Nasal Polyps: Symptoms, Causes, Risk Factors, Complications, Prevention and Treatment

Gentle, painless and noncancerous neoplasia in the lining of the nasal passages or nasal sinuses.

They hang like tears or grapes. They are the result of chronic inflammation caused by asthma , recurrent infection, allergies, sensitivity to medications or certain immune disorders.

This condition can affect anyone, but it is more common in adults. Medications can often reduce or eliminate nasal polyps, but surgery is sometimes needed to remove them. Even after successful treatment, nasal polyps often return.

symptom

Nasal polyps are associated with inflammation of the lining of the nasal passages and paranasal sinuses that lasts more than 12 weeks ( chronic rhinosinusitis , also known as chronic sinusitis ). However, it is possible, and even somewhat more likely, to have chronic sinusitis without nasal polyps.

Small nasal polyps may not cause symptoms, are soft and lack sensitivity. Larger growths or groups of nasal polyps may block the nasal passages or cause respiratory problems, loss of smell and frequent infections.

The common signs and symptoms of chronic sinusitis with nasal polyps include:

  • A runny nose
  • Persistent congestion
  • Goteo postnasal.
  • Sense of smell diminished or absent.
  • Loss of the sense of taste.
  • Facial pain or headache.
  • Pain in the upper teeth.
  • A feeling of pressure on his forehead and face.
  • Ronquidos.

When to see a doctor

Consult your doctor if your symptoms last more than 10 days. The symptoms of chronic sinusitis and nasal polyps are similar to those of many other conditions, including the common cold.

Seek immediate medical attention if you experience the following symptoms:

  • Serious problems to breathe.
  • Sudden worsening of your symptoms.
  • Double vision, reduced vision or limited ability to move the eyes.
  • Severe swelling around your eyes.
  • Increasingly intense headache accompanied by high fever or inability to tilt the head forward.

Causes

Scientists still do not fully understand what causes nasal polyps. It is not clear why some people develop chronic inflammation or why continued inflammation triggers the formation of polyps in some people and not in others.

Inflammation occurs in the lining that produces fluids (mucous membrane) of the nose and sinuses.

There is some evidence that people who develop polyps have a different response from the immune system and a different chemical marker in their mucous membranes than those who do not develop polyps.

Nasal polyps can form anywhere in your sinuses or nasals, but they appear most often in an area where the sinuses near the eyes, nose, and cheekbones drain through sinuous passages to the nose (complex ostiomeatal).

Risk factor’s

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 inflammation and constriction of the respiratory tract in general.
  • Sensitivity to aspirin may cause some people to be more prone to developing nasal polyps.
  • Allergic fungal sinusitis , an allergy to fungi in the air
  • Cystic fibrosis, a genetic disorder that results in the production and secretion of abnormally thick and sticky fluids, including the thick mucus from the nasal and sinus membranes.
  • Churg-Strauss syndrome, a rare disease that causes inflammation of the blood vessels.
  • Your family history can also play a role. There is some evidence that certain genetic variations associated with the function of the immune system make it more prone to develop nasal polyps.

Complications

Nasal polyps can cause complications because they block the flow of normal air and drainage of fluids, and also due to the chronic inflammation that underlies their development. Possible complications include:

  • Obstructive sleep apnea :  In this potentially serious condition, it stops and begins to breathe frequently during sleep.
  • Asthma flare-ups: Chronic rhinosinusitis can aggravate asthma.
  • Sinus Infections: Nasal polyps can make you more susceptible to sinus infections that often recur or become chronic.

Prevention

It can help reduce your chances of developing nasal polyps or that nasal polyps reappear after treatment with the following strategies:

  • Manage allergies and asthma: Follow your doctor’s treatment recommendations to control asthma and allergies. If your symptoms are not well controlled, talk to your doctor about changing your treatment plan
  • Avoid nasal irritants: Avoid breathing airborne substances that can contribute to inflammation or irritation of the nose and sinuses, such as allergens , tobacco smoke, chemical fumes, and dust. and fine waste
  • Practice good hygiene: Wash your hands regularly and completely. This is one of the best ways to protect against bacterial and viral infections that can cause inflammation of the nasal passages and sinuses
  • Humidify your home: Use a humidifier if the air in your home tends to be dry. This can help to moisten the respiratory passages, improve the flow of mucus from the sinuses and help prevent blockage and inflammation
  • Use a nasal rinse or a nasal wash: Use a salt water spray (saline) or a nasal wash to rinse your nostrils. This can improve the flow of mucus and eliminate allergens and other irritants.

You can buy saline sprays without a prescription or nasal wash kits with devices, such as a Neti pot, to administer a rinse.

If you do your own rinsing, use distilled, sterile water, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller to form the irrigation solution.

Also make sure to rinse the irrigation device after each use with distilled, sterile, previously boiled, cooled or filtered water, and allow it to air dry.

Diagnosis

Your doctor can usually make a diagnosis based on your answers to questions about your symptoms, a general physical examination, and an examination of your nose. The polyps can be visible with the help of a simple illuminated instrument.

Other diagnostic tests include:

  • Nasal endoscopy: A narrow tube with an illuminated magnifying lens or a tiny camera (nasal endoscope) allows your doctor to perform a detailed examination inside the nose and sinuses.
  • Imaging studies: The images obtained with computed tomography (CT) can help your doctor identify the size and location of the polyps in the deepest areas of the paranasal sinuses and assess the degree of inflammation.

