Key concepts
Nasal polyps are soft benign, multiple or solitary tumor growths that grow along the nasal mucosa or within the paranasal sinuses.
Causes
Although it is not possible to trace a precise and unequivocal cause, it is assumed that the formation of nasal polyps is related to diseases such as: allergy, asthma, cystic fibrosis, chronic sinusitis (especially), immunodeficiency and connective diseases, administration of some drugs, smog.
Symptoms
The characteristic symptoms caused by nasal polyps are: ageusia, anosmia, headache, nasal congestion, difficulty breathing, facial pain, rhinorrhea, watery eyes, itchy eyes and snoring.
Diagnosis
The diagnosis of nasal polyposis is ascertained by subjecting the patient to one or more investigative tests. Among the most validated diagnostic techniques we mention: medical history, otorhinolaryngology examination, skin allergy tests, haematological tests, tests on nasal and olfactory respiratory function. Sometimes, imaging (CT or MRI) and endoscopic tests are also required.
The cystic fibrosis test is indicated for infantile nasal polyposis.
Therapy
- Drug therapy (for small polyps): corticosteroid drugs (to be sprayed in the nose or to be taken by mouth), antihistamines (for the treatment of allergy-dependent nasal polyps), antibiotics or antifungals (in the case of bacterial / mycotic superinfections)
- Surgical therapy: Polypectomy or endoscopic sinus surgery
What is a nasal polyp?
Nasal polyps are small benign tumor growths that grow along the nasal mucosa or within the paranasal sinuses. Generally painless, nasal polyps tend to progressively increase in volume, thus obstructing the respiratory tract and obstructing normal breathing. It is assumed that the nasal polyps are the final result of an inflammatory process of the nasal mucosa, in turn triggered by secondary pathological conditions, such as asthma, recurrent infections, hypersensitivity to some nebulized drugs, allergies or alterations of the immune system.
The curious term "polyp" recalls the aspect that the nose-paranasal mucosa takes on during this disorder: it appears shiny, clear and soggy, just like an octopus.
The nasal polyp is a soft edematous pedunculate manifestation, which can appear in any portion of the nasal mucosa or paranasal sinuses.
Nasal polyps are distinguished by their cellular composition: thus, "neutrophils" are defined as nasal polyps consisting mainly of neutrophil cells, and "eosinophils" when eosinophilic leukocytes represent its main components.
Incidence
Although nasal polyps can appear at any age, adults are certainly the most affected category. It is estimated that 2-4% of the global population complains about this disorder, with a clear male prevalence (the male-female ratio is 2/4: 1).
Multiple benign polyposis occurs in patients over the age of 20, and is extremely common in males over forty. In children, on the other hand, nasal polyps are a rather rare phenomenon: when they occur in children, it is recommended that the patient be tested for cystic fibrosis.
Nasal polyps can recur even after a pharmacological or surgical treatment.
Causes
The etiolopathological mechanism of nasal polyposis has not yet been demonstrated with certainty. Despite the nasal polyposis - already for many centuries - it is considered a pathological entity in all respects, it is still not possible to trace a definition based on clear and unambiguous assumptions.
However, most researchers suggest that nasal polyps are the ultimate manifestation of repeated chronic inflammation on the nasal mucosa. For this reason, it is considered possible that some pathological conditions may predispose the patient to nasal polyposis:
- Allergy
- Asthma
- Cystic fibrosis: the nasal polyps in children are a lit spy of cystic fibrosis
- Chronic rhinosinusitis / sinusitis (bacterial or fungal)
- Immunodeficiency diseases:
- Churg-Strauss syndrome: it is a systemic vasculitis affecting the small blood vessels
- Primary ciliary dyskinesia: congenital disease linked to alterations of the structure and function of the cilia of the respiratory mucosa
- Selective IgA deficiency: fairly common congenital defect of the immune system characterized by a reduction in plasma IgA levels
- Connective diseases (rare)
- Intake of some drugs, in particular aspirin and salicylates
- Chronic irritation of irritating substances (eg smoke, smog)
- Alcohol intolerance
- Infections with Aspergillus, Fusarium or other molds
Nasal polyps: symptoms
To learn more: Symptoms Nasal Polyps
The symptoms of nasal polyposis occur when the size of the polyps increases to the point of obstructing breathing. In this regard, nasal congestion (stuffy nose) and difficulty breathing are the two main symptoms of nasal polyposis.
The clinical picture is often completed by a series of secondary symptoms:
- Alteration of the olfactory capacity (anosmia)
- Taste alteration (hypogeusia / ageusia)
- Headache
- Facial pain
- Toothache
- Dripping nose (rhinorrhea)
- Eyes that water
- Perception of pressure on the forehead and face
- Itchy eyes
- Snoring
The disease can sometimes be asymptomatic, especially when the size of the nasal polyps is negligible.
In more severe cases, nasal polyps can give rise to serious complications, such as obstructive sleep apnea, spread of infection to the eye, meningitis, aneurysms and asthma attacks. Considering the real risk of a collapse of the clinical picture, it is strongly advised to request immediate medical consultation in the event of severe respiratory difficulties, doubling of vision, sudden worsening of symptoms, high fever and significant swelling around the eyes.
It is however necessary to point out that serious complications from nasal polyposis are rather rare: in the vast majority of cases, small nasal polyps regress spontaneously or with a specific pharmacological treatment. Large polyps need surgical excision instead.
