Nasal Polyps
Introduction
Small nasal polyps usually cause few problems, but larger ones can affect your breathing and diminish your sense of smell. Sometimes they may cause dull headaches or snoring, and in rare cases, massive nasal polyps can alter the shape of your face.
It's hard to breathe, your nose drips constantly, and your sense of smell just isn't what it used to be. If this sounds like you, you probably blame allergies or a chronic sinus infection. But in some cases, your signs and symptoms may be due to nasal polyps— soft, noncancerous (benign) growths that develop on the lining of your nose or sinuses.
Nasal polyps result from chronic inflammation in the lining of your nose or sinuses, but just what triggers the inflammation isn't always clear. Although nasal polyps can affect anyone, they're more common in people older than 40 and in adults and children with conditions such as asthma, chronic sinus infections, hay fever and cystic fibrosis.
Medications are the most common treatment for small nasal polyps. Surgery may be needed to remove larger growths, but polyps frequently return.
Signs and symptoms
You may have a single nasal polyp or several, clustered together like grapes on a stem. The polyps are generally soft and pearl colored, with a consistency like jelly. Very small single or multiple polyps may not cause any problems, but larger ones are likely to obstruct the airways in your nose, making it difficult to breathe. This may lead to mouth breathing, especially in children.
Other signs and symptoms of nasal polyps include:
- A runny nose
- Persistent stuffiness
- Chronic sinus infections
- Loss or diminishment of your sense of smell
- Dull headaches
- Snoring
Although you may think of your nose mainly in terms of its appearance, it filters, warms and moistens the air you breathe, and it transmits scent-related information to your brain.
Your nose is mainly composed of bone, cartilage and mucous membrane. Each nasal cavity contains three or four bony shelves (turbinates) that curve from the outer part of your nose toward the septum — a thin, cartilage-and-bone divider that separates your nasal cavity. A thick mucous membrane covers both the turbinates and septum. This acts as a filter to remove bacteria and dirt particles, which are swept out of your nose by tiny hairs called cilia.
When incoming air is cold or dry, the highly sensitive tissue that lines the turbinates swells, narrowing your nasal passages and slowing the flow of air so that it becomes warm and moist before reaching your lungs.
Your nose also contains olfactory nerves that pick up scents and send the information to your brain, where the scents are identified. Without the nose-brain connection, you couldn't smell mom's apple pie or the ripeness of a fresh peach. In fact, without the olfactory nerves, you wouldn't be able to taste those foods either because most of your ability to taste depends on your sense of smell.
How nasal polyps form
Nasal polyps can develop in the mucous lining of your nose or in one or more of your sinuses — four hollow cavities above and behind your nose. But polyps aren't a disease. Rather, they're the end product of ongoing inflammation that may result from viral or bacterial infections, from allergies or from an immune system response to fungus. Chronic inflammation causes the blood vessels in the lining of your nose and sinuses to become more permeable, allowing water to accumulate in the cells. Over time, as gravity pulls on these waterlogged tissues, they may develop into polyps.
Treatment
If you have one or more small polyps, your doctor is likely to prescribe a corticosteroid nasal spray such as fluticasone (Flonase), triamcinolone (Nasacort), budesonide (Rhinocort), flunisolide (Nasarel) or mometasone (Nasonex). These medications relieve inflammation, increase nasal airflow and may help shrink polyps.
Side effects of steroid nasal sprays are far less serious than are those of oral steroids, but may include nosebleeds, headache or sore throat.
Other medications for nasal polyps include:
- Oral corticosteroids. Sometimes your doctor may prescribe an oral corticosteroid, either alone or in combination with a nasal spray. Because oral steroids can cause serious side effects, you usually take them for a brief period — often no longer than a few weeks.
- Medications to control allergies or infection. In addition to treating your polyps, your doctor may prescribe medications to control allergies or infection. Antihistamines, for instance, counteract histamine, an inflammatory substance released when your immune system encounters an allergen. If you have hay fever or other allergies, antihistamines may help relieve your congestion, although they won't eliminate polyps. In addition, your doctor may prescribe antibiotics for an acute sinus infection.
- Antifungal medications. Researchers have discovered that some cases of chronic sinusitis may be caused by an unusual immune system response to environmental fungus. For that reason, antifungal medications may be useful, though surgical removal of fungal debris also may be necessary.
Treatment for nasal polyps may also involve surgery. When medications aren't effective, your doctor may recommend removing your polyps. This is often the only option for people with cystic fibrosis who usually don't respond to steroids. The type of operation depends on the size, number and location of the polyps. Options for nasal polyps surgery 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. After polypectomy, you'll be treated for any underlying inflammation, usually with corticosteroid nasal sprays and sometimes with antibiotics or oral steroids. Even so, polyps frequently return, and you may need additional surgery.
- Endoscopic sinus surgery. This is a more extensive procedure that not only removes polyps, but also opens the part of the sinus cavity where polyps usually form. If your sinuses are very blocked or inflamed, your doctor may open even more of your sinus cavity. In both cases, your surgeon uses a thin, rigid tube and a camera called a video endoscope. Because endoscopic surgery requires small incisions, you generally heal more quickly and with less discomfort than with other types of surgery. Still, full recovery may take several weeks, and polyps often return.
In many cases, polyps can't be prevented. But if you have asthma, hay fever or chronic sinus infections, managing your symptoms may reduce any nasal congestion or trouble breathing. That means taking medications as your doctor suggests and avoiding — as much as possible — indoor and outdoor allergens and pollutants.
Irrigating your sinuses with salt water may help relieve mild nasal congestion and eliminate mucus. Avoid over-the-counter saline sprays that contain additives, such as benzalkonium, which can actually inflame the mucous lining of your nose and exacerbate your symptoms. Instead, look for preservative-free saline sprays.
To make your own saline solution, mix 1/4 teaspoon salt in 8 ounces of warm water. Pour some of the solution into your cupped hand and sniff into your nostrils. You can also inject the solution using an ear bulb or syringe. Then gently clear your nose with a tissue. Use any remaining solution within 24 hours or discard.
Credit: National Institute of Health.