Nasal polyps are soft,
jelly-like overgrowths of the lining of the sinuses. They look
like grapes on the end of a stalk. They occur in around 1 in 200
people, mostly by the age of 40 years.
Symptoms of nasal polyps
Polyps do not always cause symptoms. As they often grow through
the tunnel that connects the sinuses to the nose, the result is
often a blocked nose. More importantly, they can block the tunnels
connecting the nose to the sinus cavities. Like water in a stagnant
pond, this can lead to sinus infections.
Causes of nasal polyps
The cause is unknown, but inflammation in the sinuses (from allergy
or infection) may trigger polyps and make them grow faster, and
come back faster after sinus operations. It is not known whether
there is a genetic link. An allergic response to fungus normally
present within the nose may be the main cause of nasal polyps
in some patients. About 30% of patients seem to respond to a nasal
spray containing an antifungal medication.
Nasal polyps are also seen in three unique situations: asthma,
cystic fibrosis and aspirin sensitivity. Nasal polyps occur in
- 15% of asthma patients
- 25% of cystic fibrosis patients
- Most asthma patients with aspirin sensitivity
Treatment:
- Surgical removal, although they will regrow eventually in around
50% of people.
- Cortisone tablets will shrink them down temporarily, but long-term
use is restricted to the most severe cases because of side-effects.
- Cortisone / steroid nose sprays slow polyp growth. People with
recurrent polyps who have had multiple operations are often advised
to stay on these sprays forever. In people with recurrent disease,
nasal steroid sprays should be considered as "weed killers",
which need to be used continuously. Slower growth means fewer
sinus infections, less antibiotics and less frequent surgery.
- Allergy desensitization injections are sometimes used in allergic
people with hay fever as well as polyps. While this often helps
hay fever, it is not known for certain whether the injections
help shrink the polyps as well as they decrease the severity of
the allergy.
- Diet - there is no evidence that altering the diet will help.
- Other medications - sometimes other tablets and sprays are used.
- People with aspirin allergy, nasal polyps and asthma (a condition
known as the aspirin triad) have the option of aspirin desensitization,
which can reduce asthma severity, the rate of polyp regrowth and
the severity of sinusitis. The decision to undertake aspirin desensitization
should be made by an allergy specialist.
