Do hormones and allergies worsen nasal polyps?

Question

Hello Doctor,

I have been dealing with nasal polyps for over a year, and they have now completely blocked my nose. I have lost my sense of smell entirely, and food has no taste. A CT scan recommended by my ENT specialist showed extensive polyps throughout both nasal passages and sinuses. I was diagnosed with chronic rhinosinusitis with nasal polyposis and prescribed oral Prednisone 40 mg for two weeks, but the polyps returned even larger afterward. I have also been using Fluticasone nasal spray twice daily for the past six months, but there has been no improvement. The nasal congestion is so severe that I cannot sleep properly and constantly breathe through my mouth. It is affecting my work as a teacher, as my voice always sounds congested.

My allergist conducted skin testing and found allergies to dust mites, mold, and various pollens. I was prescribed Montelukast, but it caused significant mood changes and had to be stopped. My ENT now recommends endoscopic sinus surgery, but I am concerned about potential complications. I also noticed that my symptoms worsened during my last menstrual period. Could hormonal changes be contributing to the growth of these polyps?

Kindly help.

Answer 1

Hello,

Welcome to iCliniq.com.

I understand your concern.

Exposure to dust or any irritative substance to which your body is hypersensitive will initially initiate reflexes such as sneezing to remove the offending agent. If this fails, mucosal cells in your nose start to hyperfunction, producing loads of mucus to trap dust (owing to its sticky nature). This mucus has nowhere to go other than either being blown out of the nose or pushed into the throat, owing to mucociliary activity, thereby entering into a new zone. The throat initially reacts by activating cough impulses to push out the mucus, but if that fails, a local inflammation around the throat starts, which often leads to symptoms such as a feeling of a lump in the throat and repeated feeling to clear the throat.

Chronic, long-standing inflammation around the nose leads to involvement of the eustachian tubes, which ventilate air and equalise pressure between the nose and the ear. Inflamed tubes do not function well, and this leads to a negative pressure in the ear, causing ringing sensations, muffled noise, and sometimes decreased hearing as well.

Long-standing inflammation in the nose also blocks the outflow tract of the sinuses, leading to secretions getting collected, which then get infected and cause a pressure headache around your eyes, forehead, and cheeks.

Once the inflammation reaches its peak, you will start developing edematous sinus mucosa, which will prolapse directly into your nasal cavity, obstructing the nasal passages and causing loss of smell.

I know the problem has existed for a long time, but I am not sure if you have followed any specific treatment chart, which is usually recommended before we consider any patient for surgery. This treatment chart is custom-made according to your symptoms and follows the guidelines to treat both allergy and sinus-induced polyps.

The menstrual cycle has no such major effect on the polyposis. However, there could be some congestion during the periods.

The following aspects can be considered to manage allergies with polyposis.

Wear a mask regularly to avoid exposure to dust and allergens – this is essential for long-term relief.
Tablet Chlorpheniramine maleate – one tablet twice daily after food for 15 days.
Tablet Montelukast and Fexofenadine – one tablet twice daily after food for 15 days.
Tablet Aceclofenac (100 mg) + Thiocolchicoside 4 mg (milligrams) – one tablet twice daily after food for five days.
Tablet Clarithromycin 500 mg – one tablet twice daily after food for 15 days.
Nasal spray Azelastine – two puffs in each nostril twice a day for three months (do not inhale while spraying).
Tablet Acetylcysteine 600 mg – one tablet twice daily after food for seven days.
Steam inhalation three to four times daily.
Salt water gargles 8 to 10 times daily for one month.
Avoid smoking and alcohol, as they impair nasal clearance.

All precautionary measures have to be followed strictly for maximum relief; otherwise, medications won't be useful in the long term.

Surgery can be considered (if the above medications and precautionary measures do not give any relief). However, the symptoms might come back sometimes, even on a higher scale, after a brief relief following surgery, if the precautionary measures post-surgery are not followed. More than the complications that you are worried about, it's the recurrence (even after a good, complete surgery) that is bothersome. There is nothing that you need to worry about; once you follow the advice mentioned above, your symptoms should start coming down, and I am sure you will recover with time.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.