What Are Nasal Polyps?
Nasal polyps are soft, fleshy growths appearing in the inner lining of the nasal passage or along the sinuses. They usually occur in older people above the age of 40 but when present in children, they could be symptoms of other illnesses such as cystic fibrosis. Nasal polyps are non-cancerous and harmless in themselves. However, if they are too numerous or large, they can block nasal drainage, cause breathing problems, infections, allergies, sleeplessness, pain, headaches, vision disturbances. Symptoms are commonly confused with cold/congestion. Few known causes exist for their occurrence. Treatment: non-invasive topical cortico-steroid sprays, home remedies and surgery in severe cases.
Nasal Polyp Facts
1. These are fleshy, transparent growths that occur within the nasal passage, usually in the lining of the passages. They may also occur in the para-nasal spaces along the sinuses. (Sinuses are the empty cavities, which are interconnected and are present in the skull. They’re thought to be useful in de-humidifying the air we breathe and also control our voice pitch)
2. Nasal polyps are soft, painless and generally non-cancerous.
3. They may appear as single polyps or in clusters. Usually, if they are in clusters, they appear on both sides of the insides of the nasal passage. They may be pinkish or yellow-brown and are shaped like tear-drops.
4. These benign growths are similar to cysts that may occur on the surface of the skin. In fact, by themselves, they cause very little damage. However, the problems occur when they grow larger in size and affect other systems in the body.
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• In general, nasal polyps are more frequent in adults, but they do occur in children, albeit of a different variety.
• Children under ten rarely develop nasal polyps.
• Roughly about 1-4% of the general population may suffer from this condition.
• The incidence increases with age and the greatest likelihood is between 40-60 years of age.
• Nearly 50% of people with aspirin allergy develop nasal polyps.
• Almost 40% of people with analgesic allergy may also develop the condition.
Causes: Though there are no completely certain causes for nasal polyps, there are triggers that may set off their growth. Usually, repeated infections or inflammation of the nasal mucus tends to damage the nasal lining. The fluid that keeps the lining wet begins to continuously drip, causing further irritation, resulting in the formation of a polyp. Occurrence of nasal polyps has no connection with uterine or colonic polyps.
Other triggers could be:
• Chronic hay fever
• Cystic fibrosis
• Frequent sinus infections
• Injury or foreign body in the nose
• Aspirin sensitivity
• Rare genetic disorders
• Immune system disorders
• Bacterial/viral infection
• Non-allergic respiratory problems
One of the issues being researched is the role of air pollution in the formation of nasal polyps. Suspended particulate matter in the air due to industrial and vehicular pollution could be a factor. Exposure to toxic chemicals like chromium may also be a probable cause.
Risks: In themselves, nasal polyps are benign growths. However, if there are multiple polyps and they grow to a bigger size, they can block the nasal passage or the sinuses, causing great discomfort, breathing difficulties, pain and headaches. They may also cause loss of sensitivity, loss of sense of smell, frequent infections.
Further complications can arise from the polyps blocking flow of air and normal drainage. These complications include serious ones like:
Stop and start breathing: This is particularly dangerous during sleep and is known as obstructive sleep apnea. It can be fatal in severe cases, leading to cut off of oxygen supply and ultimately, death, during sleep.
Chronic sinus infections: The presence of multiple polyps can increase the patient’s chances of getting recurring sinus infections, which in turn can become difficult to treat.
Recurrent Asthma: This can become a vicious cycle of asthma leading to nasal polyps and then back to recurrence of asthma. Apart from asthma, allergic rhinitis and other chronic brionchial conditions may also become established. Often, the nasal sprays and drugs used to treat asthma can create conditions for nasal polyps, so there are potentially very complicated conditions that can arise from asthma attacks.
Eye-infections: If the drainage channels from the eyes get blocked by nasal polyps, this can lead to dryness and severe eye infections. The infections, if not managed properly, can spread into the eye socket, leading to bulging, vision problems and possibly even blindness in extreme cases.
Facial deformity: In severe, untreated cases, the facial structure itself may become distorted, with the eyes moving further apart.
Neurological infections: Nasal polyps may create infections that can easily spread from the nasal lining into the brain, spinal cord etc, leading to illnesses like meningitis.
Bleeding: Large clusters of nasal polyps can cause bleeding and this should be a matter of great concern, as the growths could be cancerous. Inflammation of the blood vessels or Churg-Strauss syndrome could be another fall-out of nasal polyps.
