Nasal Polyps

Nasal Polyps

 

Definition

A polyp is the medical term for any overgrowth of tissue from the surface of a body organ. Polyps come in all shapes—round, droplet, and irregular being the most common. Nasal polyps are teardrop-shaped while growing and resemble peeled grapes when they have reached their full size. The condition of nasal polyps is sometimes called nasal polyposis.

Description

Nasal polyps tend to occur in people with respiratory allergies. Hay fever (allergic rhinitis) is an irritation of the membranes of the nose by airborne particles or chemicals. These membranes secrete mucus. When irritated, they can also grow polyps. The nose is not only a passageway for air to reach the lungs; it also provides the connection between the sinuses and the outside world. Sinuses are lined with mucous membranes, just like the nose. Polyps can easily obstruct the drainage of mucus from the sinuses. When any fluid in the body is trapped so it cannot flow freely, it becomes infected. The result, sinusitis, is a common complication of allergic rhinitis.
Nasal polyps may also develop in children with cystic fibrosis.

Causes and symptoms

Some people who are allergic to aspirin develop both asthma and nasal polyps.
Nasal polyps often plug the nose, usually one side at a time. People with allergic rhinitis are so used to having a stopped-up nose they may not notice the difference when a polyp develops. Other polyps may be closer to a sinus opening, so airflow is not obstructed, but mucus becomes trapped in the sinus. In this case, there is a feeling of fullness in the head, no sense of smell, and perhaps a headache. The trapped mucus will eventually get infected, adding pain, fever, and perhaps bloody discharge from the nose.

Diagnosis

A physical examination will identify most polyps. Small polyps located higher up or further back may be hidden from view, but they will be detected with more sophisticated medical instruments. The otorhinolaryngologist is equipped to diagnose nasal polyps. In order to perform the examination, the doctor must apply medicine to reduce congestion in the swollen membranes. Cotton balls soaked with one of these agents and left in the nostrils for a few minutes provide adequate shrinkage.

Treatment

Most polyps can be removed by the head and neck surgeon as an office procedure called a nasal polypectomy. Bleeding, the only complication, is usually easy to control. Nose and sinus infections can be treated with antibiotics and decongestants, but if airflow is restricted, the infection will recur.

Key terms

Allergen — Any substance that irritates only those who are sensitive (allergic) to it.
Asthma — Wheezing (labored breathing) due to allergies or irritation of the lungs.
Decongestant — Medicines that shrink blood vessels and consequently mucus membranes. Pseudoephedrine, phenylephrine, and phenylpropanolamine are the most common.
Polyposis — The medical term for the development of multiple polyps on a body part.
Sinus — Air-filled cavities surrounding the eyes and nose are lined with mucus-producing membranes. They cleanse the nose, add resonance to the voice, and partially determine the structure of the face.

Prognosis

Polyps may reappear as long as the allergic irritation continues. In addition, one study of patients who had undergone nasal polypectomy reported that 60% had a recurrence of nasal polyposis, and 47% were advised to have revision surgery. The risk of recurrence is higher among patients with asthma.

Prevention

If aspirin is the cause of the polyps, all aspirin containing medications must be avoided.
Since most nasal polyps are the result of allergic rhinitis, they can be prevented by treating this condition. New treatments have greatly improved control of hay fever. There are now several spray medicines that are quite effective. Spray cortisone-like drugs, usually beclomethasone (Beconase, Vancenase) or flunisolide (Nasalide), are the most popular. Over-the-counter nasal decongestants have an irritating effect similar to the allergy they are supposed to be treating. Continued use can bring more trouble than relief and result in an addiction to nose sprays. The resulting disease, rhinitis medicamentosa, is more difficult to treat than allergic rhinitis.
Allergists and ENT surgeons both treat allergic rhinitis with a procedure called desensitization. After identifying suspect allergens using one of several methods, they will give the patient increasing doses of those allergens in order to produce blocking antibodies that will impede the allergic reaction. This approach is effective in a number of patients, but the treatment may take a period of months to years.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Nose and Paranasal Sinuses: Polyps." Section 7, Chapter 86 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Bikhazi, N. B. "Contemporary Management of Nasal Polyps." Otolaryngologic Clinics of North America 37 (April 2004): 327-337.
Drake-Lee, A. B. "Nasal Polyps." Hospital Medicine 65 (May 2004): 264-267.
Wynn, R., and G. Har-El. "Recurrence Rates after Endoscopic Sinus Surgery for Massive Sinus Polyposis." Laryngoscope 114 (May 2004): 811-813.

Organizations

American Academy of Allergy, Asthma and Immunology (AAAAI). 611 East Wells Street, Milwaukee, WI 53202. (800) 822-2762. http://www.aaaai.org.
American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince Street, Alexandria, VA 22314-3357. (703) 836-4444. http://entnet.org.
References in periodicals archive ?
Although most anosmics who are not born with the condition can pinpoint what caused the loss of their sense - perhaps through trauma to the head, a sinus infection or nasal polyps - Karen is not sure what made her lose her ability to smell.
The pathogenesis of nasal polyps has been debated for many years.
When to see your GP The symptoms of nasal polyps can be very similar to a cold, but nasal polyps won't get better unless they are treated.
Bloody discharge or pus from the nose indicates a nasal tumor or nasal polyps, which is an overgrown gland that produces mucus.
40% of the affected suffer from chronic rhinosinusitis with nasal polyps (CRSwNP)[sup.
Failure to receive the correct treatment for allergic rhinitis can lead to rhino sinusitis, nasal polyps, and asthma, which are more serious conditions that can be avoided, he said.
Colds can do this in the short term but a more prolonged cause could be allergy, inflammation of the sinuses or nasal polyps.
severe septal deviation/spurs, nasal polyps, neoplasms, concha bullosa, paradoxically bent turbinates
Your GP may check for nasal polyps and prescribe nasal steroids.
The diagnosis of sinusitis is guided by a recent European position paper on rhinosinusitis and nasal polyps (EPOS).
They advise referral to secondary care when there is recurrent or chronic sinusitis, progressive or unremitting facial pain, and nasal polyps which are causing significant nasal obstruction and patients have had a trial of intranasal corticosteroids for 3 months which was ineffective.
These include otology disorders such as facial palsy, chronic otitis media, and Meniere's disease; rhinology problems like nasal polyps, tumors, and trauma; head and neck disorders, including voice disorders, thyroid swelling, salivary gland diseases, and sleep apnea; and pediatric problems.