Nasal Polyps
Information on the causes, symptoms, treatments, and prognosis of benign tumors that develop inside the nose.
Symptoms and Causes
Nasal polyps, or nasal polyposis, are a condition characterized by the formation of benign cysts inside the nasal cavity or the paranasal sinuses as a result of a chronic inflammatory process affecting the nasal mucosa.
They usually develop progressively and, when they reach a certain size or are multiple, they may cause persistent nasal obstruction and other respiratory symptoms.
Based on the size of the nasal polyps, the disease can be classified into four grades:
- Grade I: small polyps located in the middle meatus, the space between the middle nasal turbinate and the inferior nasal turbinate.
- Grade II: lesions that extend beyond the lower border of the middle turbinate without obstructing the nasal cavity.
- Grade III: protrusions that occupy a large portion of the nasal cavity, although they do not completely obstruct it.
- Grade IV: large polyps that completely obstruct the nasal cavity.
Although recurrence is common even after surgical removal of the cysts, the prognosis of nasal polyposis is favorable, as it rarely causes complications and is not associated with malignant cell proliferation.
Symptoms
Small nasal polyps may be asymptomatic. Larger polyps usually present with the following symptoms:
- Sinusitis: swelling of the inner tissue of the nose and paranasal sinuses. This inflammatory process typically lasts around twelve weeks.
- Nasal congestion.
- Rhinorrhea.
- Difficulty breathing.
- Postnasal drip.
- Anosmia: loss of the sense of smell.
- Ageusia: loss of the sense of taste.
- Headache.
- Facial pain or a sensation of pressure, especially in the forehead.
- Snoring.
- Dry mouth.
- Rhinolalia: nasal speech.
Causes
Nasal polyps develop when the mucosa lining the inside of the nose increases in size and subsequently accumulates thick fluid within it. The exact cause of this hypertrophy is currently unknown; however, studies associate nasal polyposis with three conditions that often occur together, known as the ASA triad (nasal polyposis, asthma, and aspirin intolerance).
Risk Factors
The risk of developing nasal polyposis increases in the following situations:
- Recurrent inflammatory diseases affecting the nose, such as rhinitis and sinusitis.
- Asthma.
- Untreated allergies.
- Cystic fibrosis.
- Anatomical abnormalities.
- Family history.
- Dental infection.
Complications
Some complications that may arise from nasal polyps include:
- Chronic nasal obstruction that interferes with breathing.
- Sleep apnea.
- Chronic sinusitis.
- Worsening of asthma.
- Nasal bleeding.
Prevention
Nasal polyposis can be prevented by following these recommendations:
- Adhering to appropriate treatment for allergies and asthma.
- Avoiding exposure to irritant agents. When avoidance is not possible, wearing a mask is recommended.
- Nasal irrigation with saline solutions.
- Preventing infections through frequent handwashing.
- Following a healthy diet.
Which doctor treats nasal polyps?
Nasal polyposis is primarily managed within the specialty of Otorhinolaryngology. Pulmonology and Allergology specialists may also be involved in patient care.
Diagnosis
To diagnose nasal polyps, the interior of the nose must be examined. Depending on each case, different procedures may be used:
- Nasal endoscopy: a flexible probe with a light and a camera at the tip is inserted to visualize the nasal passages as it is slowly advanced.
- Computed tomography (CT) scan: once polyps have been detected, this imaging test allows assessment of their size, depth, and exact location.
To identify the underlying causes of nasal polyposis, additional examinations are performed. The most common include:
- Allergy tests: the most frequent are skin tests, which involve pricking the skin—usually on the forearm—with an allergen and waiting to observe whether the immune system reacts to the substance.
- Cystic fibrosis testing: the most common is the sweat test, in which an area of the body is stimulated to induce sweating. A sample is collected and analyzed in the laboratory to determine chloride levels. Elevated results confirm the condition.
- Blood tests: these provide an overall assessment of the patient’s health status and are useful for detecting immune system abnormalities, infections, inflammatory processes, and allergies.
Treatment
Treatment of nasal polyps may be conservative or surgical, depending on disease characteristics and individual patient needs:
- Medication: corticosteroids are effective in reducing and eliminating nasal polyps. They are usually administered intranasally, although oral administration may sometimes be required. This may be the sole treatment or used to reduce lesion size prior to surgery.
- Endoscopic nasal surgery: surgical instruments are introduced through the nostrils, so no external incisions are required. During this procedure, excess tissue is removed and accumulated mucus is drained.
