Polyps in the nose

Synonyms in the broader sense

Medical: polyposis nasi

nasal polyps

English: Nasal polyps

introduction

Nasal polyps ( polyposis nasi, nasal polyps ) are benign growths of the mucosa of the nose or paranasal sinuses. These changes usually go hand in hand with limited nasal breathing and, if left untreated, can lead to complications.

However, since an early diagnosis and good therapy are usually possible, polyps of the nose almost always take a favorable course. Swollen pharyngeal tonsils, commonly referred to as polyps, are not true polyps of the nose.

The term "polyp" describes a visible with the naked eye (macroscopically) raising the mucous membrane (mucosa), which grows mostly stalked, sometimes broad-based in the interior of a hollow organ. In principle, polyps may be benign or malignant, for example in the paranasal sinuses, intestines, stomach or uterus.

Polyps of the nose are usually benign, a few millimeters to centimeters in size, shiny and typically come from the mucous membrane of ethmoidal cells ( see also: inflammation of the ethmoidal cells) or the maxillary sinuses. In principle, nasal polyps may occur at any age, but are more of a rarity in children (unless there are certain conditions such as cystic fibrosis or nasal dysfunction).

Overall, up to 12% of the total population suffer from nasal polyps, with men being slightly more affected than women. Incidentally, polyps of the nose are most common around the age of 30.

causes

Although there are several known triggers for polyps of the nose, but why some people with existing risk factors ultimately polyps arise and not others, is not yet clarified to this day.

  • Chronic sinusitis: The most common form of polyps of the nose is chronic inflammation of the sinuses ( sinusitis ). As a result, the mucosa is constantly irritated and reacts with the deposition of tissue fluid and consequently swelling.
  • Allergies (house dust mite allergy or hay fever)
  • chronic fungal infections
  • Hereditary predisposition: In addition, there seems to be some genetic predisposition to the development of nasal polyps.
  • Asthma Bronchial Asthma
  • Painkillers (especially aspirin, but also ibuprofen or diclofenac)

Especially when polyps develop in children, often a metabolic disease called cystic fibrosis (cystic fibrosis) underlies. Rarely is there even a primary ciliary dyskinesia, a dysfunction of the cilia of the mucosal cells.

symptoms

The severity of the symptoms caused by nasal polyps depends on how large the polyps of the nose are and exactly where they are. In some cases, they do not even cause discomfort over a long period of time.

However, at some point, limiting the flow of secretion from the sinuses and restricting the ventilation of these spaces will make breathing through the nose more difficult, leading to increased mouth breathing. Due to the obstructed nasal breathing, sufferers often have a nasal voice, bad breath (as the increased breathing through the mouth dries out the oral mucosa) and snoring problems.

The fact that the nose or sinuses are blocked with secretions can also lead to headaches, frequent, recurring inflammations (sinuses or the middle ear) or odor disorders (up to a complete lack of smelling ability).

If polyps of the nose remain untreated for a long time, then consequential damages such as a widening of the nose and an enlarged eye distance ( hypertelorism ) can develop. However, thanks to good diagnostics and therapy, these lasting changes are very rare nowadays.

diagnosis

As part of a diagnosis, the doctor will first perform a detailed survey of the medical history (anamnesis). The focus here is on questions about risk factors such as

  • allergies
  • asthma
  • Painkillers incompatibilities

In addition, it is asked exactly what symptoms exist and how pronounced. This is followed by an examination, which should be done at the ear, nose and throat doctor. The doctor looks at the nose and the sinuses.

If the polyps are particularly large and are in well-visible places, he can sometimes see these with the naked eye. Otherwise, a mirror and an endoscope (which is inserted through the nose, is thin and flexible and has a built-in light source) are used to detect even smaller, deeper polyps.

In existing sinusitis, a sample of the secretion is often taken simultaneously in order to identify a pathogen from this.

Rarer are imaging techniques such as

  • Computed tomography (CT)
  • radiographs
  • MRI of the paranasal sinuses

If there is a suspicion that it could also be a malignant change and not a polyp, a tissue sample is taken and then examined under the microscope.

therapy

Medical therapy

If polyps are minor in the nose, usually a drug therapy is sufficient to treat them successfully. Used are drugs that contain the active ingredient cortisone, which has anti-inflammatory effects.