Fungal infections/allergy: The patient may either develop frequent fungal infections or become severely allergic to air-borne fungi.
Keeping these possibilities in mind, nasal polyps, though inherently harmless, can create many other complications.
Signs and Symptoms: As discussed earlier, there are not many unique symptoms associated with nasal polyps. Instead, these symptoms can easily be confused with other conditions. Quite often, nasal polyps may not be diagnosed at all in early stages, since they are painless and may not interfere with the normal functioning of the nasal passage/sinuses. However, once they increase in size and number, they lead to other conditions.
Nasal polyps symptoms may often be confused with common cold, allergy etc. However, if these symptoms don’t clear up within 10 days, and actually seem to worsen, your doctor may suspect the presence of nasal polyps. Hence, very broadly, these are the nasal polyp symptoms which you can watch out for:
• Chronic inflammation of nasal passage
• Mouth Breathing
• Sleep disturbance
• Constant headaches
• Nasal fluid running into the back of the throat (post-nasal drip)
• High temperature accompanied by pain in face/forehead
• Runny nose
• Facial pain
• Pain in the upper part of the face/jaw/teeth
• Persistent stuffy nose
• Itching and dryness round the eyes
• Loss of smell
• Loss of taste
• Feeling of pressure round the forehead/eyes
• Double vision
• Serious breathing trouble
• Inability to tip your head forwards with severe headache
As mentioned earlier, all these symptoms can be attributed to other conditions, but they become a matter of concern when they persist and worsen.
Diagnosis: Based on the patient’s report of symptoms, and the doctor’s observations of the signs, a diagnosis of nasal polyps may be tentatively made. Quite often, the polyps are visible inside the nose quite clearly by shining a lighted instrument into the passage. For further confirmation, the doctor may order:
Sodium Chloride Test: If the patient is a child, the doctor may suspect cystic fibrosis. The level of sodium chloride present in the sweat is an indicator of cystic fibrosis.
Allergic Reaction Test: A small amount of known allergens are introduced into the skin via a needle-prick. The presence of antibodies after about 15 minutes is an indicator of an underlying allergic cause of nasal polyps.
CT Scan/Nasal Endoscopy: These tests are recommended when other obstructions are suspected besides the nasal polyps.
What patients and doctors can do when symptoms are seen: Broadly speaking, it’s crucial to identify the exact cause of the occurrence of nasal polyps. This is because once the condition appears; chances of recurrence are very high. Physicians recommend treatment based on causative factors as well as with a view to reducing the symptoms of pain and discomfort.
Polyps are usually shrunk with topical sprays and non-invasive medical treatments. As of now, cortico-steroids are the only known agents that can shrink the size of the polyps and help in their removal. However, in very severe cases, surgery could be the only option.
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Cold-like symptoms: Runny nose, stuffiness, post-nasal drip, high temperature, etc are akin to common cold symptoms. When they persist, the doctor may prescribe steroid sprays or nose drops if polyps are present. For larger polyps, steroid tablets may also be given.
Mouth breathing, snoring, sleeps disturbances, serious breathing trouble: Restoring proper drainage, nasal sprays, nasal lavage/rinse may reduce these symptoms. Along with this, the treatment for nasal polyps can continue.
Headaches, facial pressure, double vision: These could be related to polyps present in the sinuses. Hence, a detailed investigation must be done, to rule out any chronic conditions or infections. The treatment may be two-pronged – to clear the infection and to remove the polyps. Severe cases may require immediate surgery or intra polyp injections of cortico-steroids.
Itchiness round the eyes and face: Humidifying the environment and avoiding irritants can help reduce these symptoms. Prevent exposure to air-borne pollutants, strong chemicals, paints, odors and cleaning agents.
Asthma: is known to increase the likelihood of developing nasal polyps. Hence, the proper and consistent management of asthma and its symptoms can be beneficial along with the treatment of the nasal polyps.
When symptoms persist:
• Keep track of when the symptoms first occurred
• Keep a symptom journal
• Note the different types of symptoms
• Be alert for worsening of symptoms
• In children and seniors, be alert to breathing difficulties
• Snoring and sleep disturbances of a severe nature should be flagged
• Consult your family physician
• Explain the symptoms clearly
• Take all recommended tests
Conclusion: Keeping the risk factors, probable causes, diagnostic methods and the nature of the symptoms of nasal polyps in mind, early intervention can certainly prevent the condition from worsening or becoming more complicated.