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Written by Dr Robert Mills, consultant otolaryngologist
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What are nasal polyps?
The 'paranasal sinuses' are the air cavities within
the skull that open into the nose. If the soft tissue lining of the sinuses
becomes swollen, it fills the available space and can then expand into the nose
forming a growth called a polyp. As there are a number of small sinuses between
the eye and the nose, when polyps do occur, there will usually be several of
them.
What causes nasal polyps?
The cause of nasal polyps is not well understood. Some believe
that they result from an
allergy to things in
the atmosphere, while others believe that they are caused by a
sinus infection.
What symptoms do they cause?
Polyps block the nose. Large polyps can prevent nasal breathing,
forcing the individual to breathe through their mouth. They also cause reduced
sense of smell. Occasionally, they swell so much that they emerge from the
nostril.
When should you seek medical attention?
There are a number of more common causes of nasal obstruction,
including a
deviated nasal septum
and inflammation of the nasal lining (rhinitis).
If you have a severely blocked nose, you should see your
doctor. Inspection of the nose will reveal the presence of polyps. Your doctor
will usually refer you to an ear, nose and throat (ENT) specialist if polyps
are seen.
Does medical treatment help?
Nasal sprays and drops containing corticosteroids can shrink the
polyps in some cases. A single small polyp is occasionally cured by this type
of treatment.
Corticosteroid tablets have a
similar effect, but can only be used as a short course because of the side
effects they can cause. They may be required initially to shrink larger
polyps.
How are polyps usually treated?
The most effective treatment for nasal blockage due to polyps is
surgical removal. Most specialists will arrange an X-ray called a
CT scan to show the
extent of polyp tissue in the sinuses and the layout of the bony partitions
between the sinuses, the orbit (the bone around the eye) and the interior of
the skull.
Removal is generally carried out using a telescope (endoscope)
to look inside the nose. In some cases the polyps are simply cleared from the
nose itself. In other cases, polyp tissue is also removed from the sinuses.
Are there any risks associated with polyp surgery?
There is the risk of bleeding from the nose or a black eye due
to damage to the wall between the nose.
If the sinuses are cleared as well as the nose, there is a risk
of the surgeon's instruments entering surrounding areas. Within the orbit,
the eye and its muscles are at risk of damage. Entering the interior of the
skull causes a leakage of fluid from around the brain (CSF leak).
These complications are uncommon and can usually be avoided by
having a CT scan available at the time of surgery.
Do polyps grow again?
Unfortunately, removing nasal polyps does not always prevent
them from growing back. They may return a number of years after surgery.
Surgical removal can be repeated if necessary.
Using a steroid nasal spray on a regular basis can sometimes
prevent recurrence of polyps, and should also be seen as the first line of
treatment, in the hope of avoiding surgery at all.
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Last updated 02.06.2005
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