Nasal polyps

Nasal polyps are polypoidal masses arising mainly from the mucous membranes of the nose and paranasal sinuses. They are overgrowths of the mucosa that frequently accompany allergic rhinitis. They are freely movable and nontender.

Description
Nasal polyps are usually classified into antrochoanal polyps and ethmoidal polyps. Antrochoanal polyps arise from the maxillary sinuses and are the much less common, ethmoidal polyps arise from the ethmoidal sinuses. Antrochoanal polyps are usually single and unilateral whereas ethmoidal polyps are multiple and bilateral. Symptoms of polyps include nasal block, sinusitis, anosmia (loss of smell), and secondary infection leading to headache.[1] Despite removal by surgery, nasal polyps are found to reoccur in about 70% of cases. Sinus surgery requires great amount of precision as this involves risk of damage to orbit matter. The tendency to manifest multiple polyps is referred to as polyposis.

Types
There are 2 major types of nasal polyps.

1. Antrochoanal o a. Single, Unilateral o b. Can originate from maxillary sinus. o c. Usually found in children. 2. Ethmoidal o a. Bilateral o b. Usually found in adults.

Causes
The pathogenesis of nasal polyps is unknown. Nasal polyps are most commonly thought to be caused by allergy and rarely by cystic fibrosis although a significant number are associated with non-allergic adult asthma or no respiratory or allergic trigger that can be demonstrated.

These polyps have no relationship with colonic or uterine polyps. Irregular unilateral polyps particularly associated with pain or bleeding will require urgent investigation as they may represent an intranasal tumour. There are various diseases associated with polyp formation: 1. 2. 3. 4. 5. 6. 7. 8. Chronic rhinosinusitis Asthma Aspirin intolerance Cystic fibrosis Kartagener's syndrome Young's syndrome Churg-strauss syndrome Nasal mastocytosis

Exposure to some forms of chromium can cause nasal polyps and associated diseases. They are also linked to salicylate sensitivity.

Signs and Symptoms:

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. 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. People with small nasal polyps may have no signs or symptoms. The following signs and symptoms are typically present:

Runny nose - this may be permanent, with the patient feeling as if he/she always has a cold. Persistent stuffy or blocked nose - in some cases the patient may find it hard to breathe through the nose. There may be 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.

Medications
Steroids - the doctor may prescribe a steroid spray or nose drops. This medication shrinks the polyps and reduces inflammation. This treatment is more common for patients with one or more small polyps. The patient should feel the beneficial effects

within a week - with some of the newer steroid sprays this may take longer. Steroid sprays/drops may have the following side effects:

Sore throat Headache Nosebleeds

Steroid tablets - in cases of larger polyps or more severe inflammation the patient may be prescribed steroid tablets; either on their own or to be taken along with a nasal spray. Although steroid tablets are very effective at shrinking polyps, there is a risk of more serious side effects, such as weight gain, and should be taken for a few weeks at the most. Other medications - these will include drugs that help treat conditions which may be making the inflammation worse. Examples include antihistamines for allergies, antibiotics for infections, and antifungal drugs for fungal allergies.

Treatments
Surgery - surgery is only used if the polyps are very large, or if the patient has not responded well to other treatments. Approximately 75% of patients find that their polyps grow back about 4 years after they have been surgically removed.

Polypectomy - the surgeon enters through the nostrils. This procedure is the most common for the removal of polyps. The patient is given either a local or general anesthetic. Sometimes the surgeon may remove small pieces of bone from the nose to reduce the risk of recurrence. Endoscopic sinus surgery - this procedure is used if the polyps are particularly large, in clusters, or are seriously blocking the sinuses. A long thin tube with a video camera (endoscope) is inserted into the patient's nose and sinuses. Small cuts are made on the patient's face, through which surgical instruments are inserted to remove the polyps and open the sinus cavities.

Complications
After surgery the patient will most likely be prescribed a corticosteroid nasal spray to help prevent recurrence. Some doctors recommend the use of a saline (saltwater) rinse to help post-surgical healing. A large polyp, or a cluster of them sometimes block the flow of air and draining of fluids from the sinuses and/or nasal cavity, leading to the following possible complications:

Chronic or frequent sinus infections Obstructive sleep apnea The structure of the face may be altered, leading to double vision. Sometimes the eyes may be set wider apart than normal (more common in patients with cystic fibrosis).