Why are polyps in the nose dangerous? Symptoms, treatment and removal
Polyps in the nose are benign, rounded neoplasms that are the result of an overgrowth of the mucous membrane lining the nasal cavity. In appearance, they may look like mushrooms, peas, or grapes.
According to statistics, nasal polyps are the most common complication of chronic rhinitis. In the world, according to various sources, from 1 to 4% of people suffer from them, most of the carriers are male. They form growths 4 times more often than women. If we turn to the structure of the outgrowths, then in children anthrochoanal polyps predominate (formed from the mucous membrane lining the maxillary sinuses), and in the adult population - ethmoidal (formed from the mucous membrane lining the ethmoidal labyrinth).
The main danger of nasal polyps is that, if untreated, they can shorten the patient's life by about 6 years. The fact is that any vasoconstrictor drops will not be able to facilitate nasal breathing with polyps. For this reason, a person has to breathe through his mouth all the time, which significantly aggravates the risk of various respiratory diseases, and also increases the likelihood of developing asthma.
- Symptoms of polyps in the nose
- Causes of polyps in the nose
- Why are polyps in the nose dangerous?
- Diagnosis of a polyp in the nose
- Answers to popular questions
- Treatment of polyps in the nose
- Removal of polyps in the nose with a laser
- Endoscopic removal of nasal polyps
Symptoms of polyps in the nose
Symptoms indicating the presence of polyps on the nasal mucosa are as follows:
- Breathing through the nose is either difficult or impossible. The person experiences a feeling of constant congestion. Such difficulties are due to the fact that the tissues of the mucous membrane have grown and blocked (either completely or partially) the respiratory lumen of the nasal passage;
- When a secondary infection joins, the mucous glands begin to work hard. For this reason, the production of mucus in the patient increases, in advanced cases it may have purulent impurities;
- The person starts sneezing more often. This protective reaction of the body is due to the fact that the polyp irritates the cilia covering the walls of the nasal mucosa. They take it for a foreign body and try to clear the nose with the help of sneezing;
- Headaches. They are due to a number of factors. First, the body, including the brain, begins to suffer from a lack of oxygen. Secondly, significantly overgrown formations press on the nerve endings, causing a natural pain reaction. Thirdly, the headache can be caused by an inflammatory process occurring in the paranasal sinuses (in the sphenoid, maxillary, ethmoid labyrinth or in the frontal sinus);
Olfactory function disorders. With significantly overgrown polyps, a complete loss of sensitivity to odors can be observed. This symptom is due to the fact that the overgrown connective tissue disrupts the work of receptors that are responsible for the perception of aromas;
- Large nasal polyps can affect the patient's taste sensations and even cause an unpleasant taste in the mouth;
- In childhood, education can cause the formation of a malocclusion. If a polyp appears in the first year of life, it makes it difficult to feed it, since the child cannot suckle and swallow food normally. As a result, the baby suffers from chronic malnutrition, which leads to weight loss and general malnutrition;
- Voice change, nasal development. As a result of the fact that the air flow through the nasal passages is disturbed, the patient begins to speak into the nose. In addition, it is known that the nose is the organ that is directly involved in the formation of speech sounds.
The severity of the symptoms depends on the stage at which the growth is:
At the first stage, the outgrowth is small, therefore, it covers only the upper nasal septum. The patient experiences minor nasal congestion, which is often perceived as a common ARVI. However, already in the initial stages, a polyp can provoke the development of otitis media, tonsillitis or adenoiditis;
- The second stage of nasal polyposis is characterized by further proliferation of connective tissue. The patient begins to experience difficulties with the sense of smell, his voice changes, and nasalness is acquired. When the formation reaches the auditory tube, speech begins to distort, hearing deteriorates. If you do not seek help at this stage, pathological changes may remain forever;
- The third stage is characterized by complete blockage of the nasal passage, the symptoms are gaining full strength. When the infection joins, the body temperature rises. In addition, patients suffer from headaches and increased fatigue. The quality of life is significantly reduced by persistent nasal discharge.
