Nasal polyps

Nasal polyps are a condition characterized by soft nodules that appear in the nose as a result of inflammatory or allergic changes. Polyps are not dangerous, but they cause nasal patency, smell, rhinitis and pain when getting rid of secretions. The highest percentage of complaints is among others in immunocompromised patients. Nasal polyps are treated pharmacologically, inhalations and rinses.

What are nasal polyps?

Nasal polyps are soft nodules that appear in the nose due to inflammatory or allergic changes. They cover the nasal passages to the lumen of the nasal cavity, they can form as single or multiple changes. The condition is most common in adults between 50 and 60 years of age, usually in men (the disease almost never occurs in children). Although nasal polyps are not a serious disease, they cause nasal obstruction, smell and pain associated with the removal of secretions. Polyps can be found in several percent of the population (estimated to be around 5%) based on an ENT examination, and more specifically an anterior rhinoscopy.

The highest risk of getting sick is in people:

• showing no tolerance to non-steroidal anti-inflammatory drugs,
• suffering from bronchial asthma,
• having AD (atopic dermatitis),
• with significantly reduced immunity,
• suffering from cystic fibrosis,
• having allergic or non-allergic rhinitis.

Causes of nasal polyps

To date, the exact causes of nasal polyps have not been precisely defined, but there are some factors that increase their risk. These factors include:

• chronic inflammatory processes of the nasal mucosa and sinuses;
• genetic predisposition;
• disorders of the function and structure of epithelial cells;
• allergy;
• immobile cilia syndrome - occurs when the mucous membrane of the nasal cavity and sinuses is lined with an epithelium that has cilia that move all the time and thus move the mucus that lies in the sinuses towards the nose. Mucus from the nose is either swallowed by the patient or flows down to the throat. It can also get out through the nose, and when this is impossible due to the real estate of the cilia, it lays in the sinuses and becomes superinfected, and this leads to inflammation.

In addition, nasal polyps may occur in the course of bronchial asthma, cystic fibrosis or in patients with a significant decrease in immunity.

Types of nasal polyps

Nasal polyps can be divided into three types:

• nasal glandular polyps - characterized by the fact that swollen connective tissue contains large cysts and glands;
• nasal polyps of the edema type - it consists of swollen connective tissue, which is lined with unchanged mucous membrane;
• mixed-type nasal polyps.

In addition to the aforementioned nasal polyps, there is one more - a choroidal polyp. It is closely related to the inflammatory process in the maxillary sinus. This polyposis grows from the maxillary sinus and protrudes into the nasal cavity. It can grow even on the throat.

Nasal polyps - symptoms

The symptom of nasal polyps is:

• nasal obstruction,
• impaired sense of smell,
• sneezing,
• twang,
• breathing through the mouth,
• nose pain,
• watery or purulent discharge from the nose,
• night sleep apnea,
• snoring during sleep,
• slightly wider nose than normal,
• flowing secretion from the throat.

Polyps can be accompanied by bronchial asthma and chronic rhinitis and sinusitis. The presence of nodules can be diagnosed after imaging and laryngological examination.

At the beginning of the development of nasal polyps, their surface is lined with respiratory epithelium, containing a large number of cells secreting mucus. As the disease develops, this epithelium is transformed into a squamous epithelium due to irritation by atmospheric air. At the end of development, there are large spaces between the cells in the submucosa that contain serous fluid.

Nasal polyps - recognition

Diagnosis of nasal polyps is done by an ENT specialist. During the visit he performs frontal rhinoscopy with the help of the Hartman sight glass, thanks to which it is possible to obtain better visibility of the nasal cavity from the front. Thanks to this examination, the doctor can see smooth, shiny and pedunculated or pedunculated structures, which may have a white-yellow color or be transparent and covered with purulent secretion.

These structures, when they are touched, move and are usually located in:

• back nostrils (choroidal polyps),
• mouths of the paranasal sinuses,
• nasal conduction.

In addition, fiberoscopy can be done, which involves inserting into the nose (under local anesthesia) a flexible and small endoscope with a webcam that allows you to see enlarged the nasopharyngeal cavity. In addition, imaging tests, e.g. computed tomography, are very useful in diagnostics.

If you want to distinguish between different types of polyps, you need to consider the following diseases and ailments:

• pituitary adenoma,
• tumors of a malignant nature (malignant and benign),
• bleeding polyps of the nasal septum,
• a meningeal hernia (bulging).

Treatment of nasal polyps

Treatment of nasal polyps may include medications, rinses and infusions, but may also result in surgical removal of polyps (polypectomy). The excised material should be subjected to histopathological examination in order to exclude the neoplastic nature of the lesions. Polyps with allergic character are treated by removing allergens from the patient's environment. The administration of steroids, which causes nasal polyps to significantly shrink, and even disappear altogether, is very effective. In the case of coexistence of polyps with sinusitis or bacterial infection, an antibiotic is administered to the patient. 

Because polyps are usually a manifestation of another disorder in the respiratory system, in order to prevent their recurrence after polypectomy, therapy of the underlying disease is essential.

Removal of nasal polyps

The surgery is performed when pharmacological treatment does not bring the expected benefits and when frequent recurrent polyps and nasal obstruction occur. Then, the aforementioned polypectomy or endoscopic procedure is performed, which not only helps to remove the polyps, but also improves the obstruction of the nose and sinuses. Thanks to the development of technology, a specialized suction-rotary knife was introduced, which is part of the endoscope and allows for easier treatment.