Nasal polyps: what they are, causes, symptoms and treatment

• Nasal polyps are abnormal, soft, painless growths that form in the lining of the nasal passages and sinuses.
• These nasal polyps can cause nasal congestion and partial or complete loss of smell.
• To solve nasal polyp problems, endoscopic sinus surgery is necessary.

Nasal polyps are abnormal, soft, painless growths that form in the lining of the nasal passages and sinuses. The physical appearance of nasal polyps is in the form of a grape or droplet. Smaller formations usually do not cause many symptoms. 

Larger ones, however, can obstruct the nasal passages and cause difficulty breathing, as well as loss of sense of smell and recurrent infections.

These growths form as a result of asthmatic inflammation, frequent infections or allergies, among others. Although this pathology is more common in adults, polyps can affect anyone. For this reason, there are several types of treatments that aim to eliminate nasal polyps. 

With medication, these growths usually diminish and sometimes even disappear. However, if the polyps are not removed, endoscopic sinus surgery (ESS) is necessary.

In this surgery, the nostrils and paranasal sinuses are operated on in order to make an incision in the nasal wall to remove obstructive tissue, i.e. nasal polyps. 

The main objective of this surgery is to get the course of the mucosa back to normal, automatically.

It should be added that the appearance of nasal polyps favours the development of chronic sinusitis, which is one of the reasons why endoscopic sinus surgery is performed. Therefore, throughout this article we will discuss the main characteristics of the disease, as well as its treatment.

Nasal polyps develop inside the nose, forming in the airways and sinuses. With the appearance of these abnormal growths, the entire nasal sinus structure is affected. Therefore, before covering the main causes of polyps, we will discuss the functions that are affected by the disease.

The nasosinusal structure is formed by the nasal cavities and paranasal sinuses, cavities that are directly damaged by the appearance of these abnormal growths and are therefore intervened in the surgical treatment.

The nostrils are cavities separated by the sagittal septum. They are located in the upper part of our mouth and have numerous functions, such as:

• Filtering the air we breathe.
• Collecting impurities from the particles present in the air.
• Perceiving and differentiating odours.
• Warming the air we inhale so that it does not reach our lungs cold.

On the other hand, the paranasal sinuses are four cavities located between the bones of the face and head. Their functions include:

• Drain the mucous fluid inside.
• To distribute the air we receive through the respiratory tract.
• Moisturise the nose and contribute to its lubrication to keep it free of particles and bacteria.

The appearance of nasal polyps means that both nasal structures are affected and, therefore, the different functions are limited.

Although it is true that medicine does not pinpoint the exact causes of nasal polyps, there are some pathological factors that favour their appearance:

• Anatomical alterations of the nasal cavities and/or paranasal sinuses.
• Recurrent inflammation of the nasal mucosa.
• Rhinitis or sinusitis.
• Cystic fibrosis. Affects the glands that produce mucus, tears, sweat, saliva and gastric juices.
• Allergic rhinitis. A chronic infection causes swelling of the nasal mucous membrane, leading to excess fluid in the nasal cells.

As mentioned above, nasal polyps are abnormal, soft and painless growths that form inside the nose. This affects the nasosinusal structure and, therefore, limits its main functions. There are no clear causes for the onset of this disease. 

However, there are some alterations in the nasal cavities and paranasal sinuses that favour the development of nasal polyps, such as inflammation, sinusitis, cystic fibrosis, allergic rhinitis, etc.

Nasal polyposis initially manifests with a loss of smell and taste that progressively progresses to partial or complete nasal obstruction. 

They usually cause very annoying symptoms such as inability to breathe through the nose, loss of smell, headaches, etc. 

These growths are benign but the larger they are, the more uncomfortable the symptoms are:

• Total or partial loss of smell.
• Alteration of taste.
• Excess nasal mucus.
• Breathing difficulties. This causes dryness in the mouth and nose, thus contributing to snoring.
• headaches
• Sensation of discomfort in the area.

Endoscopic sinus surgery becomes a necessary option when polyps appear or nasal inflammation is chronic. Nasal polyposis has a pharmacological treatment, but when medications do not eliminate the abnormal growths, which cause nasal obstruction, nor reduce their size, it is necessary to intervene with nasosinusal endoscopic surgery.

If the size of nasal polyps is significant, it can cause blockage in the nasal passages. It also causes blockages in the sinus drainage pathways, and the sufferer is much more likely to get a sinus infection more easily.

