WHAT ARE NASAL POLYPS?
Nasal polyps are mucous formations that are located in the breathing area of the nose and in the paranasal sinuses.
Nasal polyps are in majority of cases benign tumours as represented by inflammatory tissue.
WHAT IS NASAL POLYPOSIS?
Nasal polyposis is a recurrent chronic condition characterized by the presence of nasal polyps located in the nasal cavity and paranasal sinuses. (forehead, jaw).
Nasal polyposis is often associated to other conditions that block the correct nasal breathing (turbinates hypertrophy, deviated nasal septum, sinusitis), to allergy conditions (vasomotor rhinitis) or to bronchi conditions (bronchial asthma).
Nasal polyposis can be treated with medications, with laser day surgery or conventional surgery. The aim of therapy to cure nasal polyps is a long term absence of any recurrent condition.
WHAT CAUSES NASAL POLYPS AND NASAL POLYPOSIS?
Nasal polyps have an unknown cause. Among the supposed causes of nasal polyps, we can mention:
– Injury of the nasal mucous that has the function of entry door for irritating allergens (germs, chemical and physical stimuli) which are responsible for the transformation of the healthy mucous into nasal polyps.
– Allergic inflammation of the nasal mucous related to specific cells, eosinophil cells, with the production of specific antibodies (IgE) that are the starting mechanism of the formation of nasal polyps.
– Intolerance to acetylsalicylic acid (aspirin) and to other anti-inflammatory medicine non-steroidal; in these clinical cases a chronic inflammatory process of the nasal and bronchial mucous develops and it is related to molecules that belong to the arachidonic acid especially leukotrienes.
– Self-destructive immunologic mechanism of the nasal mucous by the antibodies produced both from nasal mucous and from blood.
– Alterations of the nasal ventilation of the nasal cavities and paranasal cavities caused by an inappropriate oxygenation of cells and their transformation in inflammatory cells (frequent situations are: turbinates hypertrophy, deviated septum, communication anomalies between the nose and paranasal sinuses).
– Malfunction of the neuro-vegetative system that is part of the nasal mucous by irritating and creating the inflammatory processes causing the presence of nasal polyps.
– Inhalation of some products used in the industrial processing, with an increasing risk factor for specific workers (carpenters, cementers, tillers, plasterers, glassmakers, papermakers, fabric makers, tobacco workers).
– Chronic infection caused by bacteria and fungi damaging the mucous and as a consequence an inflammatory circle of demand that leads to nasal polyps.
– Hereditariness and familiarity genetic factors for nasal polyposis among the members of the same generation of the future ones
WHAT ARE NASAL POLYPS AND NASAL POLYPOSIS SYMPTOMS?
Nasal polyposis is a complex condition of the respiratory system characterized by the presence of nasal polyps and paranasal sinuses and very often by vasomotor rhinitis (inferior turbinates hypertrophy) and by bronchial asthma (sino-bronchial syndrome).
Nasal polyposis is a recurrent chronic condition and its evolution is variable. It is mainly characterized by nasal obstruction, excessive production of catarrhal secretions, reduction or disappearance of the sense of smell and major effect on respiratory infections.
A persistent nasal obstruction must always be considered as a respiratory condition with a consequent need to go to a Otorhinolaryngology Doctor for a check-up. In all medical areas an early diagnosis allows to choose non-invasive treatments and an expectation of full recovery. On the contrary minimizing or ignoring the symptoms, especially a decrease in the sense of smell, can cause the impossibility to have a full recovery from the condition (irreversible inflammation of the olfactory nerve, with permanent absence of smell and taste).
The most common symptoms related to the presence of nasal polyps are the following:
– Blocked nose
– Dripping of mucous from nostrils and in the throat
– Cough, especially when lying down
– Reduction or absence of the sense of smell
– Reduction or absence of the sense of taste
– Recurring infections of the respiratory system (long colds, sinus infections, pharyngitis, bronchitis)
– Muffled hearing (as if you were always in the mountains or at a high altitude)
– Nasal bleeding
– Sleep apnea
– Fatigue with little effort
HOW DO WE DIAGNOSE NASAL POLYPS AND NASAL POLYPOSIS?
The diagnosis for nasal polyps has to always be made by nasal and paranasal sinuses endoscopy. The nasal specula (nose opener) is obviously inadequate to make a correct diagnosis and therefore to choose the right treatment.
After appropriate check-up, especially in the perspective of a destructive surgery of the ethmoid bone, the doctor will ask for a CT scan of the facial bone without contrast agent. This is a check-up that involves radiations on the orbit and visual system and the CT scan must occur only if the Otorhinolaryngology Doctor requests it in order to avoid any harm to the interior structure of the eye.
