Introduction
Polyps inside the nose are common reasons for nasal obstruction. In patients who develop polyps there is a 30% incidence of allergic rhinitis.
In other words, these patients often have underlying inhalant allergies like dust or pollen allergies that inflame the mucous membranes insde the nasal cavities and lead to an environment conducive to the development of polyps (Ref. 4, p. 1751).
A polyp situated inside the nasal passages will obstruct the airways and can also cause sinusitis.
Signs and symptoms
Often there is recurrent nasal stuffiness and sinusitis on the side where the polyps are located.
On the other hand chronic sinusitis is often associated with the development of polyps in the sinuses or nasal cavity. Nose bleeds are more common. Reduction of the sense of smell or complete loss of smell can be other symptoms.
Diagnostic tests
Rhinoscopy or nasal endoscopy are the usual tests that are performed for diagnostic purposes. The endoscopic approach in the hands of an ENT specialist has the advantage that biopsies can be done at the same time, if a cancer is suspected. Also, smaller polyps can be taken out in the same sitting.
Treatment
This consists in the control of symptoms. Corticosteroid nasal sprays are used for allergic rhinitis and often this also reduces the size or polyps. Corticosteroids are also sometimes injected into polyps. When recurrent infections of nasal passages or sinuses is a problem, a broad spectrum antibiotic is given as well. If the polyps persist, nasal sinus surgery is done with removal of the polyps and often an enlargement of the drainage channel to the sinus cavity that is infected (Ref. 4, p. 1751).
Samter’s triad: Asthma, polyps and ASA sensitivity
The combination of asthma, nasal polyps and ASA sensitivity is called Samter’s triad. Polyps in this setting are extremely difficult to treat as they have a very high recurrence rate. Sinus congestions from blockage by growing polyps can cause severe asthma attacks in these patients. If sinus headaches are treated with ASA containing medications, it flares up both polyp growth and the asthma. Treatment is to avoid ASA, to surgically remove the polyps and to prevent recurrence of polyps with regular intranasal steroid applications. Asthma has been reported to improve by 40% to 95% after the surgical removal of polyps (Ref. 4, p. 1752).
References:
1. James Chin et al., Editors: Control of Communicable Diseases Manual, 17th edition, 2000, American Public Health Association.
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3. J M Hickner et al. Ann Emerg Med 37(6): 703-710. June 2001.
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5. Abeloff: Clinical Oncology, 2nd ed.,2000,Churchill Livingstone, Inc.
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
