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Writer's pictureDr. Koralla Raja Meghanadh

Nasal Polyps: Causes, Symptoms, and Treatment Options


Nasal polyps are semi-translucent, grape-like structures that form in the lining of the nose and sinuses. They are often the result of swelling or fluid retention in the mucosal lining, leading to a variety of symptoms and complications.

 


Nasal endoscopy reveals nasal polyps filling the nasal passages
Nasal endoscopy reveals nasal polyps filling the nasal passages.

Why Does Fluid Retention Occur?

Fluid retention in the nasal lining happens due to inflammation, which can be understood as a kind of "fire" at the micro level within the nasal and sinus lining. This inflammation is triggered by the body's immune response to foreign particles, such as bacteria, viruses, or allergens.

 

What is the Cause of Nose Polyps?

Various factors can trigger nasal polyps, but the more realistic one is that when a foreign substance enters the body, the immune system identifies it as a threat and mounts a response. This includes the release of various chemicals and immune cells that attack the foreign particles. While this process aims to eliminate the foreign particles, it can also cause collateral damage to the body's tissues.

 

In some individuals, the system that removes these toxins and inflammatory chemicals may not function optimally. Just as smoke is a byproduct of fire, these toxins are byproducts of the immune system's fight against allergens and other invaders. If these byproducts are not efficiently cleared from the body, they can contribute to ongoing inflammation. This repeated inflammation and tissue damage can lead to the development of nasal polyps in the nasal passages and sinuses.

 

Types of Nasal Polyps and Sinusitis

There are two main types of sinusitis related to nasal polyps:

  • Sinusitis with Polyps: This form is more often associated with allergies. Patients with nasal polyps typically require surgical intervention.

  • Sinusitis without Polyps: This form is usually due to infections and can often be effectively treated with medication.


It is important to note that not all sinusitis patients will have nasal polyps, but all patients with nasal polyps will have sinusitis.

 

Nasal Polyps Symptoms

Patients with nasal polyps typically experience symptoms similar to those of sinusitis symptoms, including:

  1. Running nose

  2. Nose block or stuffy nose

  3. Headaches

  4. Facial pain

  5. A feeling that phlegm is oozing out from the back of the nose to the throat

  6. A necessity to clear the throat frequently

  7. Frequent sore throat and pain in the throat

  8. Frequent attacks of cough

 

In people with nasal polyps, nasal blockage is more common. This is because the polyps physically obstruct the sinus openings, impeding proper drainage and exacerbating the sinusitis and its complications.

 

Diagnosis

Diagnosing nasal polyps typically involves a series of steps. First, doctors examine the nose using a diagnostic nasal endoscope and then give a trial medical treatment as per the findings.

 

If there is no improvement or desired results symptomatically and in the diagnostic nasal endoscopy check-up, then a CT scan of the paranasal sinuses is conducted to assess the extent of the condition, including any signs of infection, such as fungal or bacterial involvement, and to determine if there is any damage to the sinus bones.

 

Following the CT scan, nasal secretions are collected for culture to identify the specific infection present, whether bacteria or fungus. This information helps tailor the appropriate medication regimen.

 

Additionally, samples of the polyps and inflamed tissue are taken for further study, providing insights into the appropriate medical treatment needed for the patient.

 

Once these diagnostic steps are completed, doctors will tailor the treatment plan accordingly.

 

Treatment Options for Nasal Polyps

Nasal polyps do not regress with medication alone and typically require surgical intervention. However, before polyps fully develop, there is a stage known as polypoid changes. These early formations, or baby polyps, respond effectively to medical treatments.

 

However, fully developed nasal polyps do not respond well to medical treatments because they lack sufficient blood vessels and are essentially fluid bags. So, surgical removal is necessary in these cases.

 

Medical Treatment

For early-stage polyps (polypoid changes), medical treatments can be effective. This treatment involves:

  • Steroid Treatment: Steroids are the primary treatment for early polypoid changes. They can be administered orally or, more commonly, intranasally. These Intranasal Steroid Spray act locally and do not get absorbed into the bloodstream, helping to reduce inflammation and prevent the progression to full polyps.

 

Surgical Treatment

As mentioned earlier, fully developed nasal polyps do not respond to medical treatment as they are fluid-filled bags that lack sufficient blood vessels. So, we opt for surgical removal, which is necessary in these cases.

 

The polyps are removed using endoscopy surgery. During surgery, all sinuses are opened to ensure proper drainage and prevent fluid stagnation.

 

Additional Medications: Addressing Root Causes

Along with the nasal polyp treatment, it is also important to manage the underlying or root causes. This may include:

  • Antiallergics: antiallergic medication is prescribed to manage allergies contributing to this condition.

  • Antibiotics: If a bacterial infection is present, specific antibiotics are selected based on the bacteria type and effectiveness.

  • Antifungals: Antifungal medications are used in cases of fungal infections. For allergic fungal sinusitis, antiallergic medication can be effective along with antifungal treatment, but if a fungal ball is present, surgical removal is required.

 

Postoperative Care

Proper postoperative care is essential for successful recovery. Without this care, the surgery's success rate drops significantly. So this includes:

  • Nasal Irrigation: Since the surgery opens all the sinuses, it is essential to regularly rinse the nasal passages with saline solution and steroids.

  • Medication adherence: Take prescribed steroids, antibiotics, and antifungals as directed.

  • Follow-up visits: Attend regular follow-ups with the surgeon who performed the surgery.

 

Do Polyps Grow Back?

If patients neglect their post-operative medication and fail to adhere to regular visits with their surgeon, the chances of polyps recurring are significantly higher. In fact, without proper care, the results of polyp surgery can be deemed a 100% failure as they are likely to return. However, when patients diligently follow their prescribed treatment regimen and maintain regular check-ups with their surgeon, the chances of polyp recurrence decrease significantly.

 

Home Remedies for Nasal Polyps

One effective home remedy for early-stage polyps is Jal Neti, a traditional Indian practice for nasal cleansing. This method can help improve the cleaning process and reduce toxins, potentially slowing the progression of the disease.

 

How to Perform Jal Neti

  1. Fill a small pot with boiled and cooled water mixed with 5 grams of salt per half litre.

  2. Bend over a sink and pour the solution into one nostril, allowing it to flow through the nasal passage and out the other nostril.

  3. While performing this, keep your mouth open and continuously make a "Kay" sound. This action helps raise the soft palate and close the nasopharynx,

  4. Repeat on the other side.

 


In conclusion, nasal polyps can significantly affect quality of life, but with proper diagnosis and treatment, symptoms can be managed effectively. While medical and surgical treatments are effective, traditional practices like Jala Neti can also aid in maintaining nasal hygiene and preventing disease progression. By combining modern medical approaches with time-tested techniques, individuals can take proactive steps towards better nasal health and overall well-being.


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