Possible are nasal drops or sprays, which have the advantage that they really only act locally, but only develop their effect after a few days, or tablets, which are indeed more effective, but often can also be associated with systemic side effects. Often, however, treatment with cortisone is not enough.

Operative therapy

In such a case, an operation is performed in which the nasal polyps are removed. If only a single small polyp exists, it can usually be removed as part of a local anesthetic (ie without hospitalization). Otherwise, the procedures are usually minimally invasive (ie without large incisions) under the view through an endoscope through the nose in general anesthesia. The ablation is done either by a tool called Nasenpolypenschlinge or a laser.

For more extensive findings, the doctor often also undertakes a complete rehabilitation of the paranasal sinuses, in which further mucosal proliferation can be removed or openings of paranasal sinuses to the nose can be enlarged. Subsequently, the removed material is examined under the microscope to exclude malignant degeneration.

Underlying diseases such as cystic fibrosis, ciliary dyskinesia, bronchial asthma and allergies should of course be treated in any case, to prevent nasal polyps permanently.

Removal of nasal polyps

Depending on the individual disease picture, there are different ways to remove a polyp in the nose.

If it is just a small polyp, it may even be enough to treat it with cortisone. In some cases, however, these non-surgical methods are not sufficient to treat one or more polyps of the nose and surgical removal of the polyp must be performed.

Especially when respiration is restricted by the polyp, such surgical removal of proliferation is indicated. The specialists in the field of treatment and surgical removal of polyps of the nose are specialists in ear, nose and throat medicine.
So it makes sense, if people who are suffering from the disease at a local ENT doctor or in a clinic with appropriate department. Removal of the polyp or polyps (medical: polypectomy ) may be performed on an outpatient or general anesthetic basis, depending on the patient's individual symptoms. Which option is individually in question, the treating physician in the best case, discuss with the patient.
As a rule, a single polyp of medium size or smaller can be well removed on an outpatient basis, while a very large polyp or multiple growths are better removed under general anesthesia.

Even if the paranasal sinuses are severely affected, a removal and treatment in a general anesthesia offers. The surgical technique is usually minimally invasive, leaving no visible scars from the surgery. With a so-called nasal polyps loop the mucosal growths can be effectively removed. In some cases, lasers are also used, which allow high levels of energy to remove the growth. In order to exclude malignant growths, the removed material is usually examined by specialists in pathology. It goes without saying that if the polyps have developed on the soil of other underlying diseases, they must be treated further. This is the only way to reduce the likelihood that the polyps will recur.

In many cases, despite all recurrences why many patients need after a successful Nasenpolypentfernung after some time, another operation.

course

In principle, polyps take a benign course of the nose. An operation initially eliminates or at least significantly improves the symptoms in approximately 90% of patients. Unfortunately, polyps of the nose and paranasal sinuses tend to appear again and again (recurrences).

Therefore, a consistent follow-up treatment is essential, which includes the use of cortisone-containing nasal sprays and a good nasal care. This can significantly reduce the risk of recurrence.

prophylaxis

Especially if you have ever had polyps in the nose or sinuses, it is important to follow some rules to reduce the risk of re-emergence.

Diseases that are associated with an increased risk of nasal polyps (asthma, allergies, cystic fibrosis) should be recognized in good time and treated appropriately. In addition, should you suspect nasal polyps always see a doctor, if necessary, to be able to initiate therapy quickly.

Nasal polyps in the child

The presence of nasal polyps is usually a diagnosis that is mainly made in adults.

When children develop nasal polyps there is usually a disease that promotes the development of these growths. In particular, these are usually metabolic diseases such as cystic fibrosis, also known as cystic fibrosis, or a dysfunction of the cilia on the nasal mucosa ( primary ciliary dyskinesia ).

For example, about one in three children who suffer from cystic fibrosis due to a genetic defect develop nasal polyps during their lifetime. Therapy in children is no different from that in adults. In most cases, surgical removal occurs when the polyps obstruct breathing or cause other symptoms.
It is important in children especially that an underlying disease is excluded if this is not known. Thus, the appearance of polyps in the nose in children may be a first indication of the presence of another disease. Evidence that a child suffers from nasal polyps can be, for example, infantile snoring, a nasal voice and, in extreme cases, respiratory problems.


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