Nasal Polyps  

 

WHAT ARE THEY ?     Polyps are just cysts of fluid – they are not cancer.   They tend to swell and block both the ability to breath and smell.  If you look at a cross section of the nose, they appear as a white glistening sacs of fluid.

 

WHO GETS THEM ?  Men with aspirin sensitivity – and others

Text Box: Collins MM, Environmental risk factors and gender in nasal polyposis. Clin Otolaryngol. 2002 Oct;27(5):314-7. The aetiology of nasal polyps remains obscure. Although clinically associated with asthma, notably in women, there is a marked male preponderance of polyposis.. The male to female ratio was 2:1, and 52% were smokers, although only 37% of women smoked compared with 66% of men. Exposure to occupational dusts and chemicals was noted in 45% (retrospective) and 53% (prospective) of respondents. Women were 1.6 times more likely to be asthmatic and 2.7 times more likely to have allergic rhinitis than men. Men were 2.25 times more likely to be smokers and 2.48 times more likely to have been exposed to chemicals and dusts than women (all statistically significant differences). No significant gender associations were found for hayfever, eczema, aspirin intolerance, alcohol intake or hobby dust exposure Rugina M, Epidemiological and clinical aspects of nasal polyposis in FrancE. Rhinology. 2002 Jun;40(2):75-9 Severe and major symptoms were more frequently found in the female population. Environment and habitat factors did not appear to be relevant. High rates of NP (52.66%) and asthma (43.58%) were found in the family history. Hereditary factors were suggested and lead us to further study the genetic factors potentially involved in this pathology

WHAT DO THEY LOOK LIKE ?

polyp
 

side
 

top
 

 

What causes them

Text Box: Pawankar R Nasal polyposis: an update: editorial review. Curr Opin Allergy Clin Immunol. 2003 Feb;3(1):1-6. although nasal polyposis is a multifactorial disease with several different etiological factors, chronic persistent inflammation is undoubtedly a major factor irrespective of the etiologySmall polyps may be common in the normal population.  But larger polyps may be the result of recurrent infection.   Allergy and asthma are closely associated with polyps. The frequency of nasal polyps in adults with asthma is 13% as compared to 1% in the normal population. In patients with aspirin intolerance, it increases to 36%. Aspirin desensitization may be an effective treatment for aspirin-sensitive rhino-sinusitis with asthma and nasal polyps. The need for nasal polypectomies and sinus operations is thereby  reduced.   Despite intuition, allergy to airborne pollen may not be the most important issue, although allergy to certain bacteria may be crucial.

 

Text Box: Nasal polyps: still more questions than answers. Nasal polyps are common, affecting one to four per cent of the population. Their cause, however, remains unknown and it is possible that it is not the same in all patients. They have a clear association with asthma, aspirin sensitivity and cystic fibrosis. Histologically they demonstrate large quantities of extracellular fluid, mast cell degranulation and an infiltrate of inflammatory cells, usually eosinophils. While this appearance would suggest an allergic pathology there is little conclusive evidence to support this in most patients. There is, however, some preliminary evidence to suggest that a local allergic process could be the cause. While allergic fungal sinusitis is a well defined clinical entity with recognized diagnostic criteria the ubiquitous nature of fungal spores makes the role of fungal infection in patients with nasal polyps difficult to determine and currently this remains unclear. Surgical treatment of nasal polyps has declined in recent years as the benefits of medical treatment have become increasingly recognized. There is good evidence to support the use of corticosteroids both as a primary and post-operative treatment in the majority of patients. Other medical treatments require further evaluation before they could be considered a viable alternative to steroids. Assessment of the literature regarding surgical intervention is difficult and there is little evidence on which to base a surgical treatment philosophy. Bateman ND, Fahy C, Woolford TJ. J Laryngol Otol. 2003 Jan;117(1):1-9

 

Treatment

Polyps may require surgical intervention although surgery itself may be causative –polyps develop in surgically scarred tissue. If aspirin sensitivity exists, aspirin desensitization may also reduce inflammation .  An acute sinusitis in polyp patients should be treated vigorously with antibiotics and glucocorticoids as well as sinus.   Allergy should be approached in the polyp patient as a possible producer of swelling and promoter of infection.

Text Box: Asero R Nasal polyposis: a study of its association with airborne allergen hypersensitivity. Ann Allergy Asthma Immunol. 2001 ar;86(3): CONCLUSIONS: A clinically slight respiratory allergy, particularly to perennial airborne allergens, might play a relevant role in the pathogenesis of nasal polyposis, probably through the induction of a long-lasting inflammation of the nasal mucosa. Voegels RL Nasal polyposis and allergy: is there a correlation? Am J Rhino l. 2001 Jan-Feb;15(1):9-14 These results suggest that the immunologic pathway involved in the etiology of NP is different from the one correlated with allergy (IgE-mediated).

Text Box: Garrel R Endoscopic surgical treatment of sinonasal polyposis-medium term outcomes (mean follow-up of 5 years). Rhinology. 2003 Jun;41(2):91-6 Functional outcomes for patients with nasal polyposis and asthma were significantly improved by endoscopic surgical treatment, even if the appearance of the nasal mucosa did not always return to normal. Kirtsreesakul V.Role of allergy in the therapeutic response of nasal polyps. Asian Pac J Allergy Immunol. 2002 Sep;20(3):141-6. The results demonstrate that nasal polyps with positive allergen skin test had less improvement compared to nasal polyps with negative allergen skin test in all nasal signs and symptoms and these differences in improvement showed a tendency to increase over time after treatment.

WHAT DOES THE FUTURE HOLD ?  More surgery

 

Text Box: Vento SI Nasal polyposis: clinical course during 20 years. Ann Allergy Asthma Immunol. 2000 Sep;85(3):209-14. nasal polyposis was still active in 85% of patients after 20 years. Mucosal changes in paranasal sinuses were found in every patient. Loss of smell was found in 61. Eight patients had had 11 or more surgical operations during the 20-year period. Of these, 88%) belonged to the aspirin group. Bronchial asthma was found in all ASA intolerance patients Because of the high recurrence tendency and insidious symptoms of nasal polyposis, patients will require followup for the rest of their lives