Nasal polyps
What are Nasal Polyps?
Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation and are associated with asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.
Small nasal polyps may not cause symptoms. Larger growths or groups of nasal polyps can block your nasal passages or lead to breathing problems, a lost sense of smell and frequent infections.
Nasal polyps can affect anyone, but they’re more common in adults. Medications can often shrink or eliminate nasal polyps, but surgery is sometimes needed to remove them. Even after successful treatment, nasal polyps often return.
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Before Nasal Polyps Surgery
Symptoms
Individuals with nasal polyps tend to have chronic inflammation of the lining of the nasal passages and sinuses (chronic sinusitis).
If there are clusters or large polyps, the patient’s nasal passages and sinuses may be obstructed.
Some people with small nasal polyps may have no signs or symptoms; however, the following are common:
. Runny nose – this may be chronic, with the patient feeling as if they always have a cold.
. Persistent stuffy or blocked nose – in some cases, the patient may find it hard to breathe through the nose, causing sleeping problems.
. Postnasal drip – a feeling of mucus continually running down the back of the throat.
. Either no sense of smell or poor sense of smell – this may not improve after polyps are treated.
. Poor sense of taste – this may not improve after polyps are treated.
. Pain in the face
. Headache
. Snoring
. Itchiness around the eyes
. Obstructive sleep apnea (in severe cases) – this is a potentially serious condition where the patient stops breathing during sleep.
. Double vision (in severe cases) – more likely to occur if the patient has allergic fungal sinusitis or cystic fibrosis.
When to see a doctor
See your doctor if your symptoms last more than 10 days. Symptoms of chronic sinusitis and nasal polyps are similar to those of many other conditions, including the common cold.
Causes
The exact causes of nasal polyps are not known. Although a significant number of cases are linked to non-allergic asthma, in some cases, no respiratory or allergic trigger is found.
Nasal polyps have no relationship with colonic or uterine polyps found in the digestive system or uterus, respectively.
The exact mechanism of polyp formation is unknown, but most researchers agree that they are the result of swelling (inflammation) in the nose or sinuses – they are not a disease.
Some experts believe that inflammation causes an accumulation of fluid in the interstitial space (space between mucous-forming cells) of the nose and sinuses. Eventually, gravity pulls these heavy cells down, resulting in polyps. Scientists believe possible triggers are bacterial or viral infection, an allergy, or an immune response to a fungus.
Nasal polyps appear most frequently near the openings to the sinuses (in the nasal passage); however, they can develop anywhere throughout the nasal passages or sinuses.
Risk factors
Risk factors include:
. Sensitivity to aspirin – people with an allergic response to aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) are more likely to develop polyps.
. Asthma – a disease that causes the airway to swell (inflame) and narrow.
. Allergic fungal sinusitis an allergy to airborne fungi.
. Rhinitis/Rhinosinusitis – an inflammation of the nasal passage and sinuses, typically lasting 12 weeks or more. This condition includes hay fever.
. Cystic fibrosis – a chronic disease that affects organs such as the liver, lungs, pancreas, and intestines.
. Churg-Strauss syndrome – a disease that results in the inflammation of blood vessels.
. Age – Nasal polyps can occur at any age, but young and middle-aged adults are more at risk.
. Genetics – individuals whose parents have had nasal polyps have a higher risk of developing them.
. Vitamin D deficiency – which occurs when your body doesn’t have enough vitamin D
Complications
Nasal polyps can cause complications because they block normal airflow and fluid drainage, and also because of the long-term irritation and swelling (inflammation) underlying their development.
Potential complications include:
. Obstructive sleep apnea. This is a potentially serious condition in which you stop and start breathing frequently during sleep.
. Asthma flare-ups. Chronic sinusitis can worsen asthma.
. Sinus infections. Nasal polyps can make you more susceptible to sinus infections that recur often.
Diagnosis
Your doctor can usually make a diagnosis based on your answers to questions about your symptoms, a general physical exam and an examination of your nose. Polyps may be visible with the aid of a simple lighted instrument.
Other diagnostic tests include:
. Nasal endoscopy. A narrow tube with a lighted magnifying lens or tiny camera (nasal endoscope) enables your doctor to perform a detailed examination inside your nose and sinuses.
. Imaging studies. Images obtained with computerized tomography (CT) can help your doctor pinpoint the size and location of polyps in deeper areas of your sinuses and evaluate the extent of swelling and irritation (inflammation).
These studies may also help your doctor rule out other possible blockages in your nasal cavity, such as structural abnormalities or another type of cancerous or noncancerous growth.
