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| Nasal Polyps |
Last updated: May 12, 2008 |
Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | Recommendations
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Nasal polyps are the most common benign growths in the nasal cavity and often a contributing factor to complicated bacterial sinus infections. There are many unanswered questions about the incidence, cause, and optimal treatment of these lesions.
The clinical features of nasal polyps include nasal congestion (100%), loss of smell and/or taste (75%), sneezing and runny nose (60%), post-nasal drip (65%), facial pain (35%), and itchy eyes (25%).
Usually in both sides of the nose, polyps are essentially outgrowths of the nasal mucosa and can occasionally be seen on exam with a nasal speculum. Sometimes they can only be seen with special equipment. The polyps are smooth, gelatinous, semi-translucent, pear-shaped, and pink to white in color. The polyps originate near the ethmoid sinuses (located at the top of the nose on both sides of the nasal cavity) and grow into the open areas of the nasal cavity. They sometimes grow large and numerous enough to cause nasal obstruction. They are more common in adults than in children. Since polyps are devoid of sensation, they can be distinguished from other swollen tissues by a lack of pain on probing.
Polyps are seen with greater frequency in people with asthma, allergic rhinitis (hay fever), vasomotor rhinitis (may be caused by emotional upset or sexual arousal), certain kinds of drug use, and chronic sinus infections. They can be a sensitivity reaction to aspirin. Frequently, no specific cause can be found.
Conventional medical treatment with a nasal steroid spray and/or a short course of oral corticosteroids is usually effective, shrinking or eliminating the polyps. Surgery to remove the polyps and infected material is recommended if the medical treatment is not successful.
The problem with these approaches is that they are not addressing the cause. The best form of treatment would be to find out what the patient is allergic to and try to eliminate it.
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Signs, symptoms & indicators of Nasal Polyps: | |  | | | | Symptoms - Head - Nose | Reduced sense of taste or smell | Apart from causing blockage in the nose, nasal polyps decrease the sense of taste and smell and make it harder to breathe. |
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Conditions that suggest Nasal Polyps: | |  | | | | Infections | Sinusitis | As the polyps make the nasal cavity narrower, mucus forms behind the polyp and may not drain properly. This may become infected or block sinus openings resulting in chronic sinus conditions. |
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Risk factors for Nasal Polyps: | |  | | | | Allergy | Allergies Indoor | One study reported a connection nasal polyps and house dust mite and house dust allergies, particularly in patients under 40.[HNO, 1991; 39: pp.307-10] |
Allergic Rhinitis / Hay Fever | Respiratory allergies are commonly thought to be the cause of nasal polyps, though some research suggests that a chronic viral or bacterial infection such as staphyloccus of the sinuses may be the cause. The research concluded that in those patients suffering from allergy they were six times more likely to suffer from polyps. A further study reported that 57% of children who were allergic were suffering from polyps. [Asian Pac J Allergy Immunol; 1999 17 : pp.13-5; South Med J, 1978; 71: pp.911-3] |
Allergy / Intolerance to Foods (Hidden) | Nasal polyps are often caused by inhalant allergens but they can also be due to an allergy to food substances as well. Complete allergy testing for inhaled substances and foods should be considered.
A controlled study suggested a strong association between food allergy and nasal polyposis. The study was conducted in 2 parts. In the prospective study, 80 nasal polyp patients and 36 control subjects completed intradermal tests for food allergy. Sixty-five nasal polyp patients (81%) and 4 control subjects (11%) had positive intradermal food test results. This is highly significant. [Otolaryngol Head Neck Surg 2000 Feb;122(2): pp.298-301]
Another study compared the prevalence of atopy in patients afflicted by nasal polyps with the atopy prevalence in healthy volunteers without nasal polyps, since systemic allergy and allergy in the nasal mucosa are still being debated as underlying causes for nasal polyps. Thirty-four cases with nasal polyposis without asthma and history of allergy or atopic disease were enrolled in the study and compared with 20 healthy volunteer controls in respect to asymptomatic food hypersensitivity.
Hypersensitivity for 48 kinds of commonly consumed food in Turkey was investigated by an epicutaneuos prick test, Multi-Test II (Lincoln Diagnostic, Inc, USA), using a special applicator. The food allergy test was positive in 25 out of the 34 cases with nasal polyps and in 6 out of the 20 controls. The difference between the two groups was statistically significant (p < 0.001). The number of skin tests with positive results in patients with nasal polyps ranged from 1 to 37, whereas in the control subjects the range was 1 to 10. The difference in the number of food reactions was also statistically significant.