Symptoms of nasal polyps include nasal congestion, partial or complete loss of smell, reduced taste ability, runny nose, headache, swelling and discomfort in the affected area and signs of constipation.

As you may already know, nasal polyps form in the airways and paranasal sinuses, affecting the entire nasosinusal structure. Below you will find details of what functions the disease limits and which nasal and sinus structures are involved in endoscopic sinus surgery.

The nostrils are the cavities separated by the sagittal septum. They are located in the upper part of our mouth and have numerous functions. These are:

• To filter the air we breathe.
• To collect the impurities of the particles present in the air.
• To perceive and differentiate odours.
• To warm the air we inhale so that it does not reach our lungs cold.

The paranasal sinuses are four cavities located between the bones of the face and the head. The function of this nasal structure is based on the following:

• Draining the mucous fluid inside.
• To distribute the air we receive through the respiratory tract.
• Humidifying the nose and contributing to its lubrication to keep it free of particles and bacteria.

When drugs do not eliminate the disease and the area remains inflamed and infected, and therefore the functions of our olfactory system remain limited, it is necessary to resort to endoscopic sinus surgery. 

Therefore, the medical characteristics that define a patient requiring surgical intervention are as follows:

• Contracting sinusitis, whatever its type. The disease involves an increase in bacteria in the sinuses, leading to infection or the contraction of viruses by bacteria. It can be treated with drugs if the sinusitis is acute, but if it is not resolved, it can lead to chronic sinusitis. In this case, endoscopic sinus surgery would become a necessary option.
• Nasal polyposis are abnormal growths of internal nasal or mucosal tissue, called nasal polyps. These, like other diseases, can be treated medically with inhalers and pills to reduce their size. However, surgical intervention is the most effective solution.
• Episodes of epistaxis. With this disease, blood leaks occur due to ruptured blood vessels on the surface of the nasal cavity, leading to nosebleeds.
• With the appearance of nasal and sinus tumours, endoscopic nasosinusal surgery is the only effective option. The existence of these anomalies, regardless of the aerodigestive area in which they are located, requires surgical treatment for their total removal.

Nasal polyps are abnormal growths that form in the lining of the nasal passages and sinuses. When these formations are small in size, they usually do not cause many symptoms. 

However, when polyps are large, they often obstruct the nasal passages and make it difficult to breathe through the nose, affecting the sense of taste, etc.

As mentioned in previous sections, the exact cause of nasal polyps is not known. However, there are factors that favour the formation of these growths, such as asthmatic inflammations, frequent infections, allergies, among others. Although this pathology is more common in adults, polyps can affect anyone. 

For this reason, there are several types of treatments that aim to remove nasal polyps. With medication, these growths usually diminish and sometimes even disappear. 

However, if the polyps are not removed, endoscopic sinus surgery is necessary.

The diagnosis of nasal polyposis is based on the clinical condition of the patient, so possible nasal obstruction, loss of smell and thick mucus that may lead to asthma, intolerance to medication, etc. will be taken into account. 

In any case, the doctor will be able to establish the diagnosis by asking a series of questions or by a physical examination of the nose. 

Common diagnostic tests include the following:

• Nasal endoscopy. A tube with a magnifying glass and camera is inserted to examine the nostrils and sinuses.
• CT scan. This imaging test allows the doctor to know the size and location of the polyps. It can also help rule out other possible blockages or cancerous growths.
• Allergy testing. Your doctor may order a skin test to check whether any allergies promote chronic inflammation. This is a test in which you are pricked with small drops of allergens to check for signs of allergy. If a skin test is not possible, a blood test for antibodies to different allergens will be performed.
• Cystic fibrosis test. Cystic fibrosis affects the glands that produce mucus, tears, sweat, saliva and gastric juices. In this test, sweat is analysed to determine whether perspiration is saltier than normal.

Nasal polyposis has no clear cause for its occurrence. However, there are some factors that favour the development of the disease. Inflammations and infections caused by bacteria, fungi or persistent allergies contribute to the appearance of nasal polyps and their variety of symptoms, such as difficulty breathing or swelling in the area, which can cause discomfort in the face and eyes.

Before discussing endoscopic sinus surgery (ESS), the most effective treatment for nasal polyposis, we will mention some preventive measures that can avoid, as far as possible, the aggravation of some symptoms of the disease.

