January 08, 2007

Nasal Polyps


It's hard to breathe, your nose drips constantly and your sense of smell just isn't what it used to be. If this sounds like you, you probably blame allergies or a chronic sinus infection. But in some cases, your symptoms may be due to nasal polyps — soft, noncancerous (benign) growths that develop on the lining of your nose or sinuses.

Small nasal polyps usually cause few problems, but larger ones can affect your breathing and diminish your sense of smell. Sometimes they may cause dull headaches or snoring, and in rare cases, massive polyps can alter the shape of your face.

Nasal polyps result from chronic inflammation in the lining of your nose or sinuses, but just what triggers the inflammation isn't always clear. Although nasal polyps can affect anyone, they're more common in people older than 40 and in adults and children with conditions such as asthma, chronic sinus infections, hay fever and cystic fibrosis.

Medications are the most common treatment for small nasal polyps. Surgery may be needed to remove larger growths, but polyps frequently return.

Signs and symptoms
You may have a single nasal polyp or several, clustered together like grapes on a stem. The polyps are generally soft and pearl colored, with a consistency like jelly. Very small single or multiple polyps may not cause any problems, but larger ones are likely to obstruct the airways in your nose, making it difficult to breathe. This may lead to mouth breathing, especially in children.

Other signs and symptoms of nasal polyps include:

A runny nose
Persistent stuffiness
Chronic sinus infections
Loss or diminishment of your sense of smell
Dull headaches

Although you may think of your nose mainly in terms of its appearance, it filters, warms and moistens the air you breathe, and it transmits scent-related information to your brain.

Your nose is mainly composed of bone, cartilage and mucous membrane. Each nasal cavity contains three or four bony shelves (turbinates) that curve from the outer part of your nose toward the septum — a thin, cartilage-and-bone divider that separates your nasal cavity. A thick mucous membrane covers both the turbinates and septum. This acts as a filter to remove bacteria and dirt particles, which are swept out of your nose by tiny hairs called cilia.

When incoming air is cold or dry, the highly sensitive tissue that lines the turbinates swells, narrowing your nasal passages and slowing the flow of air so that it becomes warm and moist before reaching your lungs.

Your nose also contains olfactory nerves that pick up scents and send the information to your brain, where the scents are identified. Without the nose-brain connection, you couldn't smell mom's apple pie or the ripeness of a fresh peach. In fact, without the olfactory nerves, you wouldn't be able to taste those foods either because most of your ability to taste depends on your sense of smell.

How nasal polyps form
Nasal polyps can develop in the mucous lining of your nose or in one or more of your sinuses — four hollow cavities above and behind your nose. But polyps aren't a disease. Rather, they're the end product of ongoing inflammation that may result from viral or bacterial infections, from allergies or from an immune system response to fungus. Chronic inflammation causes the blood vessels in the lining of your nose and sinuses to become more permeable, allowing water to accumulate in the cells. Over time, as gravity pulls on these waterlogged tissues, they may develop into polyps.

Risk factors
Having a condition that causes chronic inflammation in your nose or sinuses is the greatest risk factor for nasal polyps. Children with cystic fibrosis and people with allergic fungal sinusitis — a serious allergy to environmental fungus — are especially likely to be affected. Nasal polyps also occur in a majority of people with Churg-Strauss syndrome, a rare disease that inflames the blood vessels (vasculitis). You're also at high risk if you have asthma, chronic hay fever or chronic sinus infections.

Other risk factors for nasal polyps include:
Aspirin sensitivity. If you're sensitive to aspirin or related products, you're at higher risk of polyps than are people who don't have this sensitivity. And if you have nasal polyps and asthma, it's important to avoid aspirin because it can cause a sudden, severe shortness of breath. Many medications, most of them available without a prescription, contain aspirin or related medications, so read labels carefully or talk to your pharmacist.

Your sex. In general, women are more likely to have nasal polyps than are men.
Age. Multiple nasal polyps tend to be more common in people older than 40.

