We Performed Nasal Polypectomy and Functional Endoscopic Sinus Surgery (FESS)

Endoscopic Removal of Nose Polyps and Sinus Operation

Nasal Polypectomy, FESS, Functional Endoscopic Sinus Surgery, Nose Polyp

The 40-year-old patient, who developed nasal congestion due to intense polyps in the nose, was applied local and systemic cortisone treatment for about 20 days and it was observed that the polyps were quite retracted, but the patient still had severe nasal obstruction. At the same time, due to the mechanical pushing of the polyps, it was seen that the nasal septum deviated to the right. We performed septoplasty, nasal polypectomy and bilateral functional endoscopic sinus surgery (fess) operations on the patient. Below you can see the photos taken out of the nose.

Nasal Polypectomy, FESS, Functional Endoscopic Sinus Surgery, Nose Polyp

Nasal Polypectomy, FESS, Functional Endoscopic Sinus Surgery, Nose Polyp

"Nasal Polyps" and "Nasal Polyposis" Definition

As is known, there are many organs or tissues filled with air in the human body. Examples are the lungs, stomach, mouth, nose, sinuses around the nose, and external auditory canal. Sinus is the name given to spaces that look like an open pouch in general. Sinuses, whose inflammatory condition is popularly known as "sinusitis", are air-filled spaces in the skull bones connected with the nasal cavity and are called "paranasal sinuses". In the human body, there is a thin, superficial tissue layer composed of cells lining all these spaces. Here, structures such as flesh that grow out of this tissue layer and grow different from normal structures are called "polyp". Polyps can develop in any organ or tissue that is hollow and they are named according to their location. Names such as ear, vocal cord, stomach, and intestinal polyps are good examples of these. Polyps may develop from damage to the tissues lining the inside of the nose or the inner surface of the sinuses around the nose, whose mouth opens into the nose. The structure formed in this case is named as "Nasal Polyp" by defining the settlement with the word "NaSal", which means the nose in Latin. The disease state in which these polyps are present is called "Nasal Polyposis". This term refers to common polyps in the nose and associated sinuses. Nasal polyps are soft, pale-colored structures that hang into the nose, are painless to touch, and can be displaced by gravity. Nasal polyps are non-malignant formations originating from the nasal and sinus mucosa that can fill all nasal and sinus cavities in the form of pale pink tears. Aspirin sensitivity cases should be evaluated for the presence of nasal polyps in the nose.

How Does Nasal Polyp Occur?

It is not known exactly how polyps are formed and what mechanisms are effective in their formation and are still being investigated by scientists. Damage to the superficial tissue lining the nose and sinuses due to various reasons and its permanent condition are the most likely reasons. The most important factors that cause damage are inflammatory conditions and allergies. Continuous contact with or inhalation of certain harmful substances or some familial-hereditary reasons may also play a role in the formation of polyp. These conditions that cause polyp formation can be on their own or they can be all together. As a result, the superficial tissue lining the inside of the sinuses swells and grows from the mouth of the sinuses and into the nose. Nasal polyp usually occurs on both sides. Nasal polyps may also occur in some known diseases such as "Asthma" and "Cystic Fibrosis".

Symptoms of Nasal Polyp

Sometimes there are no symptoms, especially in small polyps. However, the symptoms of nasal polyps are generally as follows;
  • Severe nasal congestion
  • Difficulty breathing
  • Change in voice
  • Fullness in the sinuses
  • Snoring and sleep apnea due to inability to breathe
  • Taste and smell disorders
  • Nasal and nasal discharge
  • Pain in the head, eye area and upper teeth
Facial pain is more common in people with chronic sinusitis than those with nasal polyps. It may be possible to see the polyp in the nostrils in those with a serious nasal polyps problem. These structures have a jelly-like appearance.

Prolonged nasal polyps can lead to widening of the nasal bridge, which eventually the eyes may appear separated from each other.

