What are nasal polyps?
Nasal polyps usually develop in the paranasal sinuses. From there, they can slowly grow into the nasal cavity. They are often a few millimeters in size, but can also reach several centimeters. Nasal polyps (“polyposis nasi et sinuum”) are benign, i.e. they do not grow together with their surroundings. The polyps usually appear symmetrically on both sides of the body. The main sites of origin are the ethmoid bone and the maxillary sinus. The cells store more tissue fluid there. This is why the polyps look like small drops that grow out of the mucous membrane on a stalk. However, some also lie flat on the mucous membrane.
Because of the proliferating nasal polyps, those affected can no longer breathe well through their nose. As a result, their useful functions are lost: the nose can no longer properly humidify and warm the air we breathe. Those affected usually breathe more through their mouth instead. This means that pathogens can enter the respiratory tract unhindered and lead to infections. The sense of smell is also disturbed by the polyps. Conversely, chronic inflammation of the nasal mucosa or paranasal sinuses significantly increases the risk of polyps developing.
Frequency and age of nasal polyps
In colloquial language, adenoids are also referred to as adenoids, which often occur in children. However, these consist of completely different tissue and are located in the throat. True nasal polyps are very rare in children. If they do, it is highly likely that they suffer from the metabolic disease cystic fibrosis. However, nasal polyps usually only occur after the age of 30. Men contract the disease twice as often as women. According to estimates, between one and twelve percent of people in Switzerland will see a doctor for nasal polyps in the course of their lives. In many cases, however, treatment with a cortisone nasal spray is sufficient.
Nasal polyps: Causes and risk factors
Why nasal polyps develop in one person and not in another remains unclear. In some families there appears to be an individual predisposition to the development of polyps. Some underlying diseases lead to a significantly increased susceptibility to nasal polyps. Four out of ten people with this growth suffer from bronchial asthma. People with chronic sinus inflammation (sinusitis) are particularly at risk. They very often also have nasal polyps. Other diseases that often lead to nasal polyps are:
- Allergies
- Chronic cold
- Fungi on the mucous membrane
- Intolerance to painkillers (intolerance to acetylsalicylic acid)
Polyps are very common in children who suffer from the hereditary metabolic disease cystic fibrosis. One in three of them also has nasal polyps. Conversely, almost all children with these growths are found to have cystic fibrosis.
In general, a weakened immune system also increases susceptibility to nasal polyps. Anyone who frequently spends time in rooms with very dry air or handles chemicals at work is also at a higher risk.
Symptoms: Nasal polyps block the nose
In the early stages, those affected usually do not notice that their mucous membranes are beginning to proliferate. Symptoms mainly occur when the polyps grow into the nose. The air then no longer flows freely through the nose. Those affected breathe more heavily through their mouth and their voice sounds nasal. The symptoms become more severe the larger the polyps grow. The location of the growth also determines the extent of the symptoms.
The following symptoms are also typical:
- Snoring due to increased mouth breathing
- Frequent inflammation of the paranasal sinuses
- Headache
- Impaired sense of taste due to lack of smell
- Inflammation of the upper airways
All these symptoms are caused by the fact that the polyps both obstruct the flow of air in the nose and often block the exits of the sinuses. Due to the lack of ventilation and the inadequate drainage of nasal secretions, inflammation quickly develops in the sinuses. If the polyps are not stopped, they may spread to other organs. They can trigger meningitis or inflammation of the eye socket (orbitaphlegmon).
If severely proliferating nasal polyps are not treated, there is a risk that changes in the anatomy will also occur over the years. The growth makes the nose thicker and increases the distance between the eyes. However, in view of the good medical care available, such changes have become very rare in Europe.
Nasal polyps: Diagnosis with us
We will first look into your nose and throat with the help of spreading forceps. If the polyps have already grown quite large, we can immediately see the shiny growth. We use an endoscope to detect smaller polyps. This rhinoscopy gives us a good insight into the nasal mucosa. However, this way we cannot see what the situation is in the sinuses. Therefore, if polyps are suspected in the sinuses, we must use an imaging procedure such as X-ray, magnetic resonance imaging (MRI) or computer tomography (CT). This allows us to see how widespread and large polyps are in the sinuses, as well as whether or to what extent they are inflamed. In some cases, we then discover that the growth is not a polyp, but a tumor (papilloma or malignoma). In contrast to polyps, these unilateral formations are usually bright red instead of gray or pink. If we detect an inflammation of the paranasal sinuses (sinusitis) during our examination, we also take a swab of the sinus secretions. Under the microscope we can see which pathogen is responsible for the inflammation.
Nasal polyps: Prevention, early detection, prognosis
There is no remedy that you can use to prevent nasal polyps. However, it is helpful if you have underlying conditions such as asthma or allergies under control. If you notice that you have problems with nasal breathing, you should have them treated at an early stage. You should seek medical advice, especially if you experience symptoms such as snoring or increased breathing through the mouth. People suffering from cystic fibrosis need to be particularly vigilant.
Basically, you can protect the mucous membranes of your nose and sinuses if you ensure that the room is well humidified and, if necessary, additionally moisturize your mucous membranes with nasal showers and salt water sprays. A general strengthening of the immune system through a healthy diet and plenty of exercise in the fresh air can also reduce the risk of illness.
Nasal polyps: Course and prognosis
The symptoms caused by proliferating nasal polyps usually disappear abruptly after the operation. As soon as the acute consequences of the operation have subsided, those affected can breathe freely through their nose again, sleep more peacefully and smell better. The earlier a nasal polyp is discovered and removed, the better the prospects for those affected. Of course, it is important that the underlying diseases are also treated. However, new polyps sometimes form again over time. This happens in particular with people who suffer from allergies, asthma, painkiller intolerance or cystic fibrosis. For them, the risk of a relapse (recurrence) is significantly higher at up to 50 percent.
Nasal polyps: Treatment with cortisone or surgery
There are usually two ways to treat nasal polyps. Which one we choose depends on the size and location of the growths.