. Allergy tests. Your doctor may suggest skin tests to determine if allergies are contributing to chronic inflammation. With a skin prick test, tiny drops of allergy-causing agents (allergens) are pricked into the skin of your forearm or upper back. Your doctor or nurse then observes your skin for signs of allergic reactions.
If a skin test can’t be performed, your doctor may order a blood test that screens for specific antibodies to various allergens.
. Test for cystic fibrosis. If you have a child diagnosed with nasal polyps, your doctor may suggest testing for cystic fibrosis, an inherited condition affecting the glands that produce mucus, tears, sweat, saliva and digestive juices.
The standard diagnostic test for cystic fibrosis is a noninvasive sweat test, which determines whether your child’s perspiration is saltier than most people’s sweat is.
. Blood test. Your doctor may test your blood for low levels of vitamin D, which are associated with nasal polyps.
Prevention
You may help reduce your chances of developing nasal polyps or having nasal polyps recur after treatment with the following strategies:
Manage allergies and asthma. Follow your doctor’s treatment recommendations. If your symptoms aren’t well controlled, talk to your doctor about changing your treatment plan.
Avoid nasal irritants. As much as possible, avoid breathing airborne substances that are likely to contribute to swelling or irritation in your nose and sinuses, such as allergens, tobacco smoke, chemical fumes, and dust and fine debris.
Practice good hygiene. Wash your hands regularly and thoroughly. This is one of the best ways to protect against bacterial and viral infections that can cause inflammation of the nasal passages and sinuses.
Humidify your home. Using a humidifier may help moisten your breathing passages, improve the flow of mucus from your sinuses, and help prevent blockages and inflammation. Clean the humidifier daily to prevent bacteria from growing.
Use a nasal rinse. Use a saltwater (saline) spray or nasal wash to rinse your nasal passages. This may improve mucus flow and remove allergens and other irritants.
You can purchase over-the-counter saline sprays or nasal wash kits with devices, such as a neti pot or squeeze bottle, to administer a rinse.
Use water that’s distilled, sterile, previously boiled for one minute and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller to make up the irrigation solution. Rinse the irrigation device after each use with the distilled, sterile, previously boiled, or filtered water and leave it open to air-dry.
During Nasal Polyps Surgery
Treatment
Chronic sinusitis, with or without polyps, is a challenging condition to clear up completely.
You’ll work with your health care team to develop the appropriate long-term treatment plan to manage your symptoms and to treat factors, such as allergies, that may contribute to chronic swelling (inflammation).
The treatment goal for nasal polyps is to reduce their size or eliminate them. Medications are usually the first approach. Surgery may sometimes be needed, but it may not provide a permanent solution because polyps tend to recur.
Medications
Nasal polyp treatment usually starts with drugs, which can make even large polyps shrink or disappear. Drug treatments may include:
. Nasal corticosteroids. Your doctor is likely to prescribe a corticosteroid nasal spray to reduce swelling and irritation. This treatment may shrink the polyps or eliminate them completely.
Nasal corticosteroids include fluticasone (Flonase Allergy Relief, Flovent HFA, Xhance), budesonide (Rhinocort), mometasone (Nasonex, Asmanex HFA), triamcinolone (Nasacort Allergy 24HR), beclomethasone (Beconase AQ, Qvar Redihaler, Qnasl) and ciclesonide (Omnaris, Alvesco, Zetonna).
. Oral and injectable corticosteroids. If a nasal corticosteroid isn’t effective, your doctor may prescribe an oral corticosteroid, such as prednisone, either alone or in combination with a nasal spray.
Because oral corticosteroids can cause serious side effects, you usually take them only for a limited period.
Injectable corticosteroids may be used if nasal polyps are severe.
. Medication to treat nasal polyps and chronic sinusitis. If you have nasal polyps and chronic sinusitis, your doctor may give you an injection of a medication called dupilumab (Dupixent) to treat your condition. This medication may reduce the size of the nasal polyps and lessen congestion.
. Other medications. Your doctor may prescribe drugs to treat conditions that contribute to long-term swelling in your sinuses or nasal passages. These may include antihistamines to treat allergies and antibiotics to treat a chronic or recurring infection.
Aspirin desensitization, under the care of an allergy specialist with experience in desensitization, may benefit some patients with nasal polyps and aspirin sensitivity. The treatment involves gradually increasing the amount of aspirin you take while under a doctor’s care in a hospital or clinic to help your body tolerate taking aspirin long term.
Surgery
If drug treatment doesn’t shrink or eliminate nasal polyps, you may need endoscopic surgery to remove polyps and to correct problems with your sinuses that make them prone to inflammation and the development of polyps.