Asymptomatic food hypersensitivity, being immunologically mediated, may be a triggering factor for the pathogenesis of nasal polyps. Therefore, treatment of asymptomatic food allergy in patients with nasal polyps may alleviate symptoms, slow the progress of nasal polyps and prolong the disease-free interval after polypectomy. [Asian Pac J Allergy Immunol. 2003 Jun;21(2): pp. 79-82] |
| Metabolic |
Cystic Fibrosis | Symptoms - Head - Nose |
History of nasal polyps |
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Nasal Polyps suggests the following may be present: | |  | | | | Allergy | Allergy / Intolerance to Foods (Hidden) | Nasal polyps are often caused by inhalant allergens but they can also be due to an allergy to food substances as well. Complete allergy testing for inhaled substances and foods should be considered.
A controlled study suggested a strong association between food allergy and nasal polyposis. The study was conducted in 2 parts. In the prospective study, 80 nasal polyp patients and 36 control subjects completed intradermal tests for food allergy. Sixty-five nasal polyp patients (81%) and 4 control subjects (11%) had positive intradermal food test results. This is highly significant. [Otolaryngol Head Neck Surg 2000 Feb;122(2): pp.298-301]
Another study compared the prevalence of atopy in patients afflicted by nasal polyps with the atopy prevalence in healthy volunteers without nasal polyps, since systemic allergy and allergy in the nasal mucosa are still being debated as underlying causes for nasal polyps. Thirty-four cases with nasal polyposis without asthma and history of allergy or atopic disease were enrolled in the study and compared with 20 healthy volunteer controls in respect to asymptomatic food hypersensitivity.
Hypersensitivity for 48 kinds of commonly consumed food in Turkey was investigated by an epicutaneuos prick test, Multi-Test II (Lincoln Diagnostic, Inc, USA), using a special applicator. The food allergy test was positive in 25 out of the 34 cases with nasal polyps and in 6 out of the 20 controls. The difference between the two groups was statistically significant (p < 0.001). The number of skin tests with positive results in patients with nasal polyps ranged from 1 to 37, whereas in the control subjects the range was 1 to 10. The difference in the number of food reactions was also statistically significant.
Asymptomatic food hypersensitivity, being immunologically mediated, may be a triggering factor for the pathogenesis of nasal polyps. Therefore, treatment of asymptomatic food allergy in patients with nasal polyps may alleviate symptoms, slow the progress of nasal polyps and prolong the disease-free interval after polypectomy. [Asian Pac J Allergy Immunol. 2003 Jun;21(2): pp. 79-82] |
| Metabolic |
Cystic Fibrosis |
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Recommendations for Nasal Polyps: | |  | | | | Drug | Conventional Drugs / Information | Nasal sprays and drops containing corticosteroids can shrink nasal polyps in some cases. A single small polyp is occasionally cured by this type of treatment. Corticosteroid tablets have a similar effect, but can only be used as a short course because of the side effects they can cause. They may be required initially to shrink larger polyps. |
| Lab Tests/Rule-Outs |
Test for Inhalant Allergies | Inhalant allergies are an underlying cause of mucus irritation and nasal polyp formation. |
| Oriental Medicine |
Acupuncture | Electric acupuncture has shown some positive results in the treatment of nasal polyps. |
| Surgery/Invasive |
Surgery | The most effective treatment for nasal blockage due to polyps is surgical removal. Most specialists will arrange an X-ray called a CT scan to show the extent of polyp tissue in the sinuses and the layout of the bony partitions in the area. Removal is generally carried out using an endoscope to look inside the nose. In some cases the polyps are simply cleared from the nose, while in others, polyp tissue is also removed from the sinuses. The procedure is performed under general anesthesia.
Unfortunately there is no guarantee that nasal polyps will not grow again after surgical removal. Some people seem to be much more susceptible to this condition than others and the polyps may grow back again many years after surgery. A further episode of nasal surgery may then be required. |
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KEY |  | Weak or unproven link |  |  | Strong or generally accepted link |  |  | Proven definite or direct link |  |  | May do some good |  |  | Highly recommended |
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