Clinical evidence shows that nasal polyps tend to appear concomitantly with inflammatory (inflammatory) pathologies of the respiratory muscles, in particular sinusitis, allergies, rhinitis and asthma.
Despite what has been said, scholars are unable to give an exhaustive answer on the etiopathogenesis of nasal polyps. However, it seems that genetic predisposition plays a leading role in the appearance of these nasal growths.
In most cases, small nasal polyps are a benign phenomenon, which can soon be resolved by topical application of corticosteroids (sprays). When, on the other hand, nasal polyps reach considerable size, such as to obstruct correct breathing, an intervention is conceivable. targeted surgical excision.
The presence of nasal polyps is also called nasal polyposis.
For further information: Nasal Polyps: What are they? makes use of a meticulous collection of anamnestic data: the goal is to investigate the possible genetic predisposition to the disorder and to identify further, possible, associated diseases.
The doctor therefore proceeds with an otolaryngological examination, skin allergy tests (eg Prick-test) and haematological tests; nasal (rhinomanometry) and olfactory (olfactometry) respiratory function tests are also important.
The exams of imaging radiological (CT or magnetic resonance) and endoscopic allow to carry out a qualitative and quantitative analytical balance of the disease, or to establish the danger and size of a polyp (possible malignant form) and the number of polyps present in the respiratory tract.
Testing for cystic fibrosis is thinkable when nasal polyps affect children.
The differential diagnosis must be made with all the pathological manifestations presenting with symptoms similar to nasal polyposis:
- Chronic rhinosinusitis: some forms of rhinosinusitis occur regardless of the presence of nasal polyps;
- Fungal allergic sinusitis;
- Insertion of a foreign body into the nose (typical of children);
- Benign or malignant neoplasms: in general, nasal polyps (benign tumor forms) are bilateral, therefore they tend to appear; in both sinuses. Unilateral nasal polyps (in particular) have to be distinguished from malignant tumor forms.
The drugs most used in therapy for small nasal polyps are essentially corticosteroids, taken in the form of a nasal spray and / or tablets to be taken by mouth.
The following are the most commonly used corticosteroid drugs for the treatment of nasal polyps:
- Fluticasone (eg Avamys, Alisade, Fluspiral), indicated both for the treatment and for the prevention of nasal polyps;
- Beclometasone (eg. Rinoclenil, Becotide nasale);
- Mometasone (eg Nasonex, Rinelon).
When the appearance of nasal polyps is linked to allergic reactions, therapy with antihistamines and decongestants helps to reduce inflammation of the nasal mucosa, accelerating healing times.
The antibiotic or antifungal treatment is instead indicated when the nasal polyposis is linked to bacterial or fungal infections.
Patients predisposed to nasal polyposis can follow a lighter cortisone therapy to minimize the risk of recurrence.
When nasal polyposis depends on an "intolerance to" acetylsalicylic acid, it is recommended to avoid its administration, replacing the drug with another active ingredient with similar therapeutic activity (always consult your doctor).
For further information: Drugs for the Treatment of Nasal PolypsSurgical Treatment for Nasal Polyps
Otherwise, large nasal polyps are treated surgically: the surgical exeresis (removal) of the mass is, in this sense, the only possible solution to definitively cure the disorder; it should be remembered, in fact, that nasal polyps can reach dimensions such as to seriously obstruct the airways, constituting a serious discomfort for breathing and for sleeping at night.
Surgical options aimed at removing nasal polyps are:
- Polypectomy: the polyp is removed using a small mechanical suction device or with a particular instrument (microdebrider) which allows dissection of the polyp.
- Endoscopic sinus surgery: consists in the removal of the nasal polyp accompanied by the correction of the structure of the paranasal sinuses. In fact, even a particular anatomy of the nasal structures can predispose the subject to inflammation of the mucosa. The surgical procedure is performed by introducing an endoscope through the nostrils, in order to provide an enlarged image of the internal nasal structures. Subsequently, we proceed with the correction of the problem (removal of the polyp + revision of the nasal structures).
Even after surgical removal of the polyp, the risk of recurrence is still real. To prevent the recurrence of nasal polyps, it is recommended to follow an adequate cortisone therapy (spray formulations).
in fact it can worsen the swelling of the nasal mucosa;
