Nasal polyps-Surgical Treatment in SUT Hospital, Trivandrum, Kerala, India

Nasal polyps are grape like, non malignant growths on the lining of nasal passages or sinuses.

Small nasal polyps may cause no problems and go unnoticed. Larger nasal polyps can block your nasal passages or sinuses and cause breathing difficulties, a loss of ones sense of smell, frequent sinus infections and other problems.

Although nasal polyps can affect anyone, they’re more common in adults, particularly those with asthma, frequent sinus infections and allergies. Children with cystic fibrosis often develop nasal polyps.

Medications can often lessen the size of nasal polyps or eliminate them, but surgery is sometimes necessary to remove them. Even after successful treatments, nasal polyps often return.

Nasal polyps are associated with chronic inflammation of the lining of your nasal passages and sinuses (chronic sinusitis). If you have several polyps or large polyps, they may obstruct your nasal passages and sinuses. As a result of these conditions in your nose and sinuses, you may experience some of the following-

signs and symptoms:

• A runny nose

• Persistent nasal blockage

• Postnasal drip

• Decreased or no sense of smell

• Loss of sense of taste

• Facial pain or headache

• Snoring

Any condition that contributes to chronic inflammation in the nasal passages or sinuses (chronic sinusitis), such as infections or allergies, may increase your risk of nasal polyps.

Conditions often associated with nasal polyps include:

• Asthma, a disease that causes inflammation and constriction of airways

• Aspirin sensitivity, an allergy-like response to aspirin or other nonsteroidal anti-inflammatory drugs — such as ibuprofen and naproxen

• Allergic fungal sinusitis, an allergy to fungus in the sinuses

• Cystic fibrosis, a genetic disorder that results in the production and secretion of abnormal fluids, including thick mucus from nasal and sinus membranes

Diagnosis

Polyps may be visible with the aid of a simple lighted instrument-Anterior Rhinoscopy

• Nasal endoscopy. Flexible or rigid fibre optic nasal endoscopy..

• Computerized tomography (CT) scans.

Treatment-Medical

The treatment goals for nasal polyps are to decrease the size of polyps or eliminate polyps and to treat disorders, such as allergies, that may contribute to chronic inflammation in your nasal passages and sinuses.

Medications

Drug treatments may include:

• Nasal corticosteroids. Corticosteroid nasal spray is used to reduce inflammation. This treatment may shrink the polyps or eliminate them completely. Nasal corticosteroids include fluticasone ,mometasone etc

• Other corticosteroids. Oral corticosteroid, such a Methylprednisolone, Deflzacort either alone or in combination with a nasal spray is tried. Because oral corticosteroids can cause serious side effects, you usually take them for a brief period. Make sure there is no contraindication for the use of systemic steroid like DM, hypertension.

• Antihistamines and Antibiotics. Antihistamines to treat allergies, antibiotics to treat a chronic or recurring infection,

• Antifungal medications to treat symptoms of fungal allergies.

Surgical Treatment

The type of surgery depends on the size, number and location of the polyps. Surgery options for nasal polyps include:

• Polypectomy. Small or isolated polyps can often be completely removed using a small mechanical suction device or a microdebrider – an instrument that cuts and extracts soft tissue. The procedure, called a polypectomy, is performed on an outpatient basis.

• Endoscopic sinus surgery (FESS). Endoscopic sinus surgery to remove polyps and to correct problems with your sinuses that make them prone to inflammation and the development of polyps. The surgeon inserts an endoscope, a small tube with a magnifying lens or tiny camera, into your nostrils and guides it into your sinus cavities. He or she uses tiny instruments to remove polyps and other obstructions that prevent the flow of fluids from your sinuses.

After surgery, you’ll likely use a corticosteroid nasal spray to help prevent the recurrence of nasal polyps. Your surgeon may also recommend the use of a Saline douche – rinse to promote healing after surgery.

Dr Paulose is an ENT Consultant Plastic and Laser Surgeon with over 32 years of experience covering in Ear, Nose and Throat procedures, specializing in Laser Surgery and conventional medicine across India, U.K. and Middle East. He is currently engaged with the SUT Hospital, in Kerala, India. You can contact him today for help.