These studies can also help your doctor rule out other possible obstructions in the nasal cavity, such as structural abnormalities or other cancerous or non-cancerous growths.

Allergy tests : Your doctor may suggest skin tests to determine if allergies are contributing to chronic inflammation.

With a skin prick test, small drops of allergenic agents are punctured into the skin of your forearm or upper back. If a skin test can not be done, your doctor may order a blood test that looks for specific antibodies against several allergens.

Cystic fibrosis test: If you have a child diagnosed with nasal polyps, your doctor may suggest evidence of cystic fibrosis, a hereditary condition that affects the glands that produce mucus, tears, sweat, saliva and digestive juices.

The standard diagnostic test for cystic fibrosis is a non-invasive sweat test, which determines whether your child’s perspiration is saltier than most people’s sweat.

Treatment

Treatment with nasal polyps usually begins with medications, which can cause even large polyps to shrink or disappear.

Chronic sinusitis, with or without polyps, is a condition difficult to overcome completely. You will work with your health care team to develop the best long-term treatment plan to control your symptoms and treat factors, such as allergies, that can contribute to chronic inflammation.

The treatment for nasal polyps aims to reduce their size or eliminate them.

Surgery: You may need endoscopic surgery to remove the polyps and correct problems with the breasts that make them prone to inflammation and the development of polyps.

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

Your surgeon can also enlarge the openings that go from the sinuses to the nasal passages. Endoscopic surgery is usually performed as an outpatient procedure. After surgery, you are likely to use a nasal spray with corticosteroids to help prevent the recurrence of nasal polyps.

Your doctor may also recommend the use of a salt water rinse (saline) to promote healing after surgery.

Medicines

Medications are usually the first approach. Sometimes surgery may be necessary, but it may not provide a permanent solution because the polyps tend to reappear.

Pharmacological treatments may include:

Nasal corticosteroids : Your doctor may prescribe a nasal spray with corticosteroids to reduce inflammation. This treatment can reduce polyps or eliminate them completely.

Los corticosteroides nasales incluyen fluticasona (Flonase, Veramyst), budesonida(Rhinocort), flunisolida, mometasona (Nasonex), triamcinolona (Nasacort Allergy 24HR), beclometasona (Beconase AQ) y ciclesonida (Omnaris).

Oral and injectable corticosteroids : If a nasal corticosteroid is not effective, your doctor may prescribe an oral corticosteroid, such as prednisone , either alone or in combination with a nasal spray. Injectables can be used if nasal polyps are severe.

Because oral corticosteroids can cause serious side effects, they usually take them only for a limited period.

Your doctor may prescribe medications to treat conditions that contribute to chronic inflammation in your sinuses or nasals.

These may include antihistamines to treat allergies and antibiotics to treat a chronic or recurrent infection. Desensitization and aspirin treatment may benefit some patients with nasal polyps and sensitivity to aspirin.

Preparing for your appointment

If you have signs or symptoms of nasal polyps, you are likely to start seeing your primary care doctor. However, your doctor may refer you to an otolaryngology specialist (ENT) or an allergist to perform diagnostic tests or treatment.

Because appointments can be brief and there is often a lot of ground to cover, it is a good idea to prepare in advance. Here are some suggestions to help you prepare for your appointment and understand what to expect from your doctor:

  • Consider any restriction prior to the appointment. When you make your appointment, ask if you need to fast for blood tests or if you need to do something else to prepare for diagnostic tests.
  • Write down all your symptoms, even if they do not seem to be related to your nose or sinuses. Your doctor will want to know details about when your symptoms started and if something seems to make them better or worse.
  • Carry a family member or friend, if possible. Having someone by your side can help you remember all the information provided during your appointment
  • Make a list of your other medical conditions. Your doctor will want to know if you are currently being treated for allergies, asthma or any other health condition
  • Make a list of all your medications, including over-the-counter medications and vitamins or supplements.

Questions to ask your doctor

Because time with your doctor is limited, writing a list of questions will help you make the most of your appointment. Make a list of questions for your doctor from most important to least important in case the time runs out.

  • What is probably causing my problems with breathing, the sense of smell and other problems related to my nose?
  • What kind of exams do I need?
  • What is the best mechanism of action?
  • Should I see a specialist?
  • How much will it cost?
  • Will my insurance cover it?
  • What kind of follow-up exams or care will I need?
  • If I have nasal polyps, can we effectively treat the underlying cause of the inflammation?
  • What should I expect to happen in the long term?
  • Will my new symptoms affect the way I manage my other health conditions?
  • Do I have to follow any restrictions?
  • Is there a generic alternative to the medication you are prescribing?
  • What websites do you recommend?

In addition to the questions you have prepared to consult with your doctor, do not hesitate to ask questions during your appointment.

What to expect from your doctor?

Your doctor will probably ask you a series of questions. Being prepared to respond can free up time to go over any point where you want to spend more time. Your doctor can ask:

  • When did you begin to experience the symptoms?
  • When was the last time you had a cold or sinus infection?
  • How often do you have colds or sinus infections?
  • You have allergy? Do you know what you are allergic to?
  • Do you have asthma? How well can you handle it?
  • Do you often take aspirin or other over-the-counter pain medications?
  • Do you smoke or are you exposed to second-hand tobacco smoke?
  • In your work or hobbies, are you exposed to chemical fumes or other airborne contaminants such as dust or dirt from a leaf blower?
  • Have you ever had nasal surgery?