POLYPS NASAL

NASAL POLYPS

General Infomation
Definition: 

Nasal polyps

Nasal polyps are teardrop-shaped, noncancerous growths on the lining of your nasal passages or sinuses.
Small nasal polyps may cause no problems and go unnoticed. Larger nasal polyps can block your nasal passages or sinuses and cause breathing difficulties, a loss of your sense of smell, frequent sinus infections and other problems.
Although nasal polyps can affect anyone, they're more common in adults, particularly those with asthma, frequent sinus infections and allergies. Children with cystic fibrosis often develop nasal polyps.
Medications can often lessen the size of nasal polyps or eliminate them, but surgery is sometimes necessary to remove them. Even after successful treatments, nasal polyps often return.

Symptoms: 

Nasal polyps are associated with chronic inflammation of the lining of your nasal passages and sinuses (chronic sinusitis). If you have several polyps or large polyps, they may obstruct your nasal passages and sinuses. As a result of these conditions in your nose and sinuses, you may experience some of the following signs and symptoms:
• A runny nose
• Persistent stuffiness
• Postnasal drip
• Decreased or no sense of smell
• Loss of sense of taste
• Facial pain or headache
• Snoring
• Itching around your eyes
You may have small nasal polyps and experience no signs or symptoms.
When to see a doctor
Signs and symptoms of nasal polyps are similar to many other conditions, including the common cold. If your condition continues for more than 10 days, see your doctor.
If you experience severe difficulty breathing, seek emergency medical care or call 911 or your local emergency number.

Causes & Complication
Causes: 

Your nasal passages and sinuses are lined with mucous membrane, tissue that secretes sticky fluids (mucus). The membrane contains many tiny blood vessels and is covered in tiny hair-like structures called cilia.
When you inhale, the nasal passages and sinuses provide a sort of entryway with lots of "nooks and crannies" where air can be warmed and moistened before traveling to your lungs. The air is also cleaned. Tiny particles in the air stick to the mucus, and the cilia sweep them to the front of your nose or to the back of your throat.
Development of nasal polyps
Nasal polyps can form when the mucous membrane of your nasal passages and sinuses is chronically inflamed. A nasal or sinus condition is generally defined as chronic if the signs and symptoms of inflammation last more than 12 weeks.
It's unclear exactly how chronic inflammation leads to the formation of polyps, but the response of your immune system in the mucous membrane appears to contribute.
Nasal polyps may develop anywhere throughout the nasal passages or sinuses, but they appear most often near the openings to your sinuses.

Risk Factors: 

Any condition that contributes to chronic inflammation in your nasal passages or sinuses (chronic sinusitis), such as infections or allergies, may increase your risk of nasal polyps. Conditions often associated with nasal polyps include:
• Asthma, a disease that causes inflammation and constriction of airways
• Aspirin sensitivity, an allergy-like response to aspirin or other nonsteroidal anti-inflammatory drugs — such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)
• Allergic fungal sinusitis, an allergy to airborne fungi
• Cystic fibrosis, a genetic disorder that results in the production and secretion of abnormal fluids, including thick mucus from nasal and sinus membranes
• Churg-Strauss syndrome, a rare disease that causes the inflammation of blood vessels
Other risk factors include:
• Age. Nasal polyps are more common in adults.
• Family history. There is some evidence that you may inherit a gene or genes that make you more likely to develop nasal polyps.

Complications: 

The presence of several polyps (polyposis) or a single large polyp may block the normal flow of air or the draining of fluids out of your sinuses or nasal cavity. Resulting complications may include:
• Frequent or chronic sinus infections
• Obstructive sleep apnea, a potentially serious condition in which you stop and start breathing a number of times during sleep
• Altered facial structure leading to double vision or unusually wide-set eyes (more likely associated with cystic fibrosis)

Tests
Tests and Diagnosis: 