Nasal polyps cause nasal congestion by mechanically blocking the flow of air passing through the nose. In addition, depending on whether there is another concomitant disease or not, they may cause nasal discharge that changes in consistency and color. A large part of this discharge also flows down the nasal passages and may cause an aggravation of "Asthma" disease or asthma attacks. Since the air taken from the nose is blocked, the sense of smell may be lost or reduced. They can cause headaches due to the fullness of the sinuses or after inflammatory conditions. As a result, there may be complaints such as snoring or sleep apnea, frequent throat tenderness and inflammation, and prolonged flu and flu due to the mouth breathing action. 

How Is Nasal Polyp Diagnosed?

In some cases, your doctor may diagnose nasal polyps by examining the nasal passages. During this examination, nasal endoscopy can be performed with a device with a small camera at the tip to better observe the nasal passage.

More commonly, however, sinus CT ("cat scan") is required to make a diagnosis. In some cases, it may be necessary to examine the condition of the sinuses with computed tomography. Since the diseases associated with the condition are common in people with nasal polyps, further examinations may be required.

Nasal Polyp Treatment

Nasal polyp treatment is performed by medical or surgical means, depending on the situation. Local or systemic corticosteroids can be used as medication. If there is an allergic condition, antihistamines may be preferred. Antileukotrienes can be used in patients with aspirin allergy. Again, depending on the cause of nasal polyp formation, decongestants and non-steroidal anti-inflammatory drugs may be useful. Saline nasal lavage can be applied. Benefits are provided as the sinuses will be washed along with the nasal passage. Polypectomy or endoscopic sinus surgery can be performed if there is no response to drug therapy, if it has caused chronic sinusitis or if it completely fills the nasal cavity and obstructs it. However, as there is a risk of recurrence in polyps, surgery should be the last option.

In severe cases, sinus surgery is required to remove nasal polyps and accompanying sinus infection. However, excessive use of surgery should be avoided as nasal polyp tends to grow back in at least one third of patients.

The best treatments for nasal polyps are medical treatments followed by surgical treatments. This approach will reduce the risk of nasal polyps recurring.


In the polypectomy technique, the sinuses are shaved or removed by cutting. It can be performed under local or general anesthesia.

Endoscopic Sinus Surgery (FESS)

Endoscopic sinus surgery is chosen for large polyps.

How Nasal Polypectomy and Endoscopic Sinus Surgery Are Performed?

Nasal polyp surgery has shown significant changes in parallel with the technological developments in recent years. Surgical procedures, which were performed inside the mouth or outside the face in some special cases, can now be performed endoscopically through the nose by planning on the millimetric images of computed tomography. In the endoscopic method, it is entered through the nose using a light source, camera and monitor, and polyps and damaged tissues in the nose and sinuses are cleaned. After the polyps are cleaned, the places where the sinuses are opened into the nose are also checked and if necessary, the sinuses are opened to return to normal. The surgery can be performed both through regional anesthesia and by being put to sleep under general anesthesia. These surgeries are generally called "Endoscopic Sinus Surgery". Thanks to the very fine instruments used in the endoscopic method, some unwanted results that may occur in close organs such as the eye and brain can be prevented. These new methods both naturally ensure that existing structures do not deteriorate and reduce the recurrence rate of the disease by cleaning even the smallest polyps. Since no incision is made outside the nose, there are no stitches, stitch marks and visible wounds.

Why Do Nasal Polyp Surgeries Be Required Again?

The success rate in patients with nasal polyps with simple symptoms without an obvious disease and therefore undergoing surgery is over ninety percent. However, the success rate decreases in common or co-existing cases with other diseases such as allergy, asthma, cystic fibrosis and aspirin allergy. In these people, nasal polyps may recur despite everything. In such patients, the purpose after surgery is to delay the formation of polyps as much as possible with drug therapy. The surgery can be repeated if necessary.

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

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