranasal full filling of polyp tissues and may necessitate oral or intravenous cortisone treatment. Cortisone is a "best medication for nasal polyps". Local with /without systemic cortisone treatment is the best non surgical treatment for nasal polyps.

Herbal treatment to nasal polyps

I suggest you be careful about this. Although the etiology of nasal polyps is not clear; The use of allergy drugs has a place in the treatment of polyps. On the Internet you can find a lot of information for herbal treatment of nasal polyps. For example, "5 Natural Cures For Nasal Polyps" link turmeric, garlic, tea tree oil, oranges, dandelions related to the spilled (nasal polyps homeo treatment) ... Please do not use the products of nasal polyps herbal treatment are not clear and scientifically proven without consulting your doctor. The detailed scientific studşes are needed to find nose polyps natural cure and permanent treatment of its. Many patients are looking for nasal polyps over the counter treatment for nasal polyps. To do so, just follow the advice of your ent doctor. It can be dangerous for people who are allergic in particular to use such herbal products for trial purposes for nasal polyps otc treatment. Saline can be applied at home, but do not use any other treatments that are administered inside the nose without consulting your doctor.

What is Dupilumab?

Dupilumab is a monoclonal antibody-containing product designed for the treatment of atopic diseases. This drug was developed by Regeneron Pharmaceuticals. You can look the this link >> https://www.dovepress.com/dupilumab-a-novel-treatment-for-asthma-peer-reviewed-fulltext-article-JAA

How does Dupilumab work?

This interleukin-4 receptor (IL-4Rα) binds to the alpha subunit. IL-4Rα blockage stops the signaling of the pathway of dupilumab, interleukin 4 and interleukin 13.

What diseases is Dupilumab used for?

Interleukin 4 through 13 pathways play a role in the pathophysiology of allergic diseases, particularly asthma and atopic dermatitis. So this product is mainly used in the treatment of allergic diseases.

Innovations in the treatment of nasal polyps may be in the future ...

Nasal polyposis is a health problem in which medicine is partially helpless in the treatment of allergic diseases. In the following years, genetic factors that may cause the disease to occur, drugs that can stop the onset of polyp can be developed.

Similar link >> Endoscopic Sinus Surgery

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:

Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
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