Nasal Polyp Surgery
Nasal polyps are a condition that is fairly common, affecting roughly 4-5% percent of the population. After a consultation with an ENT doctor, patients are treated with a wide range of medications and in some cases, surgery.
Read below to learn more about nasal polyps, treatment plans, and steps to take to reduce your chances of regrowth of nasal polyps.
Nasal Polyps: General Facts and Information
What is a nasal polyp?
A nasal polyp is a small, typically benign, teardrop-shaped growth on the lining of the sinus cavity or nasal passages. You might also picture them as small, peeled grapes. They appear as a result of several different issues, including prolonged swelling of the nasal tissues, chronic sinusitis, allergies, asthma or as a side effect of certain drugs.
Nasal polyps vary in size. Smaller growths are often unnoticeable because they present no symptoms. More sizeable polyps, on the other hand, can cause great discomfort, since they can block the sinus passages, affecting your ability to breathe and predisposing you to acute or chronic sinusitis.
In terms of treatment, medications are generally used as the first line of defense to try and shrink the size of the nasal polyps. If behavior modification and medications do not improve nasal polyps, surgery is an alternative that can be used to remove more problematic polyps.
Bilateral nasal polyps that are grey and smooth are generally benign. However, only a pathologist can determine if the masses in the nose are malignant or pre-malignant. Nasal polyps should also be distinguished from swollen turbinates, the thin tissue that covers your nasal bones. Swollen turbinates can be extremely painful when prodded, while polyps are not sensitive to touch.
What are the symptoms of nasal polyps?
Nasal polyps often appear after a sinus infection that lasts for an extended period of time – typically 12 weeks or greater, although you need not always suffer a sinus infection in order to contract nasal polyps. Sometimes they are the result of genetics. People of all ages are at risk of contracting nasal polyps, although medical researchers report that the most frequently affected populations are the young and middle-aged.
There is not one specific area in the nasal cavities where polyps can grow, but the most common areas where they tend to appear are near the ostiomeatal complex (where the frontal, anterior ethmoid, and maxillary sinuses open into the nasal cavity). If this area is obstructed, the sinus cavities are automatically predisposed to infection.
If your nasal polyps are particularly small in size, you may be asymptomatic, since they are soft in texture and do not produce the sensation. It is not until the polyps grow or multiply causing a restriction of the nasal passages, that you begin to notice their presence.
Review the below checklist of common symptoms of nasal polyps to find out if you should consider treatment:
- Rhinorrhea (runny nose)
- Dulled sense of smell and/or taste
- Sinus and/or facial pain
- Sinus headache (pressure/pain in your forehead and facial area)
- Aching in your upper jaw
If you notice that any of the above symptoms have persisted for one week or more, it may be time to make an appointment with your ENT doctor.
Note that nasal polyps, in rare cases, can be dangerous or life-threatening. If you have severe acute symptoms you should seek medical attention immediately. Take note of the symptoms below that are indicative of a more serious problem:
- Severe inability to breathe normally through the nose
Sharpescalation in the symptom severity
- Vision problems (seeing double, dark spots, difficulty moving the eyes)
Largeamount of swelling or puffiness in and around the eye area
- Migraines, combined with a fever and incapability to tilt your head down
Nasal Polyps Development and Side Effects
What is the root cause of nasal polyps?
Currently, medical experts have no explanation as to why nasal polyps form after nasal inflammation. They are also unable to determine why some patients’ polyps are the result of a chronic sinus infection, yet others are due to genetics and certain chemical markers in the immune system.
Am I at risk of developing nasal polyps?
Some people are more at risk than others of developing nasal polyps. Those who suffer from chronic sinus infections are more likely to develop polyps than someone with milder symptoms. However, there are a variety of other conditions and disorders that are linked with the development of nasal polyps. Read below for a list of some examples.
- Asthma – tightening and swelling of the airways
- Pain Reliever Allergies – inflammation of nasal cavities after taking ibuprofen (found commonly in OTC medications such as Motrin and Advil) and naproxen (found ordinarily in Aleve)
- Fungus Allergies – inflammation after an allergic reaction to fungi particles indoors or outdoors
- Cystic fibrosis – a gene mutation disorder where the body produces an irregularly high amount of thick mucus from the sinus membranes; those diagnosed with cystic fibrosis are 40% more likely to develop nasal polyps
- Churg-Strauss Syndrome – a rare syndrome that causes the blood vessels to become swollen
- Immune System Characteristics –you may be at a higher risk of developing nasal polyps if your DNA carries a genetic permutation linked to the specific immune system function that causes polyps
- Tip: Whether or not you suspect you suffer from nasal polyps, make sure you always have an extensive report of your family history before visiting your doctor
When should I seek treatment for nasal polyps?
