adenoids

Synonyms in the broader sense

Medical: polyposis nasi

nasal polyps

English: Nasal polyps

definition

The popularly named polyps are swollen, bilateral enlargements (hyperplasia) of the nasal mucosa or the mucous membrane of the paranasal sinuses.
They are therefore called polyps because the enlargement of the mucous membrane looks like a fungus on a tree trunk.
Mucosal enlargement usually starts from the maxillary sinus ( maxillary sinus ) or the ethmoid sinus (ethmoid sinus) and grows towards the middle nasal passage. The nasal passages can be almost completely closed with pronounced growth.
The outlets (ostia) of the paranasal sinuses located there can be affected by the nasal polyps and almost completely occluded. The quality of life can be significantly reduced by polyps.

causes

There are several causes that stimulate increased growth of the mucous membranes. First and foremost among children are chronic colds and colds (chronic rhinitis) and sinusitis (chronic sinusitis). Other pathogens, such as fungi (mycoses), which appear in dusty, warm air, can promote polyps. Allergy sufferers are also stimulated by pollen and other allergens, a mucosal growth.

symptoms

Not infrequently, children, especially after having suffered several colds (runny nose), suffer from impaired nasal breathing and get a noticeable nasal voice. At some point, the parents notice the ever-open mouth of their child. Even at night, the mouth must remain open to breathe, you start to snore, sleeps worse and is limited in its performance during the day. Children then often suffer from lack of concentration and stand out due to their school weaknesses.

You can find more information about child inability to concentrate and other school problems in our educational portal Learning Problems.

Constant mouth breathing leads more frequently to infections of the pharynx (pharyngitis), palatine tonsils (tonsillitis) and bronchial tubes (bronchitis). In turn, these infections can lead to otitis media, especially in children, via the still short eustachian tube (tuba eustachii).

A permanent occlusion of the nasal passage reduces the ability to smell (hyposmia) and also promotes an increased secretion production (mucus) of the nasal mucosa.

diagnosis

Since the symptoms mentioned above can have other causes as well, the ENT specialist uses a special device (endoscope) to look into the nasal cavities and look up the exits of the paranasal sinuses there. Here he looks for the origin of the polyps. In addition, an imaging technique (CT, computed tomography) can visualize the nasal polyps.

therapy

Unfortunately, as the polyps do not regress themselves, they often need to be surgically removed.
The polyps are cleared over the nose and at the same time the outlets of the paranasal sinuses are widened. The patient is recommended after this procedure a regular nasal cleaning by inhalation, nasal irrigation and nasal douche (Emser Sole ® ).
Risky is this procedure in that the nasal mucosa is very well supplied with blood and complication of the operation is the rebleeding.

If an allergy is responsible for the development of nasal polyps, then this should be treated unconditionally.

Which includes:

  • antihistamines
  • cortisone-containing nasal sprays
  • a long-term hyposensitization therapy.

Homeopathy in polyps

Various homeopathic remedies are available for the adjunctive treatment of polyps; However, it is primarily about the alleviation of concomitant symptoms, strengthening the immune system or reducing inflammatory reactions. If the polyps have already developed, they can not be eliminated by homeopathy and thus homeopathy does not replace the treatment by a doctor. Known remedies of homeopathy in the treatment of polyps are:

  • Calcium phosphoricum: For lively, sensitive and thin children
  • Calcium carbonicum: For sluggish, plump children who are prone to shyness and anxiety
  • Thuja occidentalis: polyps in the nose, large intestine, uterus and cold-prone patients

A homeopathic treatment should always be cared for by a doctor or alternative practitioner with the additional training in homeopathy, who can find the right remedy and the right dosage for the symptoms.

surgery

If conservative therapies (oral steroids or oral antihistamines) do not produce the desired results, surgical therapy may be attempted. There is the endonasal (through the nose) polypectomy and the endonasal surgery of the paranasal sinus with simultaneous removal of the polyps. As with all surgeries, medications prior to polyp surgery, especially blood thinners, should be discussed with the attending physician and discontinued if necessary to avoid complications during and after surgery.

Endonasal polypectomy

This surgical technique is used primarily in elderly patients, when a major surgery is not feasible, for example because of a poor general condition of the patient. It is carried out on an outpatient basis. This surgical technique often leads to relapse (the recurrence of polyps) after a short time, since the "root" of the polyp remains in the mucous membrane. It is usually advised to complete removal of polyps and diseased mucosa. In this procedure, the mucosal surface is locally stunned. It also uses a vasoconstrictor, a drug that narrows the blood vessels to make the polyps more visible and reduces bleeding. If they are pedunculated polyps, which are elongated and narrow at the base, they are covered with a metallic loop and pinched off in the area of ​​the middle nasal passage, until they are separated from the base and pulled out through the nose. In polyps with a broad base, a nasal forceps or a so-called conchotome is used for ablation. A special feature is the Choanalpolypen, which are formed by mucosal cells from the antrum, one of the paranasal sinuses, and grow into the middle nasal passage. These polyps are removed by Lange using the so-called blunt hook. The pole of the polyps is caught, torn with the hook and the polyp pulled out through the nose. But even with this type of polyps, the complete removal with affected mucosa is recommended, because otherwise recurrences may occur. After surgery, the nasal mucosa must be nursed with rinses and inhalation to prevent crusting or swelling.

