Polyps

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Polyps

Nasal polyps are common reasons for nasal obstruction. In patients who develop polyps there is a 30% incidence of allergic rhinitis. In other words, these patients often have underlying inhalant allergies like dust or pollen allergies that inflame the mucous membranes insde the nasal cavities and lead to an environment conducive to the development of polyps (Ref. 4, p. 1751).[1]

Here is a link to pictures of a polyp that obstructs the nasal passage and causes sinusitis (use return key in left upper corner of your screen to return to this page).

Signs and symptoms:

Often there is recurrent nasal stuffiness and sinusitis on the side where the polyps are located.

On the other hand chronic sinusitis is often associated with the development of polyps in the sinuses or nasal cavity. Nose bleeds are more common. Reduction of the sense of smell or complete loss of smell can be other symptoms. Diagnostic tests: Rhinoscopy or nasal endoscopy are the usual tests that are performed for diagnostic purposes. The endoscopic apporach in the hands of an ENT specialist has the advantage that biopsies can be done at the same time, if a cancer is supected. Also, smaller polyps can be taken out in the same sitting.

Treatment:

This consists in the control of symptoms. Corticosteroids nasal sprays are used for allergic rhinitis and often this also reduces the size or polyps. Corticosteroids are also sometimes injected into polyps. When recurrent infections of nasal passages or sinuses is a problem, a broad spectrum antibiotic is given as well. If the polyps persist, nasal or sinus surgery is done with removal of the polyps and often an enlargement of the drainage channel to the sinus cavity that is infected (Ref. 4, p. 1751).

Sampters triad: Asthma, polyps and ASA sensitivity.

The combination of asthma, nasal polyps and ASA sensitivity is called Sampters triad. Polyps in this setting are extremely difficult to treat as they have a very high recurrence rate. Sinus congestions from blockage by growing polyps can cause severe asthma attacks in these patients. If sinus headaches are treated with ASA containing medications, it flares up both polyp growth and the asthma. Treatment is to avoid ASA, to surgically remove the polyps and to prevent recurrence of polyps with regular intranasal steroid applications. Asthma has been reported to improve by 40% to 95% after the surgical removal of polyps (Ref. 4, p. 1752).

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References:

1. James Chin et al., Editors: Control of Communicable Diseases Manual, 17th edition, 2000, American Public Health Association.

2. Behrman: Nelson Textbook of Pediatrics, 16th ed., 2000, W. B. Saunders Company

3. J M Hickner et al. Ann Emerg Med 37(6): 703-710. June 2001.

4. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001 Mosby, Inc.

5. Abeloff: Clinical Oncology, 2nd ed.,2000,Churchill Livingstone, Inc.

6. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

7. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier