Nasal Polyps and How to Beat Them Back

Nasal Polyps. A Q&A with Dr. Thrasher

picture from Bechara Y. Ghorayeb, MD at www.ghorayeb.com
Q What are they?
A While there are more scientific answers, I generally describe them as a “callous” for the mucosal lining of the nose.Q Why do we get them?
A Well, if you consider them as callouses of the nose, we get them because we breathe. While the exact mechanism of their development remains unclear, polyps form from an hyperactive response to irritants (e.g. allergens) that are breathed in.Q Why are they a problem?
A They aren’t in and of themselves dangerous. They are not tumors. They don’t become cancerous. But they can cause of any of a number of symptoms:
– decreased or loss of smell
– nasal obstruction
– nasal congestion
– nasal drainage
– pressure or pain
– sinusitis
With extreme polyp growth, many complications can occur as the polyps can put pressure on the bones around the eye and brain. While very rare, this pressure can lead to eye and/or brain problems.

Q What are the medical treatment options?
A Small polyps may not cause many symptoms. However, if left unchecked, they often will grown. If small and not causing extensive symptoms, initial treatment should consist of preventing further growth. This could consist of intranasal steroid (INS) sprays like Nasonex (mometasone). INS sprays are the only long term demonstrably effective treatment for preventing and even possibly shrinking nasal polyps. One pill, Singulair, has been shown to be effective at preventing polyp growth if used in conjunction with an INS. In fact, the combination of the two medications is synergistic such that 1+1=3 not 2. Furthermore, because most patients with nasal polyps have significant nasal allergies, trying to control these with oral medications, nasal sprays, or immunotherapy is also appropriate. Nasal saline irrigation can be quite beneficial be reducing the nasal allergen, mucus, debris, and microorganism burden.

Q So what if the polyps are as big in the above picture?
A When the polyps are causing symptoms and one goal is to shrink them to an asymptomatic level, a burst of steroids can be given. I advocate for a 2 week course of oral steroids. I traditionally do not recommend injection of steroids. However, within the nasal saline irrigation, I will often put in a much higher dose of steroid than is typically found in INS sprays. This can be effective if helping shrink nasal polyps. Very frequently, large obstructive polyps are associated with a significant sinus infection which will be treated with oral and/or topical antibiotics.

Q Is surgery ever indicated?
A Certainly surgery is an option for nasal polyps. In fact, it is rare that polyps will ever completely resolve without surgery. However, even with surgery, polyps have a very high recurrence rate. The rate is so high, in fact, I counsel patients to expect regrowth at some point. My surgical goal is to lengthen the time to recurrence to many years not many months. Surgery to remove polyps is also elective. It is the option to choose when you no longer can tolerate your symptoms and medicine is not providing enough relief. I would never advocate surgery as a first line treatment.

Q Isn’t surgery a difficult thing to recover from?
A When surgery is performed at the time when I advocate for it–when symptoms are too significant to ignore and not improved by medication–I have found that patients often feel immediately better, not worse, after sinus surgery. This is not always the case with patients who undergo sinus surgery when there are no polyps. I would also suggest that prior to 2005, sinus surgery was much less refined than it is now and that the recover these days is overall far better than it was then. One reason for this is the lack of packing. I have not had to pack a nose for sinus surgery in over 10 years. Anyone who ever had their nose packed for sinus surgery is certainly not someone whose experience you’ll envy.

Q What should a patient do who suspects they have polyps?
A While I am a strong supporter of the primary care physician as the initial care provider for any complaint, nasal polyps can be more thoroughly evaluated by an ENT than any other specialty. We have the ability to take high-definition video of the polyps and see their true extent. We can determine whether or not there are concerning complications and make sure that they truly are polyps and not a more concerning tumor. Therefore, after discussing with your PCP the nature of your problem, I would seek the input of a board certified otolaryngologist, particularly someone with an extensive knowledge of the condition and the surgical experience to treat them if ultimately needed. Of course, I’d love for patients to visit our website and make an appointment. Nevertheless, a good ENT in any community should have the experience to at least provide good counsel on these troublesome nasal blockers.

 

Posted in: Nose

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