Definition

A polyp is any overgrowth of tissue from a surface.
Polyps come in all shapes—round, droplet, and irregular
being the most common.

Description

Nasal polyps tend to occur in people with respiratory
allergies. Hay fever (allergic rhinitis) is an irritation
of the membranes of the nose by airborne particles or
chemicals. These membranes make mucus. When irritated,
they can also grow polyps. The nose is not only a passageway
for air to reach the lungs; it also provides the
connection between the sinuses and the outside world.
Sinuses are lined with mucus membranes, just like the
nose. Polyps can easily obstruct the drainage of mucus
from the sinuses. When any fluid in the body is trapped
so it cannot flow freely, it becomes infected. The result,
sinusitis, is a common complication of allergic rhinitis.

Causes and symptoms

Some people who are allergic to aspirin develop
both asthma and nasal polyps.

Nasal polyps often plug the nose, usually one side at
a time. People with allergic rhinitis are so used to having
a stopped up nose they may not notice the difference
when a polyp develops. Other polyps may be closer to a
sinus opening, so airflow is not obstructed, but mucus
becomes trapped in the sinus. In this case, there is a feeling
of fullness in the head, no sense of smell, and perhaps
a headache. The trapped mucus will eventually get
infected, adding pain, fever, and perhaps bloody discharge
from the nose.

Diagnosis

A physical examination will identify most polyps.
Small polyps located higher up or further back may be
hidden from view, but they will be detected with more
sophisticated medical instruments. The otorhinolaryngologist
is equipped to diagnose nasal polyps. In order to
perform the exam, medicine must be applied to decongest
the membranes. Cotton balls soaked with one of
these agents and left in the nostrils for a few minutes provide
adequate shrinkage.

Treatment

Most polyps can be removed by the head and neck
surgeon as an office procedure called a nasal polypectomy.
Bleeding, the only complication, is usually easy to
control. Nose and sinus infections can be treated with
antibiotics and decongestants, but if airflow is restricted,
the infection will reoccur.

Prognosis

Polyps reappear as long as the allergic irritation continues.

Prevention

If aspirin is the cause, all aspirin containing medications
must be avoided.

Since most nasal polyps are the result of allergic
rhinitis, they can be prevented by treating this condition.
New treatments have greatly improved control of hay
fever. There are now several spray medicines that are
quite effective. Spray cortisone-like drugs are the most
popular. Over-the-counter nasal decongestants have an
irritating effect similar to the allergy they are supposed to
be treating. Continued use can bring more trouble than
relief and result in an addiction to nose sprays. The
resulting disease, rhinitis medicamentosa, is more difficult
to treat than allergic rhinitis.

Allergists and ENT surgeons both treat allergic
rhinitis with a procedure called desensitization. After
identifying suspect allergens using one of several methods,
they will give the patient increasing doses of those
allergens in order to produce blocking antibodies that
will impede the allergic reaction. This is effective in a
number of patients, but the treatment may take a period
of months to years.