Preventive treatment

To prevent the development of nasal polyps, it is advisable to maintain good hygiene and wash the nose to improve nasal flow and eliminate allergens. Some of the tips to reduce the chances of nasal polyposis are as follows:

• Moisturise the body and sinus passages through proper hydration of the body, especially by drinking water.
• Avoid smoking, tobacco smoke and places with high levels of pollution.
• Apply decongestants if you have contracted a respiratory tract infection.

Pharmacological treatment

The aim of drug treatment for nasal polyps is to reduce their size or even eliminate them. However, when medication does not resolve the disease, nasosinusal endoscopic surgery is used.

Medications to treat nasal polyposis include the following:

• Nasal corticosteroids: These come in the form of a nasal spray containing corticosteroids to reduce inflammation and help shrink existing polyps.
• Oral and injectable corticosteroids: Your doctor will prescribe this type of medication when nasal corticosteroids are not effective. In addition, these injectables are used when nasal polyps are severe.
• Other medications: Antihistamines and antibiotics can relieve chronic inflammation of the sinuses and nasal passages. In addition, aspirin desensitisation treatment helps some patients with nasal polyposis.

Surgical treatment

Nasal polyp surgery is based on endoscopic sinus surgery, which is a minimally invasive surgical practice.

The patient who undergoes this surgery usually suffers from chronic sinusitis or polypoid sinusitis that has not been corrected with pharmacological treatment. As a result, nasal inflammation and obstruction of the nasosinusal structure becomes evident.

Nasal polyp surgery removes these abnormal growths that develop inside the nose. The surgical intervention is performed with the aim of restoring normality and fulfilling the different functions of the nasosinusal structure, such as: acting as a filter for the air we breathe, draining the mucous liquid and giving us the ability to perceive odours, as well as distinguishing them.

What is the surgical technique used?

Endoscopic sinus surgery is the surgical technique used to remove nasal polyps and clean the paranasal sinuses. It is performed under general anaesthesia, although it can also be performed under local anaesthesia and patient analgesia.

This technique is a medical breakthrough as it has significantly reduced postoperative complications and ailments.

The procedure uses a camera attached to a very thin cylinder about 15 to 20 centimetres long. A light is inserted into the camera to see the inside of the nasal cavity and the part that communicates with the throat, which is where the polyps are normally formed. 

It is connected to a monitor so that the otorhinolaryngologist can see everything that can be operated on through the viewer. In this way, all the surgical tools used in this technique are adapted to it and designed to be able to open, cut and clean the entire nasosinusal structure.

Below, we will show you the step-by-step of endoscopic sinus surgery through Operarme. It is undoubtedly the least invasive procedure we know of. 

The steps involved in nasal polyp surgery

Like any surgical procedure, endoscopic sinus surgery involves a preoperative and a postoperative period.

After the preoperative stage, the date of the intervention will be set. On the day of the nasal polyp surgery, you will hand in all the required documentation in admissions, although all of this will be explained to you by our patient care service. 

Once you have handed them in, and moments before going to the operating theatre area, you will be given surgical clothes and you will be given a line through which the anaesthesia and relevant medication will be applied.

You will then arrive at the operating theatre where the specialist and the anaesthetist, with whom you have previously had a consultation, will start the operation:

• The first step will be taken by the anaesthetist administering the anaesthetic.
• Secondly, and after the anaesthesia has taken effect, a nasal decongestant will be applied to deflate the affected area.
• The third step is the dissection of the nasal wall, using the fibre optics mentioned above, to remove the abnormal and obstructive tissue.
• The fourth and final step is to plug the bleeding sites after they have been located. This is done in order to prevent bleeding. Silicone sheets can also be used to prevent the walls from sticking together or rubbing against the scars.

This procedure lasts between 1 and 3 hours. Moreover, as it is a very minimally invasive technique, as no external incisions are made, your recovery will be quick and you will be able to return to your daily routine in 3 to 5 days.

As you may already know, Operarme is a company that offers the most demanded surgeries in the medical sector. 

In addition, as a company dedicated to private medicine, we offer a series of services to ensure the patient's well being before, during and after surgery.

If you would like to request an appointment for an assessment with one of our specialists, who will evaluate and determine the needs of your case, fill in our contact form, or call at +34 91 141 33 56 and our team will contact you to arrange a free consultation.

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