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Nasal polypsBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/nasal-polyps/DS00498
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Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.
Small nasal polyps may not cause symptoms. Larger growths or groups of nasal polyps can block your nasal passages or lead to breathing problems, a lost sense of smell, and frequent infections.
Nasal polyps can affect anyone, but they're more common in adults. Medications can often shrink or eliminate nasal polyps, but surgery is sometimes needed to remove them. Even after successful treatment, nasal polyps often return.
Nasal polyps are associated with inflammation of the lining of your nasal passages and sinuses that lasts more than 12 weeks (chronic rhinosinusitis, also known as chronic sinusitis). However, it's possible — and even somewhat more likely — to have chronic sinusitis without nasal polyps.
Nasal polyps themselves are soft and lack sensation, so if they're small you may not be aware you have them. Multiple growths or a large polyp may block your nasal passages and sinuses.
Common signs and symptoms of chronic sinusitis with nasal polyps include:
- A runny nose
- Persistent stuffiness
- Postnasal drip
- Decreased or absent sense of smell
- Loss of sense of taste
- Facial pain or headache
- Pain in your upper teeth
- A sense of pressure over your forehead and face
- Itching around your eyes
When to see a doctor
See your doctor if your symptoms last more than 10 days. Symptoms of chronic sinusitis and nasal polyps are similar to those of many other conditions, including the common cold.
Seek immediate medical care or call 911 or your local emergency number if you experience:
- Serious trouble breathing
- Sudden worsening of your symptoms
- Double vision, reduced vision or limited ability to move your eyes
- Severe swelling around your eyes
- Increasingly severe headache accompanied by high fever or inability to tip your head forward
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Scientists don't yet fully understand what causes nasal polyps. It's not clear why some people develop chronic inflammation or why ongoing inflammation triggers polyp formation in some people and not in others. The inflammation occurs in the fluid-producing lining (mucous membrane) of your nose and sinuses. There's some evidence that people who develop polyps have a different immune system response and different chemical markers in their mucous membranes than do those who don't develop polyps.
Nasal polyps can form at any age, but they're most common in young and middle-aged adults. Nasal polyps may form anywhere in your sinuses or nasal passages, but they appear most often in an area where sinuses near your eyes, nose and cheekbones all drain through winding passages into your nose (ostiomeatal complex).
Any condition that triggers chronic inflammation in your nasal passages or sinuses, such as infections or allergies, may increase your risk of developing nasal polyps. Conditions often associated with nasal polyps include:
- Asthma, a disease that causes overall airway inflammation and constriction
- An allergy-like response to aspirin or to pain relievers such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)
- Allergic fungal sinusitis, an allergy to airborne fungi
- Cystic fibrosis, a genetic disorder that results in the production and secretion of abnormally thick, sticky fluids, including thick mucus from nasal and sinus membranes
- Churg-Strauss syndrome, a rare disease that causes the inflammation of blood vessels
Your family history also may play a role. There's some evidence that certain genetic variations associated with immune system function make you more likely to develop nasal polyps.
Nasal polyps can cause complications because they block normal airflow and fluid drainage, and also because of the chronic inflammation underlying their development. Potential complications include:
- Obstructive sleep apnea. In this potentially serious condition, you stop and start breathing frequently during sleep.
- Asthma flare-ups. Chronic rhinosinusitis can trigger asthma attacks.
- Sinus infections. Nasal polyps can make you more susceptible to sinus infections that recur often or become chronic.
- Spread of infection to your eye socket. If an infection spreads to your eye socket, it can cause swelling or bulging of your eye, inability to move your eye, reduced vision or even blindness that can become permanent.
- Meningitis. Infection can also spread to the membranes and fluid surrounding your brain and spinal cord.
- Aneurysms or blood clots. Infection can cause problems in the veins surrounding the sinuses, interfering with the blood supply to parts of your brain and putting you at risk of a stroke.
Preparing for your appointment
If you have signs or symptoms of nasal polyps, you're likely to start by seeing your primary care physician. However, your doctor may refer you to a specialist in ear, nose and throat disorders (ENT doctor, or otolaryngologist) or an allergy specialist (allergist) for diagnostic tests or treatment.
Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to prepare ahead of time. Here are some suggestions to help you get ready for your appointment and understand what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. When you make your appointment, ask if you need to fast for blood work or if you need to do anything else to prepare for diagnostic tests.
- Write down all of your symptoms, even if they seem unrelated to your nose or sinuses. Your doctor will want to know details about when your symptoms started and whether anything seems to make them better or worse.
- Take along a family member or friend, if possible. Having someone along can help you recall all the information provided during your appointment.
- Make a list of your other medical conditions. Your doctor will want to know if you're currently being treated for allergies, asthma or any other health conditions.
- Make a list of all your medications, including over-the-counter drugs and vitamins or supplements.
Questions to ask your doctor
Because time with your doctor is limited, writing down a list of questions will help you make the most of your appointment. List questions for your doctor from most important to least important in case time runs out. If you think you have symptoms of nasal polyps, you may ask some of the following questions:
- What is likely causing my problems with breathing, sense of smell and other problems related to my nose?
- What kinds of tests do I need?
- What is the best course of action?
- Do I need to see a specialist? What will that cost? Will my insurance cover it?
- What type of follow-up examinations or care will I need?
- If I have nasal polyps, can we effectively treat the underlying cause of inflammation?
- What should I expect to happen over the long term?
- Will my new symptoms affect how I manage my other health conditions?
- Do I need to follow any restrictions?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to respond may free up time to go over any points you want to spend more time on. Your doctor may ask:
- When did you begin experiencing symptoms?
