Nasal Polyps – Causes, Symptoms and Treatment
Nasal polyps are benign, soft growths of the mucous membrane inside the nose or sinuses that can cause breathing difficulties and chronic inflammation.
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Nasal polyps are benign, soft growths of the mucous membrane inside the nose or sinuses that can cause breathing difficulties and chronic inflammation.
What Are Nasal Polyps?
Nasal polyps (medical term: polyposis nasi) are noncancerous, soft tissue growths that develop on the lining of the nasal passages or sinuses. They typically result from chronic inflammation and are usually painless. Nasal polyps can appear as single growths or in clusters and vary in size from a few millimetres to several centimetres.
Causes
The exact cause of nasal polyps is not yet fully understood. However, several known risk factors and triggers have been identified:
- Chronic inflammation: Persistent inflammation of the nasal lining, such as in chronic sinusitis, is considered the most common cause.
- Allergies: Allergic rhinitis (hay fever) increases the risk of developing nasal polyps.
- Asthma: People with asthma are more likely to develop nasal polyps than those without the condition.
- Aspirin sensitivity: The so-called aspirin triad (asthma, nasal polyps, and aspirin intolerance) is a well-known clinical pattern.
- Cystic fibrosis: Nasal polyps frequently occur in people with this hereditary condition.
- Genetic predisposition: A family history of nasal polyps is a recognized risk factor.
Symptoms
Small nasal polyps often cause no symptoms. As they grow larger, the following symptoms may develop:
- Nasal obstruction or blocked nose, sometimes complete
- Chronic runny nose and nasal congestion
- Reduced or lost sense of smell (hyposmia or anosmia)
- Pressure or pain in the face
- Snoring and disturbed sleep
- Frequent sinus infections
- Changes in voice quality (nasal-sounding speech)
Diagnosis
Nasal polyps are diagnosed by an ear, nose, and throat (ENT) specialist. The following examination methods are commonly used:
- Nasal examination (rhinoscopy): The doctor inspects the nasal cavity using a light source or mirror.
- Endoscopy: A thin, flexible endoscope allows detailed visualization of the nasal passages and sinuses.
- Imaging: A computed tomography (CT) scan of the sinuses can precisely show the extent and location of polyps.
- Allergy testing: Skin-prick tests or blood tests can help identify possible allergies as an underlying cause.
Treatment
Medication
The first-line treatment for nasal polyps typically involves medication:
- Corticosteroid nasal sprays: These reduce inflammation and can shrink polyps or slow their growth.
- Systemic corticosteroids: In severe cases, corticosteroid tablets may be prescribed, usually only for short periods due to potential side effects.
- Biologics: Modern monoclonal antibody therapies (e.g., dupilumab) are approved for severe, treatment-resistant nasal polyps.
- Antihistamines: These can help relieve symptoms when allergies are a contributing factor.
Surgical Treatment
If medications are not sufficiently effective, surgery may be necessary:
- Functional endoscopic sinus surgery (FESS): Polyps are removed minimally invasively using an endoscope. Blocked sinuses can also be opened during the same procedure.
It is important to note that nasal polyps can regrow after surgery. Regular follow-up appointments and continued medical treatment are therefore essential.
Prevention
Complete prevention is not always possible, but the following measures can reduce the risk of recurrence:
- Consistent management of allergies and asthma
- Regular use of corticosteroid nasal sprays as directed by a doctor
- Nasal irrigation with isotonic saline solution to maintain healthy mucous membranes
- Avoiding irritants such as cigarette smoke
References
- Fokkens WJ et al. - European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020). Rhinology. 2020;58(Suppl S29):1-464.
- Bachert C, Gevaert P - Pathophysiology of Nasal Polyps. In: Flint PW et al. (eds.): Cummings Otolaryngology. 7th edition. Elsevier, 2021.
- Laidlaw TM, Bhatt DL - Aspirin-exacerbated respiratory disease. New England Journal of Medicine. 2020;382(12):1134-1145.
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Related search terms: Nasal Polyps + Nose Polyps + Nasal Polyp + Polyposis Nasi + Nasal Polyposis