Treatments For Nasal Polyps
Nasal polyps often appear if you have chronic sinusitis. Whether or not you have polyps with this condition, you will want to treat your condition as assertively as possible. Since it is hard to completely see the polyps disappear, it is best to work with an ENT doctor to figure out a long-term treatment plan. The treatment approach for the sinusitis and the polyps is often the same, with the overall goal being to minimize symptoms, inflammation and, if present, the size or existence of the polyps. In many cases, medication is the first approach, but if the polyps are resistant, removal either in the office or in the operating room might be necessary. Polyps can re-occur as well so close observation is important.
Medication Options
There are a number of medications that can help polyps shrink or disappear completely. Your ENT doctor might first prescribe a nasal corticosteroid to reduce swelling or irritation. If that isnt effective, you might move on to an oral or injected corticosteroid alone or in combination with the nasal version. Some patients may be candidates for injectable medications called biologics that may decrease the size of the polyps and take away some of your congestion. There are other medications that treat allergies and thereby help relieve a possible trigger for polyp growth.
Procedural Options
When Surgery May Be Needed
An endoscopic surgery to remove nasal polyps may be recommended if nonsurgical treatments are ineffective or if the nasal polyps are very large. This typically is an outpatient procedure, meaning you can go home the same day as long as you have no complications.
During the procedure, your surgeon will insert a thin tube into your nasal passage. The tube has a light on the end as well as surgical instruments to help your surgeon cut out the polyps.
Surgery to remove nasal polyps can treat symptoms and help you breathe more easily. However, keep in mind that unless the underlying cause is under control, then nasal polyps can recur.
Is There A Way To Prevent Polyps After Surgery
Its very common for nasal polyps to return after surgery. However, there are steps you can take to prevent a recurrence. Regular saline rinses, avoiding dust and pollution, and using an air purifier and humidifier can decrease irritation for some people. In addition, your doctor may recommend the routine use of a corticosteroid spray moving forward.
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How Long Does It Take
Nasal polyp surgery itself usually lasts a few hours. If youre undergoing general anesthesia, you may spend the day in surgery preparation and postsurgery recovery.
In most cases, you should be able to go home the same day as your surgery. Some people may need to stay at the hospital overnight.
Make sure youve arranged for a ride home and for someone to stay with you overnight to help monitor your condition.
What Causes Nasal Polyps
Nasal polyps are the result of chronic inflammation, though we dont yet understand what triggers them in some people and not others. Certain conditions are shown to increase your risk of developing nasal polyps, including:
- Aspirin sensitivity
- Frequent sinus infections
There is not yet a cure for nasal polyps. While we can remove polyps, there is a chance they will return. However, treatment options are becoming more advanced every day, resulting in more days, months, or even years without intrusive nasal polyp symptoms.
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What Are The Complications Of Nasal Polyps
In addition to affecting your sense of smell, polyps can cause thick mucus and postnasal drip, plus repeated infections if your sinuses are blocked, says Brad deSilva, MD, an otolaryngologist at The Ohio State University Wexner Medical Center in Columbus.
Constant inflammation due to allergies, asthma, or autoimmune conditions contributes to the growth of polyps, says deSilva, who treats Black.
Before considering surgery for nasal polyps, your doctor will try to shrink or eliminate them with other treatments. Along with saline rinses to improve mucus flow and remove irritants, you may use steroid nasal sprays, steroid pills, and/or injections of biologic drugs. The goal of these treatments is to shrink the polyps so you can breathe easier.
When Do You Need Surgery For Nasal Polyps
But polyps can be difficult to treat. Medicines don’t always do the trick.
That’s when your doctor may recommend surgery to remove the polyps, if they think you’re a good candidate.
First, they’ll do imaging scans. This lets them see how many polyps you have and how large they are, and get a look at the bone structure in your sinuses. That creates a roadmap for the surgeon.
Surgery can prevent rare but serious problems that can result from nasal polyps. These include complex sinusitis, which can lead to bone loss and pockets of infection. These abscesses can grow around your eye socket and brain. You even could get meningitis, which is infection of the tissues around the brain and spinal cord.
Thereâs no cure for nasal polyps. But surgery âhas tremendous results for the right patient who is chosen properly,” deSilva says.
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If That Doesn’t Work What Happens
If the polyps are growing, they cause signs that affect your life negatively. Your doctor may recommend surgery for removal if other treatments such as nasal sprays do not work. If an ENT doctor recommends surgery, the disease is so serious that you can consider removing it.
It is time to figure out when to have your nasal polyps removed once you and your doctor have agreed to do an operation. You will be working with your doctor in advance to plan a surgery, leaving plenty of time for rehabilitation so that the procedure does not stop any significant upcoming events.
This timetable should be considered carefully. You may not want to delay a procedure which can impact your health and quality of life, but you will also want to be reasonably fit in your entire life. In some cases, patients may go home the day of the procedure, but it is a good idea to stay in the hospital overnight.
In addition, make sure you have a few weeks to rest so that your sinuses can be healed properly after surgery.
Most sufferers with sinusitis had been told or had previously had sinus operations requiring the uncomfortable wrapping of gauze in the nasal passages and a long period of healing. Gauze dressing is seldom used today. New progress makes the procedure much easier, comfortable and more effective, with faster restoration times. The best time for the removal is determined by you and your doctor.
When Is Polyps Removal Surgery Needed
Even when these tissue growths are often not cancerous, they are nevertheless abnormal patterns. After all, you cannot risk letting it progress into cancer. For some polyps types, like the ones in the vocal cords or nose, polyp removal could be necessary to support normal function. Hence, when you feel like there could be a polyp growing inside your body, it is best to seek medical attention immediately.
- Initial