Nasal Polyps Treatment in Delhi, India

Small polyps may not present any clinical symptoms. But as they grow, they may cause:

• Headaches
• Nosebleeds
• Nasal congestion or stuffy nose
• Loss of smell or taste
• Runny nose
• Snoring
• Postnasal drip or constantly feeling like clearing the throat
• Pain or pressure in the sinuses, face, or teeth.

Large polyps can block the nasal passages and sinuses, leading to:

• Frequent asthma attacks in patients with asthma.
• Recurrent sinus infections.
• Sleep apnea or other sleeping problems.
• Trouble breathing, even in people who don't have asthma.

Studies are being conducted to understand the exact cause of nasal polyps. Nasal polyps are common in people with health conditions such as:

• Asthma
• Aspirin sensitivity
• Chronic sinus infections
• Cystic fibrosis
• Hay fever or allergic rhinitis
• Certain hereditary factors may also contribute to the development of nasal polyps—especially the genes that have a role to play in the immune system and inflammatory response.

The doctor diagnoses nasal polyps based on the symptoms and a physical nose examination. Diagnostic tests are:

• Nasal endoscopy: A nasal endoscope enables the doctor to examine the nose and sinuses thoroughly.
• Imaging studies: Computerized tomography or CT scan can help assess the exact size and location of the polyp in deeper areas of the sinuses. It also helps evaluate the extent of swelling and irritation. Other possibilities of blockages in the nasal cavities, such as abnormal growths and structural abnormalities, can also be ruled out.
• Allergy tests: The doctor may suggest skin tests to determine the presence of allergies contributing to chronic inflammation. In a skin prick test, tiny drops of allergy-causing agents are pricked into the skin of the forearm or upper back. The healthcare professional observes the skin for signs of allergic reactions. Alternatively, a blood test may be advised to evaluate the presence of any allergens.
• Cystic Fibrosis Test: It is an inherited condition affecting the glands producing tears, sweat, mucus, digestive juices, and saliva. The test is a non-invasive sweat test, which determines whether the child's perspiration is saltier than most people's sweat or not.
• Blood test: The doctor may advise blood tests for low vitamin D levels associated with nasal polyps.

The key to treating a nasal polyp is not only to remove it in-toto but to eliminate the root cause of its development. The doctor discusses the treatment plan to manage symptoms and treat allergies that may be contributing to chronic swelling.

Medicines are the first approach to treating nasal polyps, followed by surgery, if necessary.

Medications

Nasal polyp treatment begins with the administration of drugs, which may shrink large polyps. Drug treatments include:

• Nasal corticosteroids: A corticosteroid nasal spray reduces swelling and irritation, thereby shrinking the polyps or eliminating them. Nasal corticosteroids help in decongesting the nasal passage and shrinking the polyp.
• Oral and injectable corticosteroids: Ineffective nasal corticosteroids require the use of oral corticosteroids, either taken singly or in combination with a nasal spray may help achieve the goal of eliminating the polyp and decongesting the nose.
• Injectable corticosteroids may be advised in cases of severe nasal polyps.
• Other medications: The doctor may prescribe other drugs, such as antihistamines to treat allergies; antibiotics to treat chronic or recurring infections.

Endoscopic Sinus Surgery

Endoscopic surgery may be necessary when drug treatment fails to shrink or eliminate nasal polyps. It is performed as an outpatient procedure.

During surgery, an endoscope is inserted into the nostrils and guided into the sinus cavity. Powered instruments (debride) are used to remove polyps and other substances blocking the flow of fluids from the sinuses. The surgeon enlarges the openings leading from the sinuses to the nasal passages.

After the surgery, a corticosteroid nasal spray is prescribed to help prevent the recurrence of nasal polyps. The doctor may also advise using saltwater rinse to promote healing after surgery.

Nasal polyps can cause complications since they obstruct normal airflow and drainage of fluid. Long-term irritation and swelling (inflammation) also contribute to their development.

Potential complications are:

• Obstructive sleep apnea: A life-threatening condition in which a person stops and starts breathing frequently during sleep.
• Asthma flare-ups: Chronic sinusitis worsens asthma.
• Sinus infections: Nasal polyps make a person more susceptible to sinus infections that recur often.

Conditions that trigger prolonged irritation and swelling or inflammation in the nasal passages or sinuses, such as infections and allergies, increase the risk of nasal polyps. Conditions associated with nasal polyps are as follows:

• Asthma- Causes inflammation or swelling of the airways, thereby narrowing them.
• Sensitivity to aspirin
• Allergic fungal sinusitis
• Cystic fibrosis- A genetic disorder that causes abnormally thick, sticky fluids in the body, including thick mucus from nasal and sinus linings
• Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis)- a rare disease that causes the inflammation of blood vessels
• Vitamin D deficiency
• Genetic variations may be associated with the development of nasal polyps

With surgical treatment, most symptoms get better with time. However, if some sense of smell is lost, it may never return. Even with surgery, nasal polyps may regrow in up to 15 per cent of people with a chronic nasal condition.

Reviewed by Dr. Sumit Mrig, Associate Director and Head, ENT(Ear Nose Throat) on 27-Apr-2023.