Definition of nasal polyp
Nasal polyps - more correctly defined nasal-sinus polyps - are soft benign tumor growths that affect the nasal mucosa and the paranasal sinuses.
The clinical evidence shows that nasal polyps tend to appear in conjunction with inflammatory pathologies of the respiratory moss, in particular sinusitis, allergies, rhinitis and asthma. Despite what has been said, scholars are unable to give an exhaustive answer on the etiopathogenesis of nasal polyps. However, it appears that genetic predisposition plays a major role in the appearance of these nasal growths.
In most cases, small nasal polyps are a benign phenomenon, soon to be resolved by topical application of corticosteroids (spray). When the nasal polyps reach considerable dimensions, such as to obstruct the correct breathing, a targeted surgical excision is conceivable.
Diagnosis
The diagnostic evaluation of nasal polyposis makes use of a meticulous collection of anamnestic data: the objective is to investigate the possible genetic predisposition to the disorder and to identify further possible associated diseases. The doctor then proceeds with an otorhinolaryngological examination, skin allergy tests (eg Prick-test) and hematology. Also important are the tests on nasal respiratory function (rhinomanometry) and olfactory (olfactometry).
Radiological imaging examinations (CT or MRI) and endoscopic examinations allow to carry out a qualitative and quantitative analytical balance of the disease, or establish the danger and size of a polyp (possible malignant form) and the number of polyps present in the respiratory tract.
The cystic fibrosis test is conceivable when the nasal polyps affect children.
The differential diagnosis must be made with all the pathological manifestations that present with symptoms similar to the nasal polyposis:
- Chronic rhinosinusitis: some forms of rhinosinusitis occur independently of the presence of nasal polyps
- Fungal allergic sinusitis
- Insertion of a foreign body in the nose (typical of children)
- Benign or malignant neoplasms: in general, nasal polyps (benign tumor forms) are bilateral, therefore they tend to appear in both paranasal sinuses. Unilateral nasal polyps (in particular) should be distinguished from malignant tumor forms.
Therapy and treatment
PHARMACOLOGICAL THERAPY
To learn more: Drugs for the treatment of Nasal Polyps
The therapy for small nasal polyps is generally symptomatic, ie aimed exclusively at the remission of symptoms. The administration of some specific drugs is generally necessary to improve the clinical profile of the patient.
The drugs most used in therapy for small nasal polyps are essentially corticosteroids, taken in the form of nasal spray and / or tablets to be taken by mouth.
The following are the most commonly used corticosteroid drugs for the treatment of nasal polyps:
- Fluticasone (eg Avamys, Alisade, Fluspiral), indicated both for the treatment and for the prevention of nasal polyps
- Beclometasone (eg Rinoclenil, nasal Becotide)
- Mometasone (eg Nasonex, Rinelon)
When the appearance of nasal polyps is linked to allergic reactions, therapy with antihistamine and decongestant drugs helps reduce inflammation of the nasal mucosa, speeding up healing time. Antibiotic or antifungal treatment is instead indicated when the nasal polyposis is linked to bacterial or fungal infections.
Patients predisposed to nasal polyposis may follow a lighter cortisone therapy to minimize the risk of relapse.
When nasal polyposis depends on an intolerance to acetylsalicylic acid, it is recommended to avoid its administration, replacing the drug with another active ingredient with similar therapeutic activity (always consult your doctor).
SURGICAL TREATMENT
In contrast, large nasal polyps are treated surgically: the surgical exeresis (removal) of the mass constitutes, in this sense, the only possible solution to cure the disorder definitively. We remember, in fact, that the nasal polyps can reach such dimensions as to seriously obstruct the airways, constituting a serious discomfort for breathing and for night rest.
Surgical options for removing nasal polyps are:
- Polypectomy: the polyp is removed by a small mechanical suction device or with a particular instrument ( microdebrider ) that allows the dissection of the polyp.
- Endoscopic sinus surgery: consists in the removal of the nasal polyp accompanied by the correction of the structure of the paranasal sinuses. In fact, even a particular anatomy of the nasal structures can predispose the subject to inflammation of the mucosa. The surgical procedure is performed by introducing an endoscope through the nostrils, in order to provide an enlarged image of the internal nasal structures. Subsequently, we proceed with the correction of the problem (removal of the polyp + revision of the nasal structures).
Even after surgical removal of the polyp, the risk of recurrence is still real. To prevent the reappearance of nasal polyps, it is advisable to follow an adequate cortisone therapy (spray formulations).
Guidelines to prevent relapses of nasal polyposis in predisposed subjects:
- Use an ambient humidifier, useful for reducing the risk of sinusitis and respiratory tract infections;
- Perform frequent nasal washes with saline solution;
- Limit alcohol consumption: alcohol can worsen swelling of the nasal mucosa;
- Managing allergic phenomena: allergy is in fact a possible risk factor for sinusitis and nasal polyps.
