How are nasal polyps managed effectively?

Question

Hello doctor,

For months, I have been unable to breathe through my nose! I cannot smell the dinner being prepared, taste my food, or sleep well. I find myself constantly breathing through my mouth. An ENT specialist briefly examined my nose and mentioned that I have polyps that require surgery. He provided me with a steroid spray and quickly left. What exactly are these polyps? Why do I have them when no one else in my family does? Surgery seems quite drastic – are there any alternatives that ordinary people have successfully used? Will these polyps reappear after removal? I have read alarming accounts online regarding empty nose syndrome. An allergist suggested a link to my asthma – is that accurate? I have been prescribed three different antibiotics, assuming I had sinus infections, before receiving the correct diagnosis. What treatments are effective for severe cases?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

If you have been having chronic nasal allergy with asthma, you have a condition called hyperactive airway syndrome. The underlying problem here is your airway hyperreacting to allergens, causing inflammation via various inflammatory mediators like cytokines, leukotrienes, histamine, interleukins, and so on. A long-standing inflammatory cascade leads to the formation of polyps, which are prolapsed edematous sinus mucosa occupying the nasal cavity space, causing nasal obstruction, decreased olfaction, recurrent headaches, and repeated sinusitis.

Since this is a purely allergic problem, antibiotics have very little role to play here. Steroid nasal sprays and nasal douching before surgery have no role in treatment.

We first shrink this polyp using oral steroids in a tapering fashion and then advise a CT scan of the nose and paranasal sinuses to get an idea of the extension of residual polyps.

The role of surgery is limited to removing these residual polyps, opening up the sinuses to facilitate a better application of nasal steroid irrigation solution, which is essential.

Unnecessary removal of normal structures during the surgery can lead to empty nose syndrome which is not a common complication that we usually see.

Recurrence is definitely a common entity to be noted in patients who have not been operated on completely or who have not followed the post-operative instructions, which include steroid nasal irrigation and avoiding the allergen.

Delaying the surgery will not cause any major life-threatening problems. However, it is best that you get it done as soon as possible.

I hope this information helps you.

Feel free to ask further queries.

Thank you.