Nasal Polyps

Nasal polyps are growths that result from inflamed mucus membranes in the sinuses and nasal passages. They can extend to the opening of the nostrils, or even down to the throat area. These growths can block the nasal passages.

Polyps may develop during infections and may disappear after the infection subsides, or they may begin slowly and persist. Many people are not aware that they have nasal polyps, although they may have sneezing, nasal congestion, obstruction, drainage of fluid down the throat (postnasal drip), facial pain, excessive discharge from the nose, loss of smell (anosmia), reduced ability to smell (hyposmia), itching around the eyes, and chronic infections.

People with nasal polyps may be seriously allergic to aspirin and other nonsteroidal anti-inflammatory drugs. People with nasal polyps can develop sinus infections if the polyps block drainage from the sinuses. Many develop asthma as well. Nasal polyps also can form if a foreign body is in the nose.

Corticosteroids in the form of nasal sprays or oral tablets may shrink or eliminate polyps. Endoscopic surgery or oral corticosteroids are needed if polyps block the airways or cause frequent sinus infections. Polyps tend to grow back unless the underlying irritation, allergy, or infection is controlled. Using an aerosol corticosteroid spray may slow or prevent recurrences. However, a doctor may need to examine the person periodically with nasal endoscopy (looking in the nose with a small rigid or flexible viewing tube) to evaluate and treat persistent or recurring problems.

Signs and Symptoms of Nasal Polyps :

The majority of people with nasal polyps will experience nasal congestion, which may be severe, that isn't helped by typical allergy medications. Other common symptoms include:

* Runny nose with clear or colored mucus
* Loss or decreased sense of smell and taste
* Headache
* Sinus pressure

However, facial pain is much more common in people with chronic sinusitis compared to those with nasal polyps.

A person with severe nasal polyps may actually be able to see the polyps in their nostrils. These structures look like clumps of clear Jello-O. Long-standing nasal polyps can lead to widening of the nasal bridge, which can result in the eyes appearing to be farther apart.

Treatment:

Nasal polyps may be treated by both surgical and medical therapies. In severe cases, sinus surgery is often required to remove the nasal polyps and any accompanying sinus infection. However, since nasal polyps tend to grow back in at least one-third of patients, the overuse of surgery should be avoided.

The best therapy for nasal polyps usually involves the use of surgical therapies followed by medical therapies, as this approach helps reduce the chance that the polyps will grow back.

* Nasal Steroid Sprays and Drops

Topical nasal steroid sprays, such as Flonase (fluticasone propionate) and Nasonex (mometasone furoate), can help reduce the size of nasal polyps and prevent polyps from growing back after surgery. Some physicians, myself included, use nasal steroid drops, rather than sprays, in order to better penetrate the nasal passages and reach the nasal polyps.

* Corticosteroids

Oral corticosteroids, such as prednisone, can quickly shrink the size of nasal polyps and are helpful in people with severe symptoms. After a short course of corticosteroids (about 1 to 2 weeks), however, topical nasal steroid sprays are able to control symptoms better and prevent the polyps from growing larger.

In some cases, such as when fungal sinusitis is the cause of nasal polyps, low-dose oral corticosteroids may be required for weeks to months after surgery in order to prevent polyps from growing back.

* Antileukotriene Medications

Oral antileukotriene medications, such as Singulair (montelukast), are theoretically beneficial in people with nasal polyps -- especially those with aspirin allergy. People with aspirin allergy are known to have high levels of leukotrienes, so medications that block these chemicals should help to reduce symptoms of chronic sinus disease and polyp formation.

* Nasal Saline Irrigation

Nasal saline irrigation can be especially helpful in people with nasal polyps and chronic sinus infections. This is especially true for those who have had sinus surgery, as the saline can rinse out the sinuses and not just the nasal passages.

* Allergy Shots

Many allergists may use allergy shots in an attempt to treat or prevent nasal polyps from growing back after surgery. The best data for the use of allergy shots is in those with allergic fungal sinusitis; allergy shots may also prove to be helpful in those with nasal polyps and evidence of significant allergic triggers.



References:
1. http://www.merck.com/mmhe/sec19/ch221/ch221h.html#
2. http://allergies.about.com/od/noseandsinusallergies/a/nasalpolyps.htm
3. http://www.healthcentral.com/images/ency/fullsize/9226.jpg