Causes of polyps in the nose
Before turning to the listing of the reasons leading to the appearance of polyps, one should understand the mechanism of their occurrence. When a virus or bacteria enters the human body, infectious agents multiply. This provokes detachment of the cells of the nasal mucosa. The person begins to suffer from congestion, difficulty breathing, profuse nasal discharge. If the immune system is functioning normally and the person receives adequate treatment, then after about a week, complete recovery occurs.
When the process is chronized, local immunity malfunctions, and the mucous membrane, in order to increase the resistance to the disease, seeks to increase the occupied area. The only way to realize this is to start growing and thickening. Most often, this process occurs in the paranasal sinuses. At some point, there is little space for the dividing cells, and they enter the nasal cavity, and a polyp is formed.
Therefore, the specific reasons leading to the proliferation of the nasal mucosa are:
- Infections and colds, which are accompanied by a runny nose and occur quite often;
- Chronic inflammation occurring in the paranasal sinuses - frontal sinusitis, ethmoiditis, sinusitis;
- Allergic runny nose (hay fever);
- Diseases such as bronchial asthma, cystic fibrosis, Young syndrome, Churg-Strauss syndrome, nasal mastocytosis, Kartagener's syndrome, aspirin intolerance;
- Hereditary predisposition to polyposis;
- Too narrow nasal passages, disturbances in the structure of the nasal septum;
- Pathological failures in the work of the immune defense.
That is, nasal polyps are a polyetiological disease, which is simultaneously influenced by the anatomy of the nose, chronic inflammation of its sinuses and allergies.
Why are polyps in the nose dangerous?
The danger of overgrowth of the nasal mucosa primarily lies in the development of complications. When natural breathing through the nose is not hindered by anything, the air entering the lungs is humidified and warmed. In addition, dust particles are removed from it, which remain on the mucous membrane, and then are naturally removed. Polyps prevent air from passing freely through the nasal passage, which forces the person to breathe through the mouth.
As a result, the air does not have time to warm up properly, which provokes diseases such as:
As a result of the disruption of the natural communication between the sinuses, the patient suffers from chronic sinusitis.
The more the growth, the more it presses on the blood vessels of the nasopharyngeal tissue, thereby causing inflammation of the tonsils and the formation of adenoids, an increase in palatine tonsils with symptoms of angina. Also, impaired blood circulation can lead to the development of a clinic of chronic tonsillitis. As for violations from the auditory tube, the increased pressure on it leads to the development of otitis media or eustachitis.
Diagnosis of a polyp in the nose
The doctor can suspect that the patient has a polyp in the nose by his nasal voice, even if the patient himself does not complain of difficulty in nasal breathing. If a polyp forms in childhood, then the very appearance of the child will inform the doctor about this. In such children, the mouth is constantly open, the lower jaw drops, the folds of the nasolabial triangle are smoothed out.
To clarify the diagnosis, a rhinoscopy is performed, during which the doctor examines the nasal cavities using a special mirror. Polyps are externally fleshy, aciniform or single growths.
To assess their stage of development, CT scan of the paranasal sinuses is sometimes prescribed. This procedure is mandatory for those patients who are scheduled for surgery. It is the tomography results that will give information to the surgeon about the volume of future intervention. If CT scan is impossible for any reason, then the patient should undergo X-ray.
In addition to detecting the presence of polyps, concomitant infection should be excluded or confirmed. For this, a bacterial culture is taken from the nose and throat, pharyngoscopy, otoscopy and microlaryngoscopy are performed. Blood sampling for clinical analysis is also required. If there is a suspicion of the allergic nature of the growth, then it is advisable to conduct allergic tests.
All diagnostic procedures are prescribed by an otolaryngologist.
