Nasal Polyp Surgery - Non-surgical and Surgical Management

Introduction:

The human nose is an organ that provides a smelling sensation and breathing. Through the nose, human beings can breathe oxygen and exhale carbon dioxide. There are various disorders related to the nasal cavity and paranasal sinus - hollow spaces around the nose - such as allergies, inflammation of the sinus, infection, cold, etc.

The tissues of the nasal cavity sometimes overgrow and form a mass called a polyp. These are painless and benign (harmless). The causes of these polyp formations are still not very well understood, but it is believed that long-standing inflammation of the nasal cavity and Aspirin allergy cause polyps. Computed tomography helps in identifying nasal polyps and aids in planning appropriate treatment.

What Is a Nasal Polyp?

• A polyp is an abnormal growth of the tissues on the mucous membrane - the inner lining of an organ.
• A nasal polyp is a benign or harmless overgrowth of tissues on the lining of the nose and sinus.

What Are the Types of Nasal Polyps?

There are three types or groups of nasal polyps:

1. Localized: These occur because of any inflammation or malignancy.

2. Diffuse: These occur because of inflammation of the paranasal sinus and nasal cavity - rhinosinusitis.

3. Systemic: These occur in patients who have systemic disease nasal problems such as a nasal blockage.

What Causes Nasal Polyps?

The cause of the nasal polyp is not clear. The common causes are:

• Mostly the presence of chronic rhinosinusitis - inflammation of the paranasal sinus and nasal cavity.

• Patients with abnormal or uncommon immunity.

• Different compositions of the mucous membrane.

• Asthma.

• Patients who have allergic reactions against Aspirin.

• Inflammation of blood vessels.

• Inherited inflammatory disorder of the lungs.

What Are the Symptoms of a Nasal Polyp?

• Obstruction or blockage in the nasal passage.

• Nasal bleeding.

• Headache.

• The blurring of vision.

• Nasal discharge - rhinorrhea.

• Decreased smell sense.

How to Diagnose a Nasal Polyp?

1. Patient’s Medical History: The doctor should ask the patient about their allergy to non-steroidal anti-inflammatory drugs or Aspirin and asthma. The patient should also be asked about the history of bleeding from the nose, middle ear infection, inflammation of the lungs, or pneumonia to identify the possible cause.

2. Physical Examination: The doctor must examine the nose and polyp physically through a nasal speculum - an instrument used to assess the nasal mucosa. This process is called rhinoscopy.

3. Imaging Test: Nasal endoscopy may be done to assess the nasal cavity - a thin tube with a light and camera is inserted into the nose of the patient, and the internal structures are visualized on a screen or monitor. Computed tomography of the paranasal sinus is sometimes performed. It may show single-sided or double-sided, gray, and smooth mass. Generally, the polyps are present on both sides of the nose, indicating the presence of inflammation. If the polyp is present on a single side, then a biopsy must be considered to rule out the malignancy associated with it.

How Is a Nasal Polyp Treated?

Nasal polyps are benign and do not cause any pain or discomfort to the patient.

Drug Therapy:

For an initial period, the nasal polyps are treated through medications such as:

1. Topical Steroids: Steroids in the form of nasal drops or sprays are prescribed to the patient so that the polyp can shrink.

2. Steroid Tablets: If the polyp does not shrink or is large then steroid tablets are prescribed.

3. Antibiotics: These are commonly used to treat chronic rhinosinusitis.

4. Antihistamines: These are prescribed to treat allergies but may not help in reducing or shrinking the polyp.

Before planning a surgical treatment, the nasal polyp must be treated with corticosteroids, saline irrigation, etc. for up to three months.

Surgical Approach:

There is no single technique available to surgically treat the nasal polyp. Sometimes, the patient has to undergo multiple nasal polyp surgeries. In general, different nasal polyp surgeries are mentioned below:

1. Nasal Polypectomy: It is the surgical removal of the polyp from the nose. It is done when the polyp is within easy reach and visible. In this procedure:

• Local or general anesthesia is given to the patient.

• The obstruction in the nose is removed through drops of pellets of Oxymetazoline. It is a medication used to relieve congestion in the sinus.

• The nasal polyp is removed by using polyp forceps or graspers.

• The doctor may put in absorbable packs to stop bleeding.

2. Endoscopic Polypectomy: It is the surgical removal of the polyp through an endoscope. It is done when the size of the polyp is small or located in a difficult area of the nose such as the roof. In this procedure:

• Local or general anesthesia is given to the patient.

• An endoscope - a thin tube with a light and a camera - is inserted through the nostrils of the patient.

• The instrument is attached to the tip of the endoscope that is used to remove the polyp.

• The main advantage of this procedure is that it does not have any scar formation because there are no incisions or cuts made on the nose.

3. Steroid Stents: These are biodegradable steroid-eluting stents that are inserted during surgery. These stents prevent the recurrence of the obstruction and/or polyp and release steroids for up to 30 days. This helps in treating the inflammation.

What Is Nasal Polyp Surgery Called?

Nasal polyp surgery is called a polypectomy.

What Are the Complications of Nasal Polyp?

The complications arising due to nasal polyps depend on the underlying cause. The general risks and complications are:

• Difficulty in breathing because of obstruction.

• Disturbance in sleeping.

• Formation of mucocele - a benign mucus-filled cyst-like lesion.

• Complete loss of smell - anosmia.

• Repetitive collapsing of airways during sleeping - obstructive sleep apnea.

• Excessive bleeding.

• Damage to internal structures.

Recovery Time for Nasal Polyp Surgery:

In most patients, the recovery takes up to two weeks.

Conclusion:

Nasal polyps are harmless overgrown tissues in the nasal cavity that are best treated with Corticosteroids and polypectomy. Because these overgrowths are painless, it becomes difficult to diagnose them. Imagining tests are the best diagnostic tools for nasal polyps. X-rays may not help diagnose the polyp, but a computed tomography and endoscopy may show a clear image of the polyp, its size, locations, etc. The initial treatment approach includes the administration of Corticosteroids through local sprays, drops, and tablets. Proper patient education and adherence to the treatment are important to prevent a recurrence.