Nose polyp ( NP ) is a non-cancerous growth in the nose or sinus. Symptoms include difficulty breathing through the nose, odor loss, decreased taste, post nasal drip, and runny nose. Its growth is like a pouch, moving, and painless, although facial pain can sometimes occur. They usually occur in both nostrils in those affected. Complications may include sinusitis and expansion of the nose.
The exact cause is not clear. They may be associated with chronic inflammation of the sinus lining. They occur more commonly among people who have allergies, cystic fibrosis, aspirin sensitivity, or certain infections. The polyp itself is an overgrowth of the mucous membrane. Diagnosis can occur by finding the nose. CT scans can be used to determine the number of polyps and help plan the operation.
Treatment is usually with steroids, often in the form of nasal spray. If this operation is not effective it can be considered. This condition often relaps after surgery, so the continued use of steroid nasal sprays is often recommended. Antihistamines can help with symptoms but do not change the underlying disease. Antibiotics are not required for treatment unless infection occurs.
About 4% of people today have nasal polyps while up to 40% of people develop them at some point in their lives. They occur most often after the age of 20 and more often in men than in women. Nasal polyps have been described since ancient Egypt.
Video Nasal polyp
Signs and symptoms
Polyp symptoms include nasal congestion, sinusitis, odor loss, thick nasal mucus, facial pressure, nose speech, and mouth breathing. Recurrent sinusitis may be produced from polyps. Long-term nasal polyps can cause nasal bone damage and nasal dilation.
When the polyps grow larger, they end up prolapse into the nasal cavity resulting in symptoms. The most prominent symptom of nasal polyps leads to blockage of the nasal passages.
People with nasal polyps because aspirin intolerance often have symptoms known as Samter triads, consisting of worse asthma with aspirin, aspirin-induced skin rashes, and chronic nasal polyps.
Maps Nasal polyp
Cause
The exact cause of nasal polyps is unclear. They are, however, generally associated with conditions that cause long-term inflammation of the sinuses. These include chronic rhinosinusitis, asthma, aspirin sensitivity, and cystic fibrosis.
Additional diseases associated with polyp formation include:
Chronic haemosinusitis is a common medical condition characterized by symptoms of sinus inflammation lasting at least 12 weeks. The cause is unknown and the role of microorganisms remains unclear. These can be classified as with or without nasal polyps.
Cystic fibrosis (CF) is the most common cause of nasal polyps in children. Therefore, any child under 12 to 20 years with nasal polyps should be tested for CF. Half of people with CF will have extensive polyps leading to nasal obstruction and require aggressive management.
Type
There are two main types of nasal polyps: ethmoidal and antrochoanal. Ethmoid polyps are formed from the ethmoid sinus and extend through the middle meatus into the nasal cavity. Anthrokoanal polyps usually appear in the maxillary sinus and extend into the nasopharynx and represent only 4-6% of all nasal polyps. However, antipaloanal polyps are more common in children comprising one-third of all polyps in this population. Ethmoid polyps are usually smaller and multiple whereas antrocoanal polyps are usually single and larger.
Pathophysiology
The true cause of nasal polyps is unknown, but they are thought to be caused by recurrent infections or inflammation. Polyps arise from the sinus lining. The nasal mucosa, especially in the middle meatus region becomes swollen by extracellular fluid collection. This extracellular fluid collection causes the formation of polyps and bulges into the nasal or sinus cavities. The sessile polyps initially become stemmed by gravity.
In people with nasal polyps due to aspirin or NSAID sensitivity, the underlying mechanism is due to impairment in arachidonic acid metabolism. Exposure to cyclooxyase inhibitors such as aspirin and NSAIDs leads to shunting of products through the path of lipoxygenase leading to increased production of inflammatory products. In the airways, these inflammatory products cause asthma symptoms such as wheezing the formation of nasal polyps.
Diagnosis
Nasal polyps can be seen on a physical examination inside the nose and are often detected during the evaluation of symptoms. On examination, the polyp will appear as a visible mass in the nostrils. Some polyps may be seen with anterior rhinoscopy (seen in the nose with nasal and light speculum), but often, they further return to the nose and should be seen by nasal endoscopy. Nasal endoscopy involves passing a rigid small camera with a source of light to the nose. An image is projected onto the screen at the office so doctors can examine the nasal passages and sinuses in more detail. This procedure is generally not painful, but patients can be sprayed with decongestants and local anesthetics to minimize discomfort.