Answers to popular questions about nasal polyps
Do I need to remove polyps in the nose? Polyps are terrible for their complications, such as sleep apnea, exacerbation of asthma, chronic sinusitis. Surgery is the only way to remove nasal polyps. However, it is worth highlighting such modern methods of removal as laser burning and endoscopic resection with a shaver. As for conservative therapy, it is aimed, first of all, at eliminating the cause of the proliferation of the nasal mucosa. Therapeutic treatment acts as a preparatory stage before the operation;
- Can polyps in the nose be warmed? It is impossible to heat polyps. This is not only an absolutely ineffective procedure, but to some extent even dangerous, since there is a high risk of burning the mucous membrane. Warming up should not be confused with thermally removing the polyp using silica fiber. This procedure is performed by a doctor in a hospital setting;
- Is it possible to treat nasal polyposis without surgery? Treatment without surgery can be aimed at preventing recurrence of polyps, or if there are specific contraindications to surgery. However, it is important to understand that if a polyp has already formed in the nasal cavity, then it will not be able to eliminate itself without surgical intervention.
Treatment of polyps in the nose
Conservative therapy of nasal polyposis is designed, first of all, to eliminate those factors that affect the increased proliferation of the mucous membrane. This can be a whole range of procedures offered by modern medicine: laser therapy, injection treatment, therapeutic warming up, taking medications.
Only an otolaryngologist surgeon can choose the optimal treatment regimen. Sometimes additional consultation with an allergist-immunologist is required.
So, conservative treatment comes down to:
- Eliminate the influence of provocative factors that have a positive effect on the thickening and growth of the mucous layer. It is important to avoid contact with all kinds of allergens (household, pollen, medicinal, professional);
- Elimination of all infectious and inflammatory processes in the nasopharynx;
- Compliance with a diet with the exception of allergenic foods, as well as spicy and salty. Coffee and alcohol are prohibited. It is highly desirable to stop taking NSAIDs, as well as food containing preservatives, dyes, salicylates;
- Regular rinsing of the nasal cavity using saline solutions, for example, Dolphin, Aqua-Maris, Marimer, Goodwada, Physiomer, Dr. Theiss Alergol, Otrivin-More;
- Special gymnastics for restoration of nasal breathing according to Strelnikova, according to the Buteyko method, independent massage of the ternary nerve;
- Antiallergic and immune medication correction.
Another non-surgical treatment for polyps is thermal treatment, when the formations are heated with a silica fiber inserted into the nose. The temperature reaches 70 ° C, which leads to rejection of the polyps after about three days. If the patient is unable to blow their nose on their own, the doctor will remove the detached polyps with tweezers.
It is advisable to carry out such treatment if a person has the following contraindications:
- Ischemic heart disease;
- Heart failure;
- Blood clotting disorders;
- Severe bronchial asthma.
Treatment with hormonal drugs is performed if any surgical intervention is completely excluded. In high doses, the patient receives oral corticosteroids for 3 weeks. Or they are injected directly into the growths. However, this method of treating nasal polyps poses a high risk of recurrence.
In addition, hormonal therapy is dangerous for its complications, including addiction of the body, immunosuppressive effect, suppression of the adrenal glands. The result from the use of hormonal agents comes very quickly, but after a while the patient will again feel worsening. If this therapy is practiced frequently, the person's health will be undermined.
It is necessary to dwell in more detail on the treatment of nasal polyposis with hormones. Most often, doctors use prednisone for this. Its action is based on a decrease in the rate of cell division, which does not allow the mucous membrane to sag further, and the outgrowth itself is destroyed over time. This technique is called "drug polypotomy". However, in order to achieve a positive effect, the patient will need to take very high doses of prednisone daily and for a long time. This will relieve polyps, but will lead to other serious health problems, for example, stomach ulcers, obesity, a drop in immune strength, etc.
