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.
Signs, symptoms & indicators of Nasal Polyps
Having nasal polyps
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.
Conditions that suggest Nasal Polyps
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.
Risk factors for Nasal Polyps
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]
Cystic Fibrosis
About a quarter of people with cystic fibrosis also have nasal polyps.
History of nasal polyps
Nasal Polyps suggests the following may be present
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]
Cystic Fibrosis
About a quarter of people with cystic fibrosis also have nasal polyps.
Recommendations for Nasal Polyps
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.
Test for Inhalant Allergies
Inhalant allergies are an underlying cause of mucus irritation and nasal polyp formation.
Acupuncture
Electric acupuncture has shown some positive results in the treatment of nasal polyps.
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.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| May do some good |
| Highly recommended |
Glossary
Polyp
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Benign
Literally: innocent; not malignant. Often used to refer to cells that are not cancerous.
Post-Nasal Drip
A constant flow of mucous and discharge down the "back of the throat", generally caused by acute infection or allergies. This drip can in turn be responsible for the development of a secondary cough due to irritation of the larynx, and bronchospasm in asthmatic individuals.
Mucosa
Mucous tissue layer lining tubular structures (nasal passages, ear canal, etc.).
Asthma
A lung disorder marked by attacks of breathing difficulty, wheezing, coughing, and thick mucus coming from the lungs. The episodes may be triggered by breathing foreign substances (allergens) or pollutants, infection, vigorous exercise, or emotional stress.
Allergic Rhinitis
Also known as hay fever, this is an inflammation of the nasal mucous membranes that is caused by specific allergen(s). It is an allergy characterized by sneezing, itchy and watery eyes, a runny or stuffy nose, coughing and a burning/scratchy sensation of the palate and throat.
Rhinitis
Inflammation of the nasal mucous membrane.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Steroid
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Allergen
A substance that is capable of producing an allergic response in the body.
Atopic
Genetically predisposed toward developing immediate hypersensitivity reactions to common environmental allergens.
Asymptomatic
Not showing symptoms.
Cystic Fibrosis
(CF) An incurable genetic disease involving a sticky buildup of mucus in the lungs (which makes breathing difficult and leads to infections), as well as pancreatic insufficiency (which leads to digestive problems). Symptoms include chronic cough producing thick mucus, excessive appetite combined with weight loss, intestinal disorders, salty sweat/skin and pneumonia. Lung-related problems are the most frequent cause of death. CF is a recessive disease, occurring only when a person inherits two mutated copies of the CF gene - one from each parent. Individuals with CF generally have a life expectancy of about 30 years.