Your doctor can usually make a diagnosis based on your answers to questions about your symptoms, a general physical exam and an examination of your nose. Polyps may be visible with the aid of a simple lighted instrument.
Other diagnostic tests include:
• Nasal endoscopy. A nasal endoscope, a narrow tube with a magnifying lens or tiny camera, enables your doctor to look at the inside of your nose in detail. He or she inserts the endoscope into a nostril and guides it into your nasal cavity to locate nasal polyps.
• Computerized tomography (CT) scan. Computerized tomography is a type of X-ray imaging that enables your doctor to locate nasal polyps and other abnormalities associated with chronic inflammation. It's also important in helping your doctor rule out the presence of other possible obstructions in the nasal cavity, such as a cancerous growth.
• Allergy tests. Your doctor may suggest allergy skin tests to determine if allergies are contributing to chronic inflammation. With a skin prick test, tiny drops of allergy-causing agents (allergens) are pricked into the skin of your forearm or upper back. The drops are left on your skin for 15 minutes before your doctor or nurse observes your skin for signs of allergic reactions. If a skin test cannot be performed, your doctor may order a blood test that screens for specific antibodies to various allergens.
• Test for cystic fibrosis. If you have a young child diagnosed with nasal polyps, your doctor may suggest testing for cystic fibrosis, an inherited condition affecting the glands that produce mucus, tears, sweat, saliva and digestive juices. The standard diagnostic test for cystic fibrosis is a noninvasive sweat test, which measures the amount of sodium and chloride in your child's perspiration.

Medication & Prevention
Treatments and Drugs: 

The treatment goals for nasal polyps are to decrease the size of polyps or eliminate polyps and to treat disorders, such as allergies, that may contribute to chronic inflammation in your nasal passages and sinuses.
Medications
Drug treatments may include:
• Nasal corticosteroids. Your doctor is likely to prescribe a corticosteroid nasal spray to reduce inflammation. This treatment may shrink the polyps or eliminate them completely. Nasal corticosteroids include fluticasone (Flonase, Veramyst), budesonide (Rhinocort), flunisolide (Nasarel, others), triamcinolone (Nasacort AQ) and beclomethasone (Beconase AQ).
• Other corticosteroids. If a nasal corticosteroid isn't effective, your doctor may prescribe an oral corticosteroid, such as prednisone, either alone or in combination with a nasal spray. Because oral corticosteroids can cause serious side effects, you usually take them for a brief period. Your doctor may recommend a corticosteroid injection instead or an oral corticosteroid.
• Other medications. Your doctor may prescribe drugs to treat conditions that contribute to chronic inflammation in your sinuses or nasal passages. These may include antihistamines to treat allergies, antibiotics to treat a chronic or recurring infection, or antifungal medications to treat symptoms of fungal allergies.
Surgery
If drug treatment doesn't shrink or eliminate nasal polyps, your doctor may recommend surgery. The type of surgery depends on the size, number and location of the polyps. Surgery options for nasal polyps include:
• Polypectomy. Small or isolated polyps can often be completely removed using a small mechanical suction device or a microdebrider - an instrument that cuts and extracts soft tissue. The procedure, called a polypectomy, is performed on an outpatient basis.
• Endoscopic sinus surgery. You may need surgery to remove polyps and to correct problems with your sinuses that make them prone to inflammation and the development of polyps. The surgeon inserts an endoscope, a small tube with a magnifying lens or tiny camera, into your nostrils and guides it into your sinus cavities. He or she uses tiny instruments to remove polyps and other obstructions that prevent the flow of fluids from your sinuses. This surgery is usually performed as an outpatient procedure.
After surgery, you'll likely use a corticosteroid nasal spray to help prevent the recurrence of nasal polyps. Your doctor may also recommend the use of a saltwater (saline) rinse to promote healing after surgery.

Prevention: 

You may help reduce your chances of developing nasal polyps or recurring nasal polyps after treatment with the following prevention strategies:
• Manage allergies and asthma. Follow your doctor's treatment recommendations for managing asthma and allergies. If your symptoms aren't easily and regularly under control, talk to your doctor about changing your treatment plan.
• Avoid irritants. As much as possible, avoid things that are likely to contribute to inflammation or irritation of your sinuses, such as allergens, airborne pollutants and chemicals.
• Practice good hygiene. Wash your hands regularly and thoroughly. This is one of the best ways to protect against bacterial and viral infections that can cause inflammation of the nasal passages and sinuses.
• Humidify your home. Use a humidifier if you have dry air in your home. This may help improve the flow of mucus from your sinuses and may help prevent blockage and inflammation.
• Use a nasal rinse, or nasal lavage. Use a saltwater (saline) spray or nasal lavage to rinse your nasal passages. This may improve mucus flow and remove allergens and other irritants. You can purchase over-the-counter saline sprays or nasal lavage kits with devices, such as bulb syringes, to administer a rinse. You can make your own solution by mixing 1/4 teaspoon (1.2 milliliters) of salt with 2 cups (0.5 liter) of warm water. Avoid over-the-counter saline sprays that contain additives that may inflame the mucous lining of your nose.

By Anonymous on 01 June 2011