Nasal polyps

Mareike Müller is a freelance writer in the medical department and assistant doctor for neurosurgery in Düsseldorf. She studied human medicine in Magdeburg and gained a lot of practical medical experience during her stays abroad on four different continents.

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Nasal polyps are benign growths on the lining of the nose. Affected people often have difficulty getting enough air through their nose. This can significantly reduce performance and quality of life. In addition, there is frequent inflammation of the paranasal sinuses. Nasal polyps can be treated with medication or removed during surgery. Read more about symptoms and treatment of nasal polyps here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. J33

Nasal polyps: description

Nasal polyps are soft, benign growths on the lining of the nose that protrude into the nasal cavities. They sprout from the mucous membrane to which they are connected by a kind of stalk. Some are only a few millimeters tall and do not disturb, others can grow into extensive structures that obstruct the nasal spaces. Since this restricts nasal breathing, the disease can become very annoying and limit the quality of life enormously.

How is the nose constructed?

The nose consists of the left and right main nasal cavity, which is separated from each other by the nasal septum. Each of the main cavities is followed by two paranasal sinuses (sinuses), which are connected to the respective main nasal cavity via ducts. Main and sinuses are lined with a mucous membrane that, among other things, humidifies and filters the air we breathe.

Who is particularly affected by nasal polyps?

Nasal polyps are common. How they arise is still unclear. So far we know that there are some diseases in which those affected develop polyps in the nose more often - for example, patients with bronchial asthma. Up to 40 percent of them also suffer from nasal polyps. About 25 percent of patients with nasal polyps are allergic to acetylsalicylic acid (ASA).

Nasal polyps: symptoms

Patients with nasal polyps are usually impaired by restricted nasal breathing. You do not get enough air through your nose and you breathe more often through your mouth. As a result, those affected snore frequently, suffer from insomnia and their performance is limited. In addition, the air breathed through the mouth is not filtered.

People feel like they have nasal congestion all the time, which can also lead to a nasal voice. When they have a cold, the mucus often runs down their throat. In addition, the patients suffer from recurrent inflammation of the paranasal sinuses (sinusitis) and dull headaches. In addition, their ability to smell can be restricted and, as a result, their sense of taste - a severe loss of quality of life. Nasal polyps in children can cause otitis media.

Nasal polyps: causes and risk factors

Polyps in the nose are growths that arise from a persistently inflamed nasal lining. Under the microscope you can see fluid deposits and the body's own inflammatory cells. The exact mechanism of its formation is still unknown. A nasal polyp usually grows out of one of the paranasal sinuses into the main nasal cavity. The nasal polyps mainly arise in the maxillary sinus (sinus maxillaris) or the ethmoid cells (cellulae ethmoidales). They emerge from the excretory ducts and are mostly located in the middle nasal passage under the middle turbinate.

A common cause of the formation of nasal polyps is a tendency of the mucous membrane to become inflamed (disposition). Risk factors for the development of polyps in the nose are:

• Allergy to pain medication
• asthma
• bronchitis
• Kartagener's syndrome (rare hereditary disease with the symptoms of nasal polyps, mirror-image arrangement of the organs, widening of the bronchi)
• Cystic fibrosis

Nasal polyps: examinations and diagnosis

To diagnose nasal polyps, your doctor will first ask you in detail about your medical history (anamnesis). He will ask you the following questions, among others:

• Are you getting good air through your nose?
• Do you suffer from sinus infections more often?
• Do you often run your nose?
• Do you have asthma or bronchitis?

During the examination, the doctor first reflects the nose. To do this, he inserts small funnel-shaped pliers into one nostril and shines his headlamp into it. He assesses the appearance of the nasal mucosa and can tell whether there are polyps in the main nasal cavity. The back of the nose can also be examined by inserting a mirror in the mouth and pointing it up into the throat.

A further examination is the so-called endoscopy. To do this, the doctor inserts a small tube with a camera into the nose. In this way, he can examine the ducts of the paranasal sinuses and identify any polyps. In addition, the exact dimensions of the polyps can be determined using computed tomography (CT). This allows the surgeon to better plan a possible operation later.

Which diseases are still possible?

Most often, nasal polyps appear on both sides. If they are only present on one side, a tissue sample is usually taken under local anesthesia and examined in the laboratory. This will determine whether it is polyps or some other type of growth. Basically, a doctor must differentiate nasal polyps from other possible diseases. These include:

• Meningoencephalocele (prolapse of brain tissue, often congenital)
• Juvenile nasopharynx (growth in the nasopharynx, mainly in adolescent males)
• Papilloma or squamous cell carcinoma of the nose (other growths of the nose)
• Aspergilloma (mold infestation)

Nasal polyps: treatment

Depending on how severe the symptoms of the nasal polyps are, either conservative (drug) therapy or surgical treatment of the nasal polyps is preferred.

Treatment with medication

If the nasal mucosa is only slightly swollen, you can try to swell it down with the help of nasal sprays containing cortisone. Cortisone inhibits the activity of inflammatory cells and thus relieves the inflammatory reactions, which also include the swelling of the nasal mucous membrane. It is important to use the nasal spray regularly and for a few months. Patience is required: Often, however, the symptoms usually only improve after a few weeks of use. Nasal sprays or drops are preferred to cortisone in tablet form, as they are only effective in the nose and therefore cannot cause any side effects in other organs.

OP as a therapy option

Many patients have their nasal polyps removed, which immediately improves nasal breathing significantly. In addition to removing the polyps, the surgeon also dilates the ducts of the paranasal sinuses. In this way, they should be better ventilated and less likely to ignite.

What you can do yourself

If you have polyps in your nose, you should take care of regular nasal care. These include inhalations and salt water nasal showers. In this way, the mucous membrane of the nose is moistened, possible pathogens such as bacteria can be flushed out and the risk of developing a sinus infection is reduced. In alternative medicine, homeopathy is also used for nasal polyps. Let an ear, nose and throat specialist advise you on the means you can use to support your nasal mucosa.

Nasal polyps: disease course and prognosis

Because nasal polyps grow slowly, patients often get used to the symptoms and see a doctor late. The symptoms can be alleviated with the right therapy. Surgical removal of the nasal polyps often quickly improves the symptoms. Nevertheless, nasal polyps grow again in about 75 percent of patients in the first few years after removal. It is therefore advisable to use cortisone-containing nasal sprays for a long time even after a nasal polyp operation. These can prevent polyps in the nose from reappearing. In the process, a computed tomography scan can be used to determine whether the drug therapy is actually working. If the nasal polyps are due to another disease, this should be treated.

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