Daniel W. Todd, MD, FACS
Blocked nose? Food seem less tasty? Thick, discolored nasal drainage? You might be suffering from nasal polyps – a treatable nasal problem.
Nasal polyps are non cancerous growths occurring in the nose or sinuses. Other types of polyps occur in the bowel or urinary bladder, but have no relationship to those in the nose and sinuses. Polyps in the bowel or bladder have a chance of being cancerous; polyps in the nose and sinuses are rarely malignant.
Polyps can cause nasal blockage making it hard to breathe, but most nasal polyp problems can be helped.
While some polyps are a result of swelling from an infection, most of the time, the cause for the nasal polyps is never known. A few individuals may have a combination of asthma, aspirin sensitivity, and nasal polyps. If aspirin is taken, the asthma and nasal polyps may worsen.
Because polyps block the nose, patients often notice a decrease in the sense of smell. Since much of our sense of taste is related to our sense of smell, patients with nasal polyps may describe a loss of both taste and smell.
Nasal polyps also cause nasal obstruction and may also block the pathways where the sinuses drain into the nose. This blockage by the polyps causes the mucus (which normally forms and drains through the nose) to remain in the sinuses. When this mucous stays in the sinuses too long, it can become infected. It is this infected mucous that the patient experiences as a thick, discolored drainage in the nose and down the throat. This type of nasal obstruction and infection may also cause pressure over the forehead and face.
Many people with nasal polyps have no symptoms and therefore require no treatment. For those patients whose polyps are causing symptoms, medical or surgical management is available.
Medical management to reduce the size of the polyps often requires a series of steroid pills and nasal steroid sprays. Since the nasal steroid sprays have very little absorption into the blood stream, there are few, if any, side effects. About one half of patients with polyps have significant allergies. Identifying them and effectively treating them can be very helpful. For those patients whose polyps cannot be managed medically or choose not to manage them medically, surgery is usually effective.
Surgery for nasal polyps is usually done as an outpatient in an ambulatory surgery center where patients go home the same day as surgery. The polyps are removed from the nose and sinuses using small nasal telescopes, which not only remove the diseased tissue but also preserves the normal structures and reconstructs the normal inflow, outflow, and function of the sinuses.
While most patients with nasal polyps and asthma or nasal polyps, asthma and aspirin sensitivity have the same 90% improvement, eighteen months after surgery 40% of patients with asthma and nasal polyps report continued improvement; and 35% of patients with the combination of aspirin sensitivity, asthma and nasal polyps report still feeling well.
The asthmatic patient with nasal polyps is the most difficult to cure, but by using the endoscopic technique, as well as ongoing management with medication after surgery, we are able to help many patients breathe easier, regain their sense of smell, eliminate facial pressure, and have their asthma better controlled.