Allergy tests (skin prick test and nasal tests) and nasal cytology complete the diagnosis and staging phases of nasal polyps and nasal polyposis.
Nasal cytology is the study, with a microscope, of cells that characterize the mucous of the turbinates of nasal polyps: this allows to identify plausible causes of nasal polyps outbreaks and to choose specific treatments, especially to prevent any recurrent outbreak after surgery.
WHAT ARE THE REMEDIES OR CURES FOR NASAL POLYPS AND NASAL POLYPOSIS?
The only treatment for nasal polyps and nasal polyposis is in the majority of cases insufficient and it takes long periods of continuous treatment and as a result the outbreak of side-effects, sometimes severe ones (especially when cortisone is used).
The best treatments to contrast the symptoms of nasal polyposis are those which belong to the antihistamine category (tablets) and the cortisone ones (spray, tablets, injections).
The anti-leukotrienes (tablets) are useful in the presence of asthma instead.
The inhalation treatment (nebuliser and thermal baths) has poor results when limiting the growth of nasal polyps and in reducing chronic sinusitis.
Nasal washes with sterile phosphate-buffered saline help prevent the accumulation of secretions and even though this isn’t a proper treatment, it is recommended while waiting on the surgery to remove nasal polyps.
The medical treatment has a fundamental role in preventing chronic nasal polyps after having the surgery. In this case the medical treatment has to work on a lighter inflammation (the methods to remove nasal polyps are extremely easy nowadays) and therefore the results are very good.
The diet, homeopathy, acupuncture and all the natural remedies have never had any results when treating nasal polyps.
WHICH ARE THE TYPES OF SURGERIES AVAILABLE TO REMOVE NASAL POLYPS?
The surgery can occur as a first choice also when the nasal polyposis is mild; it is necessary when there is a severe acute syndrome of nasal polyposis with respiratory failure and disappearance of the sense of smell.
Nasal polyps, if ignored, tend to occupy all available space, up to the extreme condition of dripping out from the nostrils. The continuous growth of nasal polyps may lead to a damage and movement of the bone structures altering in a severe way the normal shape of the nose and furthermore blocking the proper air flow.
The Otorhinolaryngology Doctor, on the basis of the elements of the diagnosis mentioned above, can choose between two types of surgery in order to remove nasal polyps:
– Functional endoscopic sinus surgery (FESS) under general anaesthesia, also known as microdebrider (demolition of the ethmoid bone and as a consequence removal of nasal polyps located on it and irreversible change of the anatomical appearance between nose and paranasal sinuses)
– Laser ambulatory surgery of nasal polyps and nasal polyposis in local anaesthesia; also known as nasal laser polypectomy (selective removal of only nasal polyps without damaging the frontal bone)
LASER SURGERY ON NASAL POLYPS
– Nasal polyps are neither cut nor shattered with sharp tools (scalpel, scissors, debridement)
– Nasal swabs aren’t applied
– The absence of bleeding allows the treatment also on patients with heart disease in anticoagulant therapy, upon temporary suspension of medicine (for example Cardioaspirin or similar)
– Apart from nasal polyps infected secretions present in the nose and paranasal sinuses are sucked without traumatisms.
– The nasal polyps surgery with laser is painless both during the surgery and after
– Local anaesthesia occurs inside the nose by using a specific spray
– No nasal injection is required
– The absence of pain and the absence of needles and scalpels give the chance to treat also patients who suffer anxiety or who are particularly sensitive
– Neither day hospital nor recovery are required
– The laser surgery on nasal polyps can be treated in any moment of the year
– The patient can immediately go back to work
– The laser surgery on nasal polyps is a standardized procedure and it is supported by scientific research
– The laser surgery on nasal polyps and nasal polyposis is effective as a first treatment and also to cure any recurrent condition
– The risks are unimportant because the removal of nasal polyps occurs always not in proximity of any delicate structure like for example the eye
– The length of the surgery on nasal polyps may vary depending on the extent of the condition and on how co-operative the patient: from 30 to 90 minutes.
– In the majority of cases, one laser surgery on nasal polyps is sufficient
– One or two check-ups in time are recommended
– Results may be verified by endoscopy (a video of before and after the surgery to nasal polyps)
Endonasal laser surgery: an update. Levine HL.
Otolaryngologic Clinics of North America
Although surgical lasers were introduced more than 30 years ago,their use and popularity in nasal and sinus disease have been limited. Even so, there are many practitioners who find the laser a valuable surgical tool for nasal and sinus disease, either alone or in combination with other treatment modalities. Those who do not use lasers probably do not because of a lack of skill, knowledge,or understanding of the role and availability of the technology. This article reviews the history and current role of lasers in nasal and sinus surgery.