Nasal Polyps Treatment
Nasal polyps are inflammatory growths in the nose and sinuses that can obstruct the nose and sinuses, leading to nasal blockage, recurrent infections, and loss of sense of smell and taste. Nasal polyps can also cause other sinus symptoms including headaches, snoring, nasal congestion, and sinus drainage. Generally, They’re usually not cancerous, but they may be related to asthma, recurrent infections, allergies, drug sensitivity, or underlying immune disorders. Nasal polyps are most commonly found in adults. They may be treated successfully with medications, but if not, then surgical removal may be required. Polyps frequently recur even after successful treatment. For this and other reasons, a specialist must evaluate nose and sinus symptoms.
Physicians at the Nose and Sinus Center can perform a complete fiberoptic evaluation of your nose to determine if any polyps are visible. If polyps are present, the physicians will discuss a wide range of treatment options with you. Often, taking simple medications can result in significant improvement and symptom resolution. Recent technology has made these treatments generally more effective, safer, and more comfortable than ever before. For more information on surgery for nasal polyps, see Dr. Becker’s published paper, The Surgical Management of Nasal Polyps.
When to See a Doctor
If you’re experiencing this condition, you should definitely see a doctor, especially if your nasal polyps symptoms last more than 10 days. Nasal polyps are often associated with allergies, sinus infections, asthma, chronic obstructive pulmonary disease (COPD), and other respiratory conditions.
Nasal Polyps Causes
Polyps develop when the mucous membranes that line the nose or sinuses swell up and get inflamed. This swelling may last for a long time or it may get worse over and over again.
Researchers believe that allergies can trigger an inflammatory response that leads to nasal polyps. Based on tissue removed from nasal polyp patients, those samples contained extra leukocytes and white blood cells associated with infection and allergy. The proof suggests that allergies cause swelling within the tissues, resulting in polyp formation. Polyp formation leads to the development of nasal polyposis.
Nasal Polyps Symptoms
Symptoms of polyps include:
- Runny nose
- Postnasal drip
- Sore throat
- Ear pain
- Sinus pressure
- Loss of appetite
- Body aches
If you notice any of these symptoms, it is advisable to promptly seek medical attention from your healthcare provider. The sooner you seek treatment, the better off you’ll be.
Nasal Polyps Diagnosis and Tests
Nasal polyps usually appear during diagnostic rhinoscopy exams. They’re often associated with trouble breathing through the patient’s nostrils and may cause them to lose their sense of taste and/or smell.
Your doctor at Becker ENT and Allergy may evaluate these and other signs and perform an exam of your nose. If necessary, he or she may use a special lighted nasal device to examine your nose for polyps.
You may be advised by your physician to undergo additional tests, which include a nasal endoscopy to examine your nose and mouth, a CT scan to measure its size, shape, and position, or allergy tests to identify the cause of your chronic sinusitis symptoms.
Nasal Polyps Treatment
There are no known cures for nasal polyps. However, some treatments are used to relieve symptoms. These include medications, surgery, and endoscopic procedures. Medications can help reduce swelling and inflammation. Surgery is often recommended for severe cases. Endoscopy involves inserting a thin tube through the nostril and removing tissue samples. This procedure is commonly performed in conjunction with nasal surgery in Princeton at Becker ENT and Allergy.
Millions of people suffer from nasal polyps or chronic sinusitis. There are many different treatment options available, but not everyone responds well to them. A newer option for addressing these two conditions is the Propel sinus implant after a sinus procedure or SINUVA sinus implants.
The Propel stent is commonly placed during FESS, or functional endoscopic sinus surgery, to decrease the swelling and assist in the healing of the sinus passages. When you have chronic sinusitis, normal drainage is often prevented due to sinus passage inflammation. During surgery, these passages are enlarged. However, in some cases, post-surgical scarring can occur, and polyps may regrow, leading to a return of sinus inflammation, swelling, and, in some cases, infections.
This is where a Propel implant can make a difference. After completing the surgery, the Propel sinus implant is inserted. It is a spring-like device that helps to keep your sinuses open. The implant also contains mometasone furoate, a type of medication, which releases slowly to limit polyp regrowth and scarring to promote healing. Over the course of about one month, the implant will dissolve.
The following may make you a candidate for sinus surgery with Propel:
- Chronic sinusitis that persists beyond four months
- Having at least four cases of acute sinusitis in a year
- Conservative therapies and medicines that offer little to no relief
- History of nasal polyps
During FESS surgery, you are typically given general anesthesia so that you are asleep and can feel no discomfort. Once you are anesthetized, an endoscope is inserted into your nostrils to allow the surgical team to visualize the area. Precision surgical instruments are then used to reposition or remove any necessary tissue. Once the procedure is completed, the implant is placed to keep the sinuses open.
In most cases, FESS is performed as an outpatient procedure, so you can go home the same day. For about a week, you may experience minor pain, swelling, and stuffiness. Your surgeon will provide detailed recovery instructions and any necessary medications to promote healing and recovery.
Sinuva is an implant designed for patients who are over the age of 18, have nasal polyps, and have a history of ethmoid sinus surgery. This technology may be an option if you do not want to repeat sinus surgery.
Once the implant is in place, it begins to release mometasone furoate, a medicine that works to alleviate inflammation and nasal polyps. Once the doctor places the implant, the device uses a two-in-one approach to reduce the symptoms of congestion, nasal obstruction, and polyps. It does this by keeping the sinus cavity open while releasing the medication directly into sinus tissue.
The procedure to put this implant into place is simple. It can be performed in the office, and you can go home shortly after it is completed.