Therefore, there is another option for polypotomy with the help of hormonal agents - this is the introduction of them directly into the outgrowth itself. In this way, you can achieve the destruction of the polyp and avoid serious complications from taking hormones inside. The choice of a specific drug and its dosage is carried out for each patient individually.
The patient is given up to two injections with an interval of two weeks. This contributes to the death of the overgrown tissues of the mucous membrane, and it is removed from the body during blowing out. If the technique of carrying out medical polypotomy was not violated, and the dosage and the drug itself were chosen correctly, then this will lead to a significant improvement in the patient's well-being after 30-60 days.
A well-designed rehabilitation program will postpone the next relapse of the disease for several years. Unfortunately, hormones cannot completely eliminate the risk of mucosal re-proliferation.
Removal of polyps in the nose with a laser
Burning out overgrowth using a laser beam is one of the modern methods of surgical intervention. It is carried out using laser equipment and an endoscope with a camera.
Among the advantages of laser treatment:
- The speed of the operation;
- Lack of severe pain;
- No risk of bleeding during surgery;
- No risk of infection;
- Visual control of the performed actions;
- Low probability of recurrence of the disease;
- Short recovery period (no more than 4 days);
- The possibility of an outpatient procedure.
Among the disadvantages of laser treatment for nasal polyps:
- The impossibility of eliminating multiple growths;
- The inability to open the sinuses and remove the polypous tissue inside them, which can provoke a relapse.
Indications and contraindications for laser removal of nasal polyps
Among the contraindications to laser therapy:
- Obstructive bronchitis;
- Multiple polyposis growths;
- The period of bearing a child;
- Blooming season.
The indication for the intervention is a single nasal polyp with concomitant symptoms. In addition, the low invasiveness makes it possible to carry out the operation in patients suffering from bronchial asthma.
How is the operation going?
On the day when the procedure is carried out, the patient must refrain from eating. The essence of the operation is as follows: the doctor injects a local anesthetic, after which an endoscope equipped with a camera is brought to the site of the existing growth, as well as laser equipment. The beam heats up the cells of the polyp, and they begin to evaporate. Bleeding does not occur due to the instant sealing of the vessels (coagulation).
After the operation is completed, the person remains under medical supervision for another day, although sometimes he is released home after several hours. Over the next 4 days, he needs to visit a doctor so that he monitors the healing process of the nasal mucosa. During the recovery period, it is necessary to exclude alcohol, visit steam rooms and baths, and also refrain from high physical exertion in order to minimize the risk of postoperative bleeding.
How much does laser removal of nasal polyps cost?
In a particular clinic, the cost of laser removal of nasal polyps will vary. But on average, the price is 16,000 rubles, which makes the operation quite affordable for the majority of the population.
Endoscopic removal of polyps in the nose with a shaver
Functinal Endoscopic Sinus Surgery is a new technology that utilizes the most modern endoscopic equipment. Thus, surgeons were able to carry out low-traumatic interventions with an extremely low risk of complications. With this procedure, the formation will be completely removed from the body, which reduces the likelihood of re-growth by 50%. In addition, healthy tissue is not affected at all.
Having decided on such a procedure, preference should be given to endoscopic FESS. It is this operation that allows navigational control of the shaver (or microdebrider) operation. Only this approach allows you to completely clean the cavity of the lattice labyrinth. The importance of global cleaning is to minimize the risk of relapse. After all, if there are areas of polyposis tissue, then after a short time (from 3 months to six months) it will grow again. As a result, new interventions and financial losses. In addition, you should pay attention to the doctor's experience with such modern equipment.
There are several options for performing an intervention using endoscopic equipment:
- Endoscope + instruments (does not allow you to clean out the smallest cells, as well as those that are deeply located);
- Endoscope + shaver;
- Endoscope + shaver + navigation (optimal method).
However, despite all the advantages of such an intervention, it is impossible to implement if:
- Serious violations of the internal organs;
- Infections in the acute phase;
- Exacerbations of allergies, bronchial asthma or obstructive bronchitis;
- Ischemic heart disease or heart failure;
- Hypertension, severe malaise require some delay in intervention.