Risk: Bleeding and infection, as well as injuries to the nerves and surrounding structures are a potential surgical risk.

Endonasal surgery of the paranasal sinuses with polyp removal

For this surgical technique, a hospital stay of about one week and a general anesthetic are necessary. The disability depends on the type of occupation and takes about two weeks. In this operation, an endoscope is again used and the access to the frontal sinus is made possible by the removal of the anterior ethmoidal anterior cells ( anterior ethmoidectomy ). Now the tissue is either partially ( fenestration ) or completely removed, this is called redevelopment. This is done for frontal sinus, sphenoid sinus, and maxillary sinus. Surgery may be performed with removal of polyps, correction of the septum or removal of palatine tonsils, and reduction of the nasal turbinates to improve the ventilation of the nose and sinuses and promote the resolution of the inflammation.After the operation At the beginning, there is no whipping. The inserted tamponade for hemostasis is removed after about 1-3 days by the doctor.

Risk: The procedure is very demanding and, as with any surgery, bleeding, infection and injury to nerves and surrounding structures may occur, with bleeding being uncommon in this operation and possibly having to become electrically depleted ( coagulated ). The proximity to the brain and the meninges can lead to encephalitis or meningitis . A possible injury to the skull base is accompanied by leakage of cerebrospinal fluid through the nose ( liquorrhea ) and must be treated immediately. Also, the eye muscles and their nerves or the optic nerve can be injured or be affected by an infection. It can also lead to bleeding in the eye socket. Furthermore, there may be a (temporary) deterioration of the sense of smell. Because of these risks, albeit extremely rare, the patient is monitored very closely after surgery. Mild headaches and headaches, as well as bruising or swelling are more common.

Polyps in the intestine

Polyps in the intestine are thickened neoplasms of the intestinal mucosa, which protrude into the intestinal interior. Most commonly, this affects the large intestine, but it can occur in any section of the gastrointestinal tract. Most of these growths are benign, but they can degenerate, posing a risk for colorectal cancer. The larger the size of the polyps, the greater the risk of degeneration and cancer. With a polyp size of about one centimeter there is a risk of about 1%, with a size of four centimeters the risk increases to about 20%. Polyps in the intestine occur in various forms: they may be petiolate with a narrow base, unrestrained and broad-base, bulbous or round. In addition, there are hereditary (eg familial adenomatous polyposis, Peutz-Jeghers syndrome or Cowden syndrome) and non-hereditary forms. It is estimated that every tenth has polyps in the intestine, but intestinal polyps usually occur from the age of sixteen. As a cause of bad eating habits (rich in fat and low fiber), little exercise, enjoyment poisons such as alcohol and cigarettes and obesity are assumed. Polyps in the intestine are usually a coincidence in the colonoscopy ( colonoscopy ), as small polyps often cause no discomfort. Usually it only comes to complaints when the polyps have reached a certain size. Then it can lead to chair irregularities (such as diarrhea or constipation) and abdominal pain. They may also be the cause of blood staining in the stool or black staining of the stool. A medical examination should be carried out immediately in this case. The diagnosis is made by a colonoscopy. Here, a flexible tube, which is equipped with a camera, is inserted through the anus to the beginning of the colon, slowly withdrawn and assessed the mucous membrane of the colon. Even small samples can be taken during the examination, which takes place with the administration of a sleeping aid, in order to clarify possible changes. If the polyp is not too large, it may be removed in the same session. The examination is carried out on an outpatient basis in internist specialist practices.

The therapy is carried out as described by the removal of smaller polyps by forceps during colonoscopy. Larger polyps can be removed by an electric sling. The removal of the polyps usually causes no pain. If the polyps are larger than 3cm or if there are a lot of polyps, you usually have to undergo surgery. The affected intestinal component is often taken along. The intestinal polyps are always examined after removal of tissue to make sure that they are benign neoplasms. A regular follow-up check, or colorectal cancer screening is indicated. The colon cancer screening by colonoscopy is the most effective form of early detection of colorectal cancer and the cost of this will be taken over from the age of 55 by the statutory health insurance.
Read more about the topic: costs of a colonoscopy

If there is a suspicion of a genetically increased risk of colon cancer, the precautionary measures should start earlier. This also applies to chronic inflammatory bowel disease, as there is an increased risk of developing colon cancer here as well.

Cervical polyps

Polyps in the uterus can sometimes cause pain but are often symptom-free.