Treatment of nasal polyps is not always necessary. Those who develop a small nasal polyp and do not notice any adverse symptoms generally do not need to visit a doctor. However, for others, nasal polyps can oftentimes be a catalyst for more serious complications that relate to the way your sinus cavities drain fluid. Patients report having experienced the following conditions as a result of chronic sinus inflammation and nasal polyps:
- Obstructive sleep apnea (OSA) – during sleep, the breath becomes shallow or even stops entirely due to upper airway blockages.
- Asthma attack – an episode of rapid/difficult breathing, and a tight feeling in the chest
- Sinus infections – nasal polyps can affect the severity and frequency of sinus infections and sometimes develop into chronic sinusitis.
- Vision problems – nasal polyps patients sometimes develop vision complications if the infection spreads to the eye socket, causing swelling/bulging of the eye, reduced vision or even blindness
- Blood clots – Nasal polyps can swell and redden the veins located in the sinus cavities
Nasal Polyp Treatment
How should I prepare for my nasal polyp appointment?
If you are suffering from any nasal polyp symptom or suspect you may have chronic sinusitis, make an appointment with your primary care physician or depending on your insurance, you could go directly to an ENT specialist.
The ENT specialist will need to review your background. Come prepared with a detailed medical history including past surgeries, and medication allergies. Be sure to go over your symptoms a few times before seeing your doctor, to make sure you give your doctor the most informed and detailed description.
You will also need to report the types of medications you frequently take. This includes both over-the-counter and prescribed medications, plus vitamins and other health supplements.
Tip: Before your appointment, compile a list of any questions you might have that are related to the reason for your visit. You will ensure that you make the most of your time and fully understand the doctor’s planned course of action for treatment. Some typical questions that can be used in any instance include:
- What is the cause of my nasal congestion?
- Do you recommend any tests? If so, which?
- Will treatment from a specialist be covered by my insurance?
- Should I be concerned about any long term consequences?
- Should I make any changes to my daily routine?
What can I expect during my appointment?
When you meet with your ENT specialist, he or she will likely ask you to describe your symptoms and for how long you have been experiencing them. Your doctor will also be interested in the frequency of your sinus infections as well as whether you have a history of allergies or asthma. Your doctor will also want to know whether you have ever received sinus or nasal surgery.
Tell your doctor whether you smoke, or are exposed to secondhand smoke. Also, be sure to inform your doctor of any excessive exposure to airborne pollutants or chemical fumes.
Diagnosing Nasal Polyps
How will my doctor make a diagnosis?
After reviewing your answers to his or her questions, and scrutinizing your symptoms, your ENT doctor will complete a physical exam of your nose with the help of a headlight and nasal speculum to check for a deviated nasal septum and nasal polyps.
(1) Nasal Endoscopy
If your doctor is unable to view the polyp after a basic physical exam, he or she may use a nasal endoscope for a more thorough examination. A nasal endoscope is a thin flexible or rigid tube with a lighted magnifying glass & camera attached to the end. After slowly inserting the tube into each of your nostrils, your doctor has a much closer view of your sinus cavity to visualize the polyps.
(2) CT and MRI scans
Polyps can also be located through various imaging techniques. Both computerized tomography ( “CT scans”) and magnetic resonance imaging (“MRI scans”) are able to show your doctor a very detailed picture of your sinuses. These imaging techniques are used to
(3) Allergy Tests – Skin Prick Method and Blood Test
Chronic sinusitis leading to polyps is also often linked to certain allergens, so your doctor may order an allergy test to screen for specific allergens that are affecting your immune system. The most popular allergy test is the “skin prick method.” Your doctor inserts a few droplets of an allergen into your hand or forearm. After roughly 10-15 minutes, your skin is evaluated to conclude whether there is an allergic reaction. A blood test is an alternative method that your doctor might also perform to screen for the presence of antibodies to different allergens that cause allergic symptoms.
Nasal Polyp Treatment Plans
What types of treatment plans will my doctor suggest?
Your ENT doctor will likely devise both a short-term and long-term plan in order to clear up your nasal polyps and reduce the onset of inflammation of nasal tissues. Surgery is sometimes needed to remove the polyps completely enough to improve symptoms.
Treatment Plan No. 1: Nasal Corticosteroids
Your doctor may prescribe various medications that can shrink your nasal polyps or make them disappear. One popular treatment is nasal corticosteroids. This medication comes in the form of a nasal spray and works to decrease swelling in your nasal cavities. The most frequently-prescribed nasal corticosteroids include fluticasone (found in Flonase), mometasone (found in Nasonex), budesonide, flunisolide, and triamcinolone.