- When did you last have a cold or sinus infection?
- How often do you have colds or sinus infections?
- Do you have allergies? Do you know what you're allergic to?
- Do you have asthma? How well are you able to manage it?
- Do you often take aspirin, Advil, Aleve, or any other over-the-counter drugs for pain?
- Do you smoke, or are you exposed to secondhand tobacco smoke?
- In your work or hobbies, are you exposed to chemical fumes or other airborne pollutants such as dust or debris from a leaf blower?
- Have you ever had any sinus or nasal surgery?
Tests and diagnosis
Your doctor can usually make a diagnosis based on your answers to questions about your symptoms, a general physical exam and an examination of your nose. Polyps may be visible with the aid of a simple lighted instrument.
Other diagnostic tests include:
- Nasal endoscopy. A nasal endoscope, a narrow, flexible tube with a lighted magnifying lens or tiny camera, enables your doctor to perform a detailed examination inside your nose and sinuses. He or she inserts the endoscope into a nostril and guides it into your nasal cavity.
- Imaging studies. Images obtained with computerized tomography (CT) or magnetic resonance imaging (MRI) can help your doctor pinpoint the size and location of polyps in deeper areas of your sinuses and evaluate the extent of inflammation. These studies may also help your doctor rule out the presence of other possible obstructions in your nasal cavity, such as structural abnormalities or another type of cancerous or noncancerous growth.
- Allergy tests. Your doctor may suggest skin tests to determine if allergies are contributing to chronic inflammation. With a skin prick test, tiny drops of allergy-causing agents (allergens) are pricked into the skin of your forearm or upper back. The drops are left on your skin for 15 minutes before your doctor or nurse observes your skin for signs of allergic reactions. If a skin test can't be performed, your doctor may order a blood test that screens for specific antibodies to various allergens.
- Test for cystic fibrosis. If you have a young child diagnosed with nasal polyps, your doctor may suggest testing for cystic fibrosis, an inherited condition affecting the glands that produce mucus, tears, sweat, saliva and digestive juices. The standard diagnostic test for cystic fibrosis is a noninvasive sweat test, which determines whether your child's perspiration is saltier than most people's sweat.
Treatments and drugs
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|Endoscopic sinus surgery|
Chronic sinusitis, with or without polyps, is a challenging condition to clear up completely. You'll work with your health care team to develop the best long-term treatment plan to manage your symptoms and to treat factors, such as allergies, that may contribute to chronic inflammation.
The treatment goal for nasal polyps is to reduce their size or eliminate them. Medications are usually the first approach. Surgery may sometimes be needed, but it may not provide a permanent solution because polyps tend to recur.
Nasal polyp treatment usually starts with drugs, which can make even large polyps shrink or disappear. Drug treatments may include:
- Nasal corticosteroids. Your doctor is likely to prescribe a corticosteroid nasal spray to reduce inflammation. This treatment may shrink the polyps or eliminate them completely. Nasal corticosteroids include fluticasone (Flonase, Veramyst), budesonide (Rhinocort), flunisolide, mometasone (Nasonex), triamcinolone (Nasacort) and beclomethasone (Beconase AQ).
- Oral and injectable corticosteroids. If a nasal corticosteroid isn't effective, your doctor may prescribe an oral corticosteroid, such as prednisone, either alone or in combination with a nasal spray. Because oral corticosteroids can cause serious side effects, you usually take them only for a brief period. If your polyps don't respond to nasal and oral corticosteroids, your doctor may recommend injecting a corticosteroid directly into your polyps.
- Other medications. Your doctor may prescribe drugs to treat conditions that contribute to chronic inflammation in your sinuses or nasal passages. These may include antihistamines to treat allergies and antibiotics to treat a chronic or recurring infection.
If drug treatment doesn't shrink or eliminate nasal polyps, your doctor may recommend surgery. The type of surgery depends on the size, number and location of your polyps and the extent of inflammation. 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. This procedure, called a polypectomy, is performed on an outpatient basis.
- Endoscopic sinus surgery. You may need surgery to remove polyps and to correct problems with your sinuses that make them prone to inflammation and polyp development. 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 block the flow of fluids from your sinuses. Your surgeon may also enlarge the openings leading from your sinuses to your nasal passages. Endoscopic surgery is usually performed as an outpatient procedure.
After surgery, you'll likely use a corticosteroid nasal spray to help prevent the recurrence of nasal polyps. Your doctor may also recommend the use of a saltwater (saline) rinse to promote healing after surgery.
You may help reduce your chances of developing nasal polyps or having nasal polyps recur after treatment with the following strategies:
- Manage allergies and asthma. Follow your doctor's treatment recommendations for managing asthma and allergies. If your symptoms aren't well controlled, talk to your doctor about changing your treatment plan.
- Avoid nasal irritants. As much as possible, avoid breathing airborne substances that are likely to contribute to inflammation or irritation of your nose and sinuses, such as allergens, tobacco smoke, chemical fumes, and dust and fine debris.
- Practice good hygiene. Wash your hands regularly and thoroughly. 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 may help moisten your breathing passages, improve the flow of mucus from your sinuses, and help prevent blockage and inflammation.
- Use a nasal rinse or nasal lavage. Use a saltwater (saline) spray or nasal lavage to rinse your nasal passages. This may improve mucus flow and remove allergens and other irritants. You can purchase over-the-counter saline sprays or nasal lavage kits with devices, such as a neti pot, to administer a rinse. You can make your own saltwater solution by mixing 1/8 teaspoon (0.6 milliliters) of table salt in 8 ounces (about 237 milliliters) of distilled or purified warm water.
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