Uterine polyps ( uterine polyps ) are usually benign changes in the lining of the uterus. The polyps may be stalked (narrow base) or sessile (broad base) and have a size of a few millimeters to a few centimeters. If the polyp is stalked, which is more common, it can grow from the uterus through the cervix into the vagina. Polyps in the uterus can occur at any age, but women are particularly affected during and during menopause, due to hormone changes. A cause of uterine polyps is not clear, but a connection with hormone production and, above all, a dependence on estrogen levels are suspected. Estrogen is the female sex hormone that is produced by the ovaries and minor adrenals. Other risk factors include a permanently elevated blood pressure ( arterial hypertension ), overweight and polyps in the history. Also, the implementation of hormone replacement therapy and the use of tamoxifen (used in the treatment of breast cancer) increase the risk of polyps in the uterus. Often, uterine polyps do not cause symptoms. Possible symptoms include irregular menstruation, very heavy menstruation ( menorrhagia ) or vaginal bleeding after menopause. Vaginal bleeding after the menopause should be clarified immediately as they can often be a symptom of uterine cancer. If the polyp is well supplied with blood, it can lead to spotting out of period (so-called " spotting "). If it is particularly large, it can cause abdominal pain, especially during intercourse. Injury-like pain can also occur when the uterus tries to repel the polyp.

Polyps can be a cause of infertility if they grow so poorly that they block the entry of sperm into the uterus or act as a natural intrauterine pessary ( spiral ) and prevent the fertilized egg from nesting in the uterine lining. Miscarriages can also be caused by polyps of the uterus. Not infrequently, polyps of the uterus are incidental findings during the gynecological examination. They can be diagnosed by ultrasound, uterine endoscopy or speculum examination (examining the vagina with a special mirror). A tissue sample helps to detect malignant degeneration at an early stage. However, uterine polyps are often benign new growths. Non-symptomatic polyps do not necessarily have to be removed, but often an operation is advised. The removal of the polyps is done by a curling ( curettage ), which takes place under general anesthesia. If a precancer or cancer is suspected, the operation will be extended accordingly. The course of uterine polyps is usually good, after an operation, it is very rare for the recurrence of polyps.

Polyps in the stomach

Polyps in the stomach are newly formed gastric mucosal bulges and often benign. Often there are several polyps at the same time, one then speaks of multiple gastric polyps. Stomach polyps are common after the age of 60, but may also be present in young people. In addition to the stomach, the large intestine is often affected by polyps, but they can occur throughout the gastrointestinal tract. Through a gastroscopy, the doctor can detect the polyps in the stomach and usually also remove electrical during the examination. Gastric polyps can be categorized in various ways: their shape (stalked / unrestrained, spherical, shaggy) and their cellular structure, ie the type of gland in the mucous membrane of the gastric polyp. If it is the so-called adenomatous type, it may be a precursor to gastric cancer and should be removed above 5mm in size. Polyps in the stomach often cause no symptoms, only larger polyps can cause a feeling of fullness or pain in the upper abdomen. Warning symptoms are vomiting blood or tarry (black staining of the stool), then a doctor should be consulted immediately. A cause for the occurrence of gastric polyps has not yet been found, with poor eating habits (low fiber, high in fat) and infection with the Helicobacter pylori bacterium could play a role. There is also a genetic form of gastric polyposis known as polyposis syndrome, where polyps in the stomach and other intestinal tracts occur in large numbers and often affect several family members.

The so-called adenotomy, ie the removal of the disturbing almond, is usually carried out in childhood, since the polyps often regress themselves during adolescence. Here, a general anesthetic is performed, the polyps removed and then breastfed the possible bleeding with cotton wool. The procedure takes about ten to twenty minutes and is a commonly performed procedure. The largest and most common risk of this polyp OP is a rebleeding, which occurs especially on the day and around the 5th-8th. Day after the operation may occur, which is why a physical protection for a few days is necessary.

Polyps at the toddler

The removal of the polyps is usually performed on an outpatient basis.

As a polyp in small children is often called an enlarged throat almond. The pharyngeal tonsil belongs to the body's defense system and protects the body with the help of immune cells from pathogens. It lies above the suppository behind the nose. An enlarged throat almond alone does not have a disease value, it usually occurs in children between the 3rd and 6th year of life. However, polyps may be responsible for snoring, difficult nasal breathing, and persistent cold. Often the children breathe through the open mouth and have a slightly kibble language. Also recurring middle ear infections in children can be caused by polyps, if they lay the ventilation path between the nose and ear; in the worst case, this can lead to delaying the child's language learning. In these cases it is often advisable to remove the polyps, which is usually performed on an outpatient basis. The so-called adenotomy, ie the removal of the disturbing almond, is usually carried out in childhood, since the polyps often regress themselves during adolescence. Here, a general anesthetic is performed, the polyps removed and then breastfed the possible bleeding with cotton wool. The procedure takes about ten to twenty minutes and is a commonly performed procedure. The largest and most common risk of this polyp OP is a rebleeding, which occurs especially on the day and around the 5th-8th. Day after the operation may occur, which is why a physical protection for a few days is necessary.


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