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Nasal Polyps symptoms, causes and treatment

Nasal Polyps are pale, edematous masses inside nasal cavity, which are mucosal covered and commonly seen patients with asthma and allergic rhinitis. Nasal polyps are benign inflammatory and hyperplastic outgrowths of the sinonasal mucosa. Nasal polyps can cause nasal obstruction difficulty breathing with nose and diminished sense of smell. In patients with asthma and nasal polyps, aspirin should be avoided, to prevent severe bronchospasm. Exact cause of nasal polyps is not known but it is associated with aspirin sensitivity, allergy, rarely systemic vasculitis, and cystic fibrosis. Nasal polyposis should be suspected in patients with progressive nasal obstruction, nasal and/or facial congestion, rhinorrhea, and decreased sense of smell. Nasal polyps usually aren’t painful. But it can cause sinusitis which can cause face pain. 4 % of population have nasal polyps, but 40 % population will have nasal polyps at some point of life. It means this disease is extremely common. Diagnosis Nasal polyposis is a clinical diagnosis based on anterior rhinoscopy or a nasal endoscopic examination. Treatment: For patients with chronic rhinosinusitis with nasal polyposis, initial therapy with intranasal corticosteroids and nasal saline irrigations for approximately 2-3 months should be attempted. High-volume, low-pressure nasal saline irrigations are safe and non-expensive and increase the clearance of antigens, biofilms, and inflammatory mediators. Intranasal corticosteroids improve nasal congestion and decrease polyp size. Another treatment option is surgery. Surgery removes the anatomic obstruction and restores more normal mucosal drainage, but the underlying allergic etiology must be addressed. Topical nasal steroids and or topical antihistamines are a mainstay, together with formal allergic testing and targeted immunotherapy if available. Surgical treatment is effective but Recurrence is common with severe disease recurring in around 5%–10% patients. If a patient continues to be symptomatic despite the aforementioned strategies, oral corticosteroids are occasionally used. The mindful use of systemic steroids should be implemented to avoid unwanted side effects. Antibiotics are typically used if there is evidence of an acute bacterial exacerbation. The role of antifungals in the treatment of nasal polyps is controversial. Lastly, biologic drugs (monoclonal antibodies) can be used in refractory disease. Intranasal corticosteroids such as budesonide, fluticasone propionate, and mometasone furoate have been shown to reduce polyp size. These should be used twice daily for several weeks before optimal effects can be appreciated. In contrast, for more severe disease, oral corticosteroids can be given; these should be provided in pulses and in a tapered way. A research was done, with moderate Nasal Polyps mometasone furoate nasal spray with placebo for 16 weeks. They found a significant decrease in nasal congestion, polyp size, and improved quality of life. compared fluticasone propionate with placebo in 46 patients for 12 weeks in a randomized controlled trial. Polyp score and acoustic rhinometry improved significantly. Steroids have been shown to improve nasal breathing, improve symptoms of rhinitis, and reduce the size of NP along with the rate of recurrence. In all patients the addition of simple saline nasal douching to help cleanse the nose prior to topical medications is beneficial. These irrigations have been shown to improve nasal mucocilliary clearance measured by the saccharine test in both Nasal Polyp and healthy volunteers in an American study. These are typically available over the counter in most pharmacies. Antibiotics: Based on the concept of S. aureus intraepithelial colonization, studies have been done to support the use of antibiotics along with corticosteroids to treat patients with Nasal Polyps. Recent studies have shown that oral doxycycline (200 mg on the first day, followed by 100 mg once daily) for 20 days has shown a significantly decreased Nasal Polyp size, reduced levels of myeloperoxidase, ECP, and matrix metalloproteinase 9 in nasal secretions By © MathieuMD / Wikimedia Commons, CC BY-SA 3.0, https://commons.wikimedia.org/w/index... Clinical Practice Guideline: Nosebleed (Epistaxis) - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/a... [accessed 7 Jun, 2022]