What are nasal polyps?
Nasal polyps are smooth, painless, cancer-free growths in the lining of the nasal passages or sinuses. They hang like tears or grapes. These are caused by chronic inflammation and are associated with asthma, recurrent infections, allergies, drug sensitivity, or certain immune disorders.
Minor nasal polyps may not cause symptoms. Large growths or clumps of nasal polyps can block the nasal passages or lead to breathing problems, loss of smell, and frequent infections.
Nasal polyps affect 4 to 40 per cent of the general population and are 2 to 4 times more common in men than in women. The people who develop them are young or middle-aged adults.
Nasal polyps can affect anyone, but they are more common in adults. Medications can often shrink or remove nasal polyps, but surgery is sometimes necessary to remove them. Even after successful treatment, nasal polyps often reappear.
Symptoms of nasal polyps
Nasal polyps are associated with irritation and inflammation of the nasal passages and the lining of the sinuses that last longer than 12 weeks (chronic sinusitis). However, chronic sinusitis is more likely to occur without nasal polyps.
Nasal polyps themselves are soft and do not cause a sensation, so if they are small, you may not know they exist. Multiple growths or large polyps can block the nasal passages and sinuses.
Common signs and symptoms of chronic sinusitis with nasal polyps:
- Runny nose
- Continuous congestion
- Postnasal drip
- Decreased or no odor
- Loss of sense of taste
- Facial pain or headache
- Pain in the upper teeth
- The sensation of pressure in the forehead and face.
- Frequent nostrils
What are the causes of nasal polyps?
Nasal polyps grow in the inflamed tissue of the nasal mucosa. Mucus is a very moist layer that helps protect the inside of your nose and sinuses and hydrates the air you breathe. During an allergy-induced infection or irritation, the nasal mucosa becomes swollen and red and produces fluid. With chronic irritation, the mucus forms a polyp. A polyp is around growth (like a small cyst) that can block the nasal passages.
Although some people can develop polyps without prior nasal problems, there is often a trigger for developing polyps. These triggers include:
- Chronic or recurrent sinus infection
- Allergic rhinitis (hay fever)
- Cystic fibrosis
- Churg-Strauss syndrome
Sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin. Some people may have a hereditary tendency to develop polyps. Your genes can make your mucus respond to inflammation.
Risk factors for nasal polyps
Any condition that triggers chronic irritation and inflammation in the nasal passages or sinuses, such as infections or allergies, increases the risk of developing nasal polyps.
Common conditions associated with nasal polyps:
- Asthma, a disease that causes swelling (inflammation) and narrowing of the airways.
- Aspirin sensitivity
- Allergic fungal sinusitis, allergy to airborne fungi
- Cystic fibrosis is the formation of abnormally thick, viscous fluids in the body, including thick mucus from the nasal linings and sinuses.
- Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis), a rare disease that causes inflammation of the blood vessels.
- Vitamin D deficiency, which occurs when your body doesn’t have enough vitamin D.
- Your family history also plays a role. Some genetic variations associated with immune system function have some evidence that you may have developed nasal polyps.
Diagnosis of nasal polyps
To find out if you have, your doctor will ask you questions about how you feel. You will probably also have a physical exam.
From there, they will look at your nose using a tool called a nasal endoscope. It has a magnifying glass or camera that provides a detailed view of the nose and sinuses.
If those things don’t confirm the diagnosis, your doctor may order more tests, which may include:
- Imaging tests, including computed tomography (CT)
- Allergy testing so your doctor can determine if allergies are causing inflammation.
- Blood tests to check vitamin D levels. If they are low, they can cause polyps.
Nasal polyps treatment
Chronic sinusitis, with or without polyps, is a difficult condition to eliminate. He/She works with your health care team to manage your symptoms and develop an appropriate long-term treatment plan to treat factors such as allergies that contribute to chronic inflammation (inflammation).
The goal of treating nasal polyps is to reduce or remove them. Medications are usually the first approach. Surgery is sometimes needed, but it may not provide a permanent solution because the polyps will reappear.
Treatment of nasal polyps usually begins with medications, which also shrink or disappear in larger polyps. Treatment medications may include:
- Nasal corticosteroids: Your doctor may prescribe a corticosteroid nasal spray to reduce inflammation and irritation. This treatment can shrink polyps or remove them completely.
Nasal corticosteroids include Fluticasone (Flonase Allergy Relief, Flovent HFA, Xanax), Budesonide (Rhinocort), Mometasone (Nasonex, Asmanex HFA), Triamcinolone (NASACORMO, 24).
- Oral and injectable corticosteroids: If nasal corticosteroids are not effective, your doctor may prescribe oral corticosteroids such as prednisone alone or in combination with a nasal spray.
Since oral corticosteroids can cause serious side effects, you should generally take them only for a limited period of time. Injectable corticosteroids can be used if it is severe.
- Medicines to treat nasal polyps and chronic sinusitis. If you have this disease and chronic sinusitis, your doctor may inject you with a medicine called Dupilumab (Dupixent) to treat your condition. These medications reduce the size of this disease and reduce congestion.
- Other drugs: Your doctor may prescribe medications to treat conditions that cause chronic inflammation in your sinuses or nasal passages. These can include antihistamines to treat allergies and antibiotics to treat chronic or recurring infections.
Aspirin desensitization may benefit some patients with this disease and aspirin sensitivity, under the care of allergists with experience in desensitization. A gradual increase in the amount of aspirin you take while under the care of a doctor in a hospital or clinic is therapeutic, as your body can tolerate prolonged aspirin intake.
Endoscopic Sinus Surgery
- If it does not shrink or disappear, you may need endoscopic surgery to remove the polyps and correct sinus problems, which can lead to the development of inflammation and polyps.
- In endoscopic surgery, the surgeon inserts a small tube into your nostrils with a lighted magnifying glass or a small camera (endoscope) to guide it into the nasal cavities. He or she uses small devices to remove polyps and other substances that block the flow of fluid from your sinuses.
- Your surgeon may also extend the openings that run from your sinuses to your nasal passages. Endoscopic surgery is generally performed as an atrial procedure for the patient.
- After surgery, you can use a corticosteroid nasal spray to prevent the recurrence of nasal polyps. Your doctor may recommend a saline (saline) cleanse to promote healing after surgery.
Researchers are studying the role of biologics, including those that can treat acute asthma, in shrinking nasal polyps, and relieving symptoms. Biology works by targeting specific cells or proteins to reduce irritation and inflammation. Early research suggests that medications may become options for people who do not respond to corticosteroids or nasal polyps for surgery.
Complications of nasal polyps
Sometimes a large polyp, or group of polyps, can block the flow of air and fluid from the sinuses or nasal cavity; This can lead to the following problems:
- Chronic or frequent sinus infection
- Obstructive sleep apnea
The structure of the face can change and cause double vision. Sometimes the eyes are separated more than usual (this is more common in cystic fibrosis patients)
Prevention of nasal polyps
- Humidity: If the air in your home is dry, use humidity.
- Hygiene: Regular and thorough hand washing reduces the risk of bacterial or viral infections, resulting in less inflammation of the sinuses and nasal passages.
- Irritation: Preventing irritants like certain allergens, chemicals, and air pollutants (which cause inflammation) can help reduce the risk of developing polyps in some people.
- Asthma and allergy management: Patients who follow their doctor’s recommendations regarding asthma and/or allergy treatment are less likely to develop this disease.
- Nasal wash or nasal cleansing: Rinsing the nasal passages with a nasal wash or saline spray can help improve mucus flow and remove irritants and allergens.