Your doctor will first numb your nose to help you stay comfortable. Through the nasal opening, the doctor will insert the implant into your ethmoid sinus. Once it is in place, you usually cannot feel it, so you should have no concerns about long-term discomfort due to the implant.
The implant can remain in place for up to 90 days to keep your sinus open and to reduce symptoms of nasal congestion and obstruction. However, you can have it removed sooner at your doctor’s discretion.
Dupixent may be an option for patients with chronic rhinosinusitis with polyps that is poorly controlled with medications. Dupixent is a medicine that is injected just below the skin. It is typically given in the abdomen or thigh, but the back of the upper arm is also an acceptable injection site.
This medicine is classified as a biologic. It works to suppress and target the specific elements that trigger immune system inflammation. Injections are given every two weeks.
If intranasal steroids and other medications are not adequately controlling your nasal polyps and related symptoms, then Dupixent could be a viable alternative. It may also reduce the need for surgery to remove nasal polyps.
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Nasal Polyps FAQs
Most polyps in the nose and sinuses are the byproduct of an inflammatory process. It is unclear what drives this inflammatory process—viruses, allergies, bacteria, and environmental irritants have all been proposed. For some reason, however, it appears that an inflammatory cascade is triggered that leads to swelling of the nasal and sinus lining and, ultimately, to the development of polyps.
Polyps can form in the nose, or in the sinuses themselves. When they are present in the nose, they may alone lead to nasal obstruction. If they become large enough, polyps can block the drainage pathways of the sinuses. When the sinus drainage pathways are obstructed, the normal sinus function will be affected, and patients may develop the signs and symptoms of chronic sinusitis.
In most cases, polyps are benign growths. On occasion, however, the presence of polyps may be a manifestation of a tumor or a cancer. Any patient with sinus or nasal polyps should be seen by a trained otolaryngologist who can perform a nasal endoscopy in the clinic. This procedure is very well tolerated and takes only a few minutes. This will allow your doctor to examine the polyps closely. If the polyps are concerning for a tumor, your doctor may decide to obtain imaging (CT scan, MRI) to help define the extent of the polyp. Your physician may also perform a biopsy for a definitive diagnosis. A biopsy may be performed in the clinic or in the operating room depending on the case. If a biopsy is recommended, your physician will discuss these options with you.
Again, in most cases, polyps are benign growths, including nasal polyps dislodged during nose blowing or irritation. However, a trained otolaryngologist should examine patients with polyps to make sure that the polyp does not represent another type of mass. Encephalocoeles (herniated brain tissue) can present as a nasal or sinus polyp. An inverted papilloma is a benign tumor with a small incidence of malignant degeneration that also may present as a simple polyp. Some other lesions that may present with polyps include juvenile nasopharyngeal angiofibroma, pleomorphic adenoma, sarcoidosis, Wegener’s disease, adenocarcinoma, and squamous cell carcinoma.
Some studies have found polyps to be present in as many as 1-4 percent of people in the general population.
There is an increased prevalence of polyps in some patient groups. Patients with asthma and aspirin intolerance are more likely to have polyps than those without these conditions. Patients with cystic fibrosis and other conditions (Churg-Strauss syndrome, ciliary dysfunction syndrome) also have an increased prevalence of sinonasal polyps.
Many patients do not know that they have sinus polyps. Other patients who have complete nasal obstruction from massive polyposis that blocks all nasal airflow and impedes sinus function are well aware of their condition. Common symptoms include nasal obstruction, diminished sense of smell (hyposmia), and sinusitis. Any patient with a concern for the presence of polyps should be evaluated by an otolaryngologist who can look into the nasal cavity with a small endoscope and evaluate for the presence of polyps.
An antrochoanal polyp is a benign polyp that typically has its stalk in the maxillary sinus (The “cheek” sinus located below the eye). The polyp enlarges until it passes out of the sinus and into the nasal cavity. These masses can grow to be quite large and may distort the surrounding anatomy. Once they grow into the choana (the pathway through which air passes from the nose into the throat), patients’ symptoms may worsen as nasal breathing becomes increasingly difficult. Sometimes the polyp may actually extend all the way to the opposite choana and block nasal breathing from both sides.
Medicines for the treatment of nose and sinus polyps mostly rely on an anti-inflammatory effect. Oral steroids (i.e., prednisone) are often quite effective in shrinking polyps. However, the risks of long-term treatment with oral steroids is often thought to outweigh the benefits of treatment. Most physicians, therefore, use oral steroids in bursts to help patients with polyps who are having a bad episode of swelling. Topical steroids (nasal steroid sprays) can be used on a more long-term basis to help patients decrease the inflammation associated with nasal and sinus polyps. Other novel preparations are available, but the relative risks and benefits should be discussed with your physician.
In some patients with a significant bulk of polyps, it may be necessary to surgically remove the polyps so that topical medications can be effective. In many patients with polyps, the sinuses have also developed a chronic inflammatory state and may need to be opened as well, so that they may return to normal function.
In many patients with hyposmia (decreased sense of smell), decreasing the polyp burden (either with medicines and/or nasal surgery in Princeton) may lead to improvement in the sense of smell. Patients should be aware, however, that not all patients will have their sense of smell return or improve, and it can be difficult to predict which patients will benefit from treatment.
Most patients who have their polyps treated effectively with medicines and/or nasal surgery in Princeton will improve their nasal airflow and function.
Polyps are the byproduct of a chronic inflammatory process. The key word here is chronic. No medicine or nasal surgery can cure you of your polyps (much like no medicine or nasal surgery can cure you of high cholesterol or hypertension), but they can be managed and brought under control so that you can significantly improve your quality of life. Once removed, polyps will have a tendency to regrow. Fortunately, with a combination of topical sprays and drops, and occasional oral medications, most patients can keep their polyps under control.