Nasal Polyps

Nasal Polyps

Nasal polyps are soft, painless, noncancerous growths on the lining of the nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.

Small nasal polyps may not cause symptoms. Larger growths or groups of nasal polyps can block the nasal passages or lead to breathing problems, a loss of smell, and frequent infections.

Symptoms

Nasal polyps are associated with inflammation of the lining of the nasal passages and sinuses that lasts more than 12 weeks (chronic rhinosinusitis). However, it's possible to have chronic sinusitis without nasal polyps.

Common signs and symptoms of chronic sinusitis with nasal polyps include:

• A runny nose
• Persistent stuffiness
• Postnasal drip
• Decreased or absent sense of smell
• Loss of sense of taste
• Facial pain or headache
• Pain in your upper teeth
• A sense of pressure on the forehead and face
• Snoring

Cause

Scientists don't yet fully understand what causes nasal polyps. It's not clear why some people develop chronic inflammation or why ongoing inflammation triggers polyp formation in some people and not in others. The inflammation occurs in the fluid-producing lining (mucous membrane) of the nose and sinuses.

There's some evidence that people who develop polyps have a different immune system response and different chemical markers in their mucous membranes than do those who don't develop polyps.

Nasal polyps can form at any age, but they're most common in young and middle-aged adults. Nasal polyps may form anywhere in your sinuses or nasal passages, but they appear most often in an area where sinuses near your eyes, nose and cheekbones all drain through winding passages into your nose (ostiomeatal complex).

Risk factors

Any condition that triggers chronic inflammation in the nasal passages or sinuses, such as infections or allergies, may increase the risk of developing nasal polyps. 

Conditions often associated with nasal polyps include:

• Asthma, a disease that causes overall airway inflammation and constriction
• Aspirin sensitivity may cause some people to be more likely to develop nasal polyps
• Allergic fungal sinusitis, an allergy to airborne fungi
• Cystic fibrosis, a genetic disorder that results in the production and secretion of abnormally thick, sticky fluids, including thick mucus from nasal and sinus membranes
• Churg-Strauss syndrome, a rare disease that causes the inflammation of blood vessels

Family history also may play a role. There's some evidence that certain genetic variations associated with immune system function make you more likely to develop nasal polyps.

Diagnosis 

A diagnosis is usually made based on the symptoms, a general physical exam and an examination of the nose. Polyps may be visible with the aid of a simple lighted instrument.

Other diagnostic tests include:

Nasal endoscopy. 

A narrow, flexible tube with a lighted magnifying lens or tiny camera (nasal endoscope) enables the doctor to perform a detailed examination inside the nose and sinuses. An endoscope is inserted into a nostril and guided it into the nasal cavity.

Imaging studies. 

Images obtained with computerized tomography (CT) scan or magnetic resonance imaging (MRI) can pinpoint the size and location of polyps in deeper areas of the sinuses and evaluate the extent of inflammation. These studies may also help rule out the presence of other possible obstructions in the nasal cavity, such as structural abnormalities or another type of cancerous or noncancerous growth.

Treatments and drugs

Chronic sinusitis, with or without polyps, is a challenging condition to eliminate completely.

A long-term treatment plan to manage thesymptoms is needed and to treat factors, such as allergies, that may contribute to chronic inflammation.

The treatment goal for nasal polyps is to reduce their size or eliminate them. Medications are usually the first approach, which include topical nasal sprays and corticosteroids. Surgery may sometimes be needed, but it may not provide a permanent solution because polyps tend to recur.

Surgery

If drug treatment doesn't shrink or eliminate nasal polyps, endoscopic surgery is recommended to remove polyps and to correct problems with the sinuses that make them prone to inflammation and polyp development.

In functional endoscopic surgery (FESS) the surgeon inserts a small tube with a magnifying lens or tiny camera (endoscope) into the nostrils and guides it into the sinus cavities.

After surgery, the use of a saltwater (saline) rinse to promote healing is recommended as well as medication such as a corticosteroid nasal spray to help prevent the recurrence of nasal polyps.