Nasal Polyps

Symptoms

Nasal polyps are usually bilateral and localized benign mucosal protrusions of the nasal cavity or sinuses. The leading symptom is nasal constriction leading to a change in voice quality. Other possible symptoms include a watery discharge (rhinorrhea), impaired sense of smell and taste, pain and a feeling of fullness in the head. Nasal polyps often occur in the middle nasal passage and originate in a sinus. They are grape-shaped, composed of oedematous connective tissue, inflammatory cells, few capillaries and glands, and covered with respiratory epithelium. Eosinophilic granulocytes are among the most commonly found inflammatory cells, but others such as neutrophils and mast cells are also present.

Causes

The exact cause is unknown. Most theories describe nasal polyps as a result of chronic inflammatory processes in the nasal mucosa. They are more common in men, in adults, in the elderly, and along with nonallergic asthma. They are also common in people with cystic fibrosis and aspirin intolerance. A general association between allergies and nasal polyps has not been shown.

Complications

A common and sometimes chronic complication is bacterial superinfection and sinusitis with symptoms such as headache and facial pain. Excessive use of decongestant nasal sprays can result in rhinitis medicamentosa. Decongestant nasal sprays should not be used for treatment or should only be used for short periods (with long breaks in therapy)!

Diagnosis

Diagnosis is made with nasal endoscopy, computed tomography (CT) scan, or other procedures. Unilateral symptoms are rare and suggest neoplasms (papillomas, carcinomas). The appearance of thick, green-brown secretions is a possible indication of fungal infection. Possible differential diagnoses include rhinitis of other causes, such as hay fever or vasomotor rhinitis.

Nonpharmacologic treatment

In cases of severe constriction and recurrent sinusitis, the polyps are surgically removed. Severe complications such as vision loss are possible but very rare. Many patients experience recurrences after removal.

Drug treatment

Topical glucocorticoids:

  • Such as fluticasone, budesonide, tixocortol, or mometasone in the form of ampoules or as a spray are considered 1st-line agents. They are anti-inflammatory and antiallergic, decrease rhinorrhea, improve nasal breathing, and reduce polyp size and recurrence. On the other hand, they have little effect on the sense of smell. They can be used as sole therapy for a mild course or in combination with oral glucocorticoids or surgical methods for severe symptoms.

Cortisone tablets

  • Are additionally effective against disorders of the sense of smell, but trigger severe adverse effects with prolonged use. Therefore, they are used only in the short term during a few days to weeks. Their use has not been sufficiently studied clinically.

Other options:

Advisory

Fluticasone (Flutinase Polynex Suspension) is commercially available in many countries as a suspension in plastic ampoules. Before opening, the ampoule must first be carefully shaken. To ensure that the suspension reaches the correct site in sufficient quantity, one of the following postures must be taken:

  • Kneeling on the floor, bent forward with the head resting on the floor (Figure 1, click to enlarge).
  • Sitting or standing with head bent forward to knee level.
  • On the bed in the supine position with head tilted over the edge of the bed

Half of the ampoule (6 drops) is placed in one nostril and the other half in the other nostril and the head is held in the selected position for at least 1 minute.When lying on the bed, the head should be tilted to the side as quickly as possible (see patient information).