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Nasal polyps are swelling of the lining of the nose, which is usually due to allergic inflammation of the lining of the nose. Nasal polyps come from the lining of the nose and often originate from the ethmoid sinuses, which drain into the side wall of the nasal cavity. Nasal polyps contain inflammatory fluid and, while they can be associated with allergy and infection, the exact reason why some people get them and not others is not known.
Causes
They commonly occur in more general diseases such as asthma and cystic fibrosis.
Late onset asthma rather than childhood asthma is associated with nasal polyps. Of the patients with polyps 20% to 40% will have coexisting asthma. Although nasal allergy is present in some cases, more than two thirds of the patients show no evidence of systemic allergic disease. However, 90% of nasal polyps have eosinophilia- Absolute Eosinphil count will be high. These polyps tend to recur more than in other conditions. Nasal polyps are rare in children between the ages of two and 10 years. If found in children cystic fibrosis should be excluded.
Symptoms
Nasal polyps are common in both sexes.One-sided nasal polyps are rare and associated with a range of conditions and need further investigations both in adults and children eg.Antrochoanal polyp, Ringerts pappilloma
Polyps look like small grapes and can appear singly or in clusters in the nasal cavity. The can cause:
• Blocked nose
• Runny nose and/or sneezing are seen in about half of patients
• A poor sense of smell (Anosmia or Hyposmia) and taste which may not always return after treating the polyps
• Chronic Catarrh
Treatment
D N Endoscopy, where a small illuminated endoscope is used to see up the nose will exclude any infection or any unusual feature.
Medical treatment
Nasal polyps are known to shrink when nasal sprays or drops containing nasal steroids are used. Stronger steroids in drop form can be used but should only be used with care and limited to short courses because some is absorbed into the body.
Polyps respond and shrink using drops or sprays in up to 80% of people. New nasal steroid sprays can be taken to control symptoms for many years as very little is absorbed into the body and they can work well, but many take up to six weeks of treatment before their full effect can be felt.
Steroids in tablet form(Methyl Prednisolone, Defla cort) can provide good relief of symptoms but the effects are short-lived and they are used sparingly because of concerns about side effects. If medicines don’t work then surgery is needed.
Injection of Methyl Prednisolone 80 mg IM once in a month for 3 months can be tried.
Surgical treatment
Nasal Polypectomy. Nasal polyps blocking the nose can be removed surgically and this often helps the patient to breathe better. In three out of four patients the polyps come back after an average period of four years.
FESS.Functional endoscopic sinus surgery is the standard procedure to get the ethmoids opened and better removal of polyps.
Nasal blockage is the sensation of reduced air flow either through one nostril (unilateral) or both nostrils (bilateral). IT can be due to the following
• Mucosal swelling
• Septal deviation
• Collapse of the nasal valves
• Nasopharyngeal obstruction
• Nasal polyps
Allergic rhinitis
The mucosa is the thin moist lining that covers the bone and cartilage inside the nose.This occur in all types of rhinitis and sinusistis.
Vasomotor rhinitis
Clear mucus production is the primary problem with less nasal obstruction. This is due to overactivity of the glands in the nose.
Rhinitis medicamentosa
Overuse of some decongestant nasal sprays (Otrivine, Nasivion). These can help decongest the nose for a few hours if you have a cold but should not be taken for more than a few days as they damage the lining of the nose.
Chronic rhinitis and sinusitis
It is associated with a greenish mucus throughout the day.
Atrophic rhinitis -Ozena
Where neither allergy nor infection can be found yet the lining of the nose is swollen.
A range of rare conditions can affect the lining of the nose. These often cause a lot of crusting, spotting of blood and nasal obstruction. If there is a lot of crusting or whistling then your doctor may refer you to an ear nose and throat surgeon for further tests.
Septal deviation
The septum is a thin piece of bone and cartilage seperating the left and the right side of the nasal cavity. In some people the septum is bent or deviated over to one side and this blocks the air passage of the nose.
Septal deviation may be associated with a visibly deformed nose and a history of nasal trauma although it is not necessary as the cartilage may bend and deform as your nose grows.
Nasal obstruction is the predominant symptom, usually on one side. However, if other symptoms are present other disease processes must be excluded.
Management depends on the severity of nasal obstruction. Surgery to correct the deformity can be undertaken if the nose is blocked or unsightly.
Collapse of the nasal valves
Normally on breathing in through the nostrils there is a small amount of collapse of the nostrils.
Occasionally the problem is primarily due to a ‘floppy’ valve or side wall of the nose collapsing. Treatment using external nasal splints can sometimes be help at night. Surgery in this area is not straightforward.
Adenoids
The back of the nose just before it enters the back of the throat is called the nasopharynx. The adenoids are the most common cause of nasal obstruction in children reaching maximum size between the age of three and five and then reduce in size often by the age of seven or eight and can hardly be seen by the late teens.
Snoring alone is not an indication for adenoid removal but if the child also stops breathing while asleep (apnoea - stops breathing for more than 10 seconds regularly without a cold) then adenoidectomy and tonsillectomy may be helpful.
In children with a blocked nose on one side and a one sided nasal discharge, a foreign body may be in the nose
Treatment
Aim at the cause. Dont try to misuse OTC nasal drops without medical supervision. Please see an ENT surgeon and get examined to see the cause of nasal blockage and get the correct treatment.