Advantages and disadvantages of the method
Among the advantages of endoscopic treatment of nasal polyps with a shaver:
- No incisions required, the procedure is performed endonasally;
- Full control of the doctor's own actions;
- Gaining access to hard-to-reach areas of the nose;
- No trauma to healthy tissues;
- No bleeding;
- Rapid onset of relief, which is reported by up to 80% of patients;
- Operation in a hospital, a short stay in a hospital ward (from 3 days to a week).
Among the disadvantages of the procedure:
- The inability to eliminate the true cause of the growth, which leads to the risk of its reappearance (in 50% of cases).
How is the operation going?
The field where the intervention will take place is monitored by the doctor on the monitor. To implement the procedure, the doctor will need:
- The shaver itself (debrider or microdebrider), which will retract the outgrowth and cut it off at the very base;
- Optical endoscope with different tilt levels;
- Head-mounted illuminator;
- Nasal mirrors.
For the procedure, it will be necessary to introduce the patient into a state of general anesthesia, since this makes it possible to fully open the anastomosis, as well as improve drainage. Although the recovery time after surgery is somewhat longer compared to other methods of removing polyps, the risk of recurrence in this case is much lower. If it does arise, it is significantly delayed in time.
When the anesthesia starts to work, a special plastic tube will be inserted into the patient's mouth, allowing him to keep breathing. The sinuses are opened using special instruments, then all polyps and modified tissues are removed from them. With FESS, there is an excellent opportunity to correct the nasal septum if it is deviated, as well as to perform a tissue biopsy. At the end of the intervention, the nasal cavity is closed with cotton swabs. They can be removed after 12 hours.
- The forthcoming intervention requires a certain preparatory program. You should pass all the tests required by the doctor and undergo computed tomography of the sinuses, in addition, a coagulogram, blood tests for biochemistry and a clinic can be prescribed. It is important to determine the need for a preliminary endoscopic examination, which will give the surgeon information about the upcoming operation and optimize it.
- A week before the intervention. With severe polyposis, the patient is prescribed prednisolone for 7 days. The daily dose is 40 mg. If an active infection is found, then it must be eliminated. It is important to completely exclude the use of non-steroidal anti-inflammatory drugs, aspirin and vitamin E. This is due to the fact that they have a negative effect on the rate of blood clotting.
- The day before the operation. The patient can have supper, but the food should not be heavy. When 6 hours remain before the intervention, then any food and drink will be prohibited. If you are thirsty, you can rinse your mouth.
At this time, competent hygiene of the nasal cavity comes to the fore. The fact is that after the intervention, the activity of the ciliated epithelium decreases, the mucous membrane is damaged and is unable to produce a protective secret in full. This becomes a favorable breeding ground for bacteria. After the cotton wool is removed, crusts of blood and fibrin build up in the nose.
You can only remove the crusts that are on the eve of the nose, it is strictly forbidden to blow your nose or eat hot food. The success of the operation is evidenced by headache and soreness in some of the facial regions. The sense of smell can be restored within 30 days.
In the postoperative period, complications may develop: bleeding, recurrence of the polyp, the formation of adhesions and the addition of infection.
In order to prevent tissue overgrowth, you should rinse your nose with saline solutions, which were listed above, and also use antihistamines, including Loratadin, Claritin, Tsetrin, Zodak, Erius, etc.
In addition, the use of hormone-based aerosols is necessary:
Diet is no less important for the prevention of relapse. It acquires particular relevance during the flowering of plants. Therefore, during this period, you should stop eating potentially dangerous foods, for example, nuts and seafood.
The patient must visit the attending ENT doctor every 12 weeks. This must be done throughout the year. In addition, observation by an allergist-immunologist is indicated.
The author of the article: Lazarev Oleg Vladimirovich | ENT
Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)