When to seek medical advice
A stuffy, runny nose and diminished sense of smell are the hallmarks of nasal polyps. But they also may be signs of many other conditions, including the common cold. Colds, however, generally clear in about a week, whereas nasal polyps don't go away on their own. See your doctor if your breathing problems and runny nose persist.

A single, small nasal polyp rarely causes complications, but a large polyp or many smaller polyps (polyposis) may lead to the following:

Acute or chronic sinus infections.
Obstructive sleep apnea — a potentially serious condition in which you stop and start breathing a number of times during sleep.

Altered facial structure leading to double vision or unusually wide-set eyes. This complication is rare and is most likely to occur in people with cystic fibrosis or allergic fungal sinusitis.

If you have one or more small polyps, your doctor is likely to prescribe a corticosteroid nasal spray such as fluticasone (Flonase), triamcinolone (Nasacort), budesonide (Rhinocort), flunisolide (Nasarel, Nasalide) or mometasone (Nasonex). These medications relieve inflammation, increase nasal airflow and may help shrink polyps.

Side effects of steroid nasal sprays are far less serious than are those of oral steroids and may include nosebleeds, headache or sore throat.

Other medications for nasal polyps include:

Oral corticosteroids: Sometimes your doctor may prescribe an oral corticosteroid, either alone or in combination with a nasal spray. Because oral steroids can cause serious side effects, you usually take them for a brief period — often no more than a few weeks.

Medications to control allergies or infection: In addition to treating your polyps, your doctor may prescribe medications to control allergies or infection. Antihistamines, for instance, counteract histamine, an inflammatory substance released when your immune system encounters an allergen. If you have hay fever or other allergies, antihistamines may help relieve your congestion, although they won't eliminate polyps. In addition, your doctor may prescribe antibiotics for an acute sinus infection.

Antifungal medications: Researchers have discovered that some cases of chronic sinusitis may be caused by an unusual immune system response to environmental fungus. For that reason, antifungal medications are being tested as a treatment for sinusitis-related polyps.

When medications aren't effective, your doctor may recommend removing your polyps surgically. This is often the only option for people with cystic fibrosis who usually don't respond to steroids. The type of operation depends on the size, number and location of the polyps.

Polypectomy: Small or isolated polyps can often be completely removed using a small mechanical suction device or a microdebrider — an instrument that cuts and extracts soft tissue. The procedure, called a polypectomy, is performed on an outpatient basis. Following polypectomy, you'll be treated for any underlying inflammation, usually with corticosteroid nasal sprays and sometimes with antibiotics or oral steroids. Even so, polyps frequently return, and you may need additional operations.

Endoscopic sinus surgery: This is a more extensive procedure that not only removes polyps, but also opens the part of the sinus cavity where polyps usually form. If your sinuses are very blocked or inflamed, your doctor may open even more of your sinus cavity. In both cases, your surgeon uses a thin, rigid tube and a camera called a video endoscope. Because endoscopic surgery requires small incisions, you generally heal more quickly and with less discomfort than with other types of surgery. Still, full recovery may take several weeks, and polyps often return. This surgery has serious potential risks, including leakage of cerebrospinal fluid, injury to the optic nerve or eye muscles, and hemorrhage.

In many cases, polyps can't be prevented. But if you have asthma, hay fever or chronic sinus infections, managing your symptoms may reduce the chances that polyps will develop or recur. That means taking medications as your doctor suggests and avoiding — as much as possible — indoor and outdoor allergens and pollutants.

Irrigating your sinuses with salt water may help relieve mild nasal congestion and eliminate mucus. Avoid OTC saline sprays that contain additives such as benzalkonium, which can actually inflame the mucous lining of your nose and exacerbate your symptoms. Instead, look for preservative-free saline sprays.

To make your own saline solution, mix 1/4 teaspoon salt and 1/4 teaspoon baking soda in 8 ounces of warm water. Pour some of the solution into your cupped hand and sniff into your nostrils. You can also inject the solution using an ear bulb or syringe. Then gently clear your nose with a tissue.

Adapted from: Mayo Foundation for Medical Education and Research