In endoscopic surgery, the surgeon inserts a small tube with a lighted magnifying lens or tiny camera (endoscope) into your nostrils and guides it into your sinus cavities. He or she uses tiny instruments to remove polyps and other substances that block the flow of fluids from your sinuses.
Your surgeon may also enlarge the openings leading from your sinuses to your nasal passages. Endoscopic surgery is usually performed as an outpatient procedure.
After surgery, you’ll likely use a corticosteroid nasal spray to help prevent the recurrence of nasal polyps. Your doctor may also recommend the use of a saltwater (saline) rinse to promote healing after surgery.
Potential future treatments
Researchers are studying the role of biologic drugs, including medications that treat severe asthma, in helping reduce nasal polyps and relieve symptoms. Biologics work by targeting specific cells or proteins to reduce irritation and swelling. Early research suggests that the drugs may become options for people whose nasal polyps don’t respond to corticosteroids or surgery.
After Nasal Polyps Surgery
Recovery
You will have a drip pad under your nose to collect mucus and blood. Change it only when it bleeds through. You may have to do this every hour for 24 hours after surgery.
You may have some swelling of your nose, upper lip, or cheeks, or around your eyes. Your nose may be sore and will bleed. You may feel “stuffed up” like you have a bad head cold. This will last for several days after surgery.
The tip of your nose and your upper lip and gums may be numb. Feeling will return in a few weeks to a few months. Your sense of smell will not be as good after surgery. It will improve and probably return to normal in 1 to 2 months.
You will probably be able to return to work or school in about 1 week and to your normal routine in about 3 weeks. But this varies with your job and the extent of your surgery. Most people feel normal in 1 to 2 months.
You will have to visit your doctor regularly for 3 to 4 months after your surgery. Your doctor will check to see that your sinuses are healing well.
This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.
How can you care for yourself at home?
Activity
. Rest when you feel tired. Getting enough sleep will help you recover. Do not lie flat. Raise your head with three or four pillows. This can reduce swelling. Try to sleep on your back during the month after surgery. You can also sleep in a reclining chair.
. Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation. Also, try to sit and stand as much as you can.
. For 1 week, try not to bend over or lift anything heavier than 4.5 kg (10 lb). This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
. You can take a shower or bath. Use lukewarm, not hot water. Avoid swimming for 6 weeks.
. Avoid sawdust, chemicals, and excessive dust for 4 weeks.
. Avoid strenuous activities, such as biking, jogging, weight lifting, or aerobic exercise, for 1 week and then ease back into these activities over 2 to 3 weeks.
. You may drive when you are no longer taking prescription pain medicine and feel up to it.
. You will probably be able to return to work or school in about 1 week and to your normal routine in about 3 weeks. But this varies with your job and the extent of your surgery.
Diet
. You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
Medicines
. Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
. If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do.
. Do not take aspirin, aspirin-containing medicines, or anti-inflammatory medicines such as ibuprofen (Advil, Motrin) or naproxen (Aleve) for 3 weeks following surgery unless your doctor says it is okay.
. Take pain medicines exactly as directed.
. If the doctor gave you a prescription medicine for pain, take it as prescribed.
. Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
. If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
. If you think your pain medicine is making you sick to your stomach:
. Take your medicine after meals (unless your doctor has told you not to).
. Ask your doctor for a different pain medicine.
Incision care
. You probably will not have an incision (cut). You will have a drip pad under your nose to collect blood. Change it only when it has bled through. You may have to do this every hour for 24 hours after surgery. When bleeding stops, you can remove it.
. If you have packing in your nose, leave it in. Your doctor will take it out.
Ice and elevation
. To help with swelling and pain, put ice or a cold pack on your nose for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
. Do not sleep flat. Sleep with your head raised up. You can also sleep in a reclining chair.
Other instructions
. Do not blow your nose for 2 weeks.
. Do not put anything into your nose.
. If you must sneeze, open your mouth and sneeze naturally.
. Keep your mouth clean. Rinse your mouth with salt water or an alcohol-free mouthwash after each meal and before bedtime.
. After any packing is removed, use saline (saltwater) nasal washes to help keep your nasal passages open and wash out mucus and bacteria. You can buy saline nose drops at a grocery store or drugstore.
. Use a nasal spray containing a steroid to reduce inflammation.
. Use a humidifier to keep room air moist, especially in the bedroom.
. You can wear your glasses when you wish. Do not wear contacts until the day after the surgery.
. Do not travel by airplane for at least 2 weeks. Your sinuses are still healing, and the changes in air pressure can affect them.
What is the long-term outlook?
With surgical treatment, most symptoms get significantly better. However, if you’ve lost some sense of smell, it may never return. Even with surgery, nasal polyps may regrow in up to 15 percent of people with a chronic nasal problem.