If your doctor prescribes a nasal corticosteroid and you do not experience any improvement in your symptoms, you may be given an oral corticosteroid. Oral corticosteroids are often associated with dangerous side effects, so your doctor will likely recommend that you take them for only a short period. If there are no visible signs of reduction in the polyp after the oral corticosteroid, then your doctor may suggest a surgical biopsy or removal of the polyps.
Treatment Plan No. 2: Medications
In addition to corticosteroids, your doctor might also prescribe medication to combat the chronic inflammation in your sinus cavity. For example, he or she may prescribe an antibiotic or antihistamine.
Treatment Plan No. 3: Surgery
Surgery is seen as a last resort method to remove nasal polyps after other treatments have failed. Specific details about how the surgery is performed depending upon the size, location, and the number of nasal polyps. There are two main types of nasal polyp surgery:
Endoscopic Sinus Surgery
This procedure allows your doctor to remove the diseased tissue that makes up the polyp and to also correct any sinus issues linked to the inflammation. The surgeon inserts an endoscope into the nostril to reach the nasal cavities, and through the use of small surgical instruments, lances the polyp. He or she might also create a wider opening between the sinuses and nasal passages to increase breathing ability. This procedure is also typically performed on an outpatient basis.
Traditional Sinus Surgery
Used mainly for cancer surgery, and serious infections, this procedure is mainly otherwise historical in nature. Skin incisions are made for direct access to the inside of the nose. This is rarely used for benign nasal polyps.
Is nasal polyp surgery dangerous?
All surgeries have risks, benefits, and alternatives. Nasal polyp surgery is no different. There are some rare and uncommon side effects that exist. Note that they depend heavily on the complexity of your case, skill, and experience of your surgeon and the location of the polyps. A small percentage of patients who undergo nasal polyp surgery bleed excessively or develop a postoperative sinus infection. If you notice a pain in your nasal or cheekbone area, combined with a high fever or migraine, you may have an infection. Most infections can be cleared up with antibiotics, but it is important to call your doctor at the immediate sign of a problem.
If your nostrils and nasal passages are particularly narrow, then healing may be difficult, with some patients experiencing the sides of their noses adhering together as scar tissue develops. This is called an “adhesion” and can be corrected by your surgeon when you visit him for your post-op visit. The brain and eyes are adjacent to the sinuses and damage to these structures is a rare occurrence.
What kind of aftercare should I expect after nasal polyp surgery?
After surgery, you should rest. If you notice any pain or discomfort, take either the prescribed painkillers given to you by your doctor or over-the-counter acetaminophen (Tylenol). All other pain-killers have the potential to decrease your ability to stop bleeding. Avoid blowing your nose for the first two weeks, to prevent bleeding. After the fourteen days have passed, remember to blow your nose very gently.
Also, be sure to avoid any smoky or polluted areas for a few weeks after surgery, so as not to disrupt the healing process. While you will be able to drive about a week after surgery, you should avoid any strenuous activity like contact sports or exercise until your doctor gives you permission. Relax and mainly stay off your feet for the first few days, to reduce your chances of infection and catching a cold. Don’t bend over or look down for too long, even at a computer, because this will increase the pressure in your nose.
Nasal Polyp Prevention
How can I prevent nasal polyps?
Nasal polyps can be a painful and frustrating condition to treat. As such, if you are interested in reducing or even preventing the onset of nasal polyps, or if you have already been treated for polyps and wish to decrease the possibility that the polyps will return, review the following tactics:
Treat existing allergies and asthma.
Find out if you are susceptible to allergens or have any sensitivity to pet dander that may be linked to asthma. If so, follow the treatment plan outlined by your doctor.
Avoid outdoor/indoor nasal pollutants.
The world around us is full of fumes and substances that irritate our nasal passageways, causing inflammation and polyps. Stay away from the irritants that affect you, like dust, exhaust, pollution, cigarette smoke, and other debris.
Fight bacterial and viral infections.
Wash your hands after using public transportation or touching communal door handles. Keep a small bottle of antibacterial hand sanitizer and use it throughout the day to prevent viral or bacterial infection in your nasal cavities.
Buy an air purifier.
Filtering the air will remove the allergens and debris that can irritate the delicate lining of the inside of your nose and lungs. These air purifiers should be placed where you spend the most time: bedrooms, office or family room.
Buy a humidifier.
If you notice that the air in your house is drier than normal, invest in a humidifier to moisten the air in your common areas and bedrooms. This will keep your sinuses healthy and allow for proper drainage of the delicate mucous membranes that filter out bacteria.
Use a saline nasal spray.
Saline nasal sprays are made up of a saltwater solution that rinses out your sinus cavities and clears away any blockages. This will prevent mucus inflammation. Keep your spray on hand throughout the day for times when you feel stuffed up, and opt for a neti pot to use at home for a more thorough rinse.