Efforts have been made to develop a scoring system to determine the severity of nasal polyps. The proposed staging system considers the level of polyp seen in the endoscopic examination and the number of sinuses affected in CT imaging. The staging system is only partially validated, but in the future, it may be useful to communicate the severity of the disease, assess the treatment response, and plan the treatment.
CT scan
CT scans may show complete polyps, which may not be fully appreciated by physical examination alone. Imaging is also required to plan surgical treatments. In CT scan, nasal polyps generally have attenuation of Hounsfield 10-18 units, which are similar to mucus. Nasal polyps may be calcified.
Histology
On histologic examination, nasal polyps consist of hyperplastic (hyperplastic) edematous connective tissue with several seromous glands and cells representing inflammation (mostly neutrophils and eosinophils). Polyps have almost no neurons. Therefore, the networks that make up the polyps do not have the sensation of tissue and the polyp itself will not be painful. In the early stages, the surface of the nasal polyp is covered by normal respiratory epithelium, but then undergoes metaplastic changes into squamous epithelium with constant irritation and inflammation. Submucosa shows a large intercellular space filled with serous fluid.
Differential diagnosis
Other disorders can mimic the emergence of nasal polyps and should be considered if the mass is seen on the test. Examples include encephalocele, glioma, inverse papilloma, and cancer. Early biopsy is recommended for unilateral nasal polyps to rule out more serious conditions such as cancer, reversed papilloma, or fungal sinusitis.
Treatment
First-line treatment for nasal polyps is a topical steroid. Steroids decrease sinus mucosa inflammation to reduce the size of polyps and improve symptoms. Topical preparations are preferred in the form of nasal sprays, but are often ineffective for people with multiple polyps. Steroids by mouth often provide drastic symptom relief, but should not be taken for long periods of time due to side effects. Because steroids only shrink the size and swelling of polyps, people often experience back symptoms after steroids are stopped. Decongestants do not shrink polyps, but can reduce swelling and provide relief. Antibiotics are recommended only if the person has a bacterial infection that occurs simultaneously.
In people with nasal polyps caused by aspirin or NSAIDs, the avoidance of these drugs will help with symptoms. Desensitization of aspirin also proved useful.
Surgery
Surgical sinus endoscopy with removal of polyps is often very effective for most people who provide rapid symptomatic relief. Surgery of minimally invasive endoscope sinus and performed completely through the nostrils with the help of the camera. Surgery should be considered for those with complete nasal obstruction, uncontrolled runny nose, nasal deformity caused by polyps or subsequent symptoms despite medical management. Surgery serves to remove polyps and inflamed mucosa around it, open the open nasal passages, and cleanse the sinuses. This not only removes the obstruction caused by the polyp itself, but allows drugs such as saline irrigation and topical steroids to be more effective.
The operation lasts about 45 minutes to 1 hour and can be performed under general or local anesthesia. Most patients tolerate surgery without much pain, though this may vary from patient to patient. Patients should expect some discomfort, congestion, and drainage from the nose in the first few days after surgery, but this should be mild. Complications from sinus endoscopic surgery are rare, but may include bleeding and damage to other structures in the area including the eyes or brain.
Many doctors recommend oral steroids prior to surgery to reduce mucosal inflammation, reduce bleeding during surgery, and help visualize polyps. Nasal steroid sprays should be used preventatively after surgery to delay or prevent recurrence. People often experience recurrence of polyps even after surgery. Therefore, follow-up continued with a combination of medical and surgical management is preferred for the treatment of nasal polyps.
Epidemiology
Nasal polyps due to chronic rhinosinusitis affect about 4.3% of the population. Nasal polyps occur more frequently in men than women and more often with age, increasing drastically after the age of 40 years.
People with chronic rhinosinusitis, 10% to 54% also have allergies. It is estimated that 40% to 80% of people with aspirin sensitivity will develop nasal polyposis. In people with cystic fibrosis, nasal polyps were recorded at 37% to 48%.
References
External links
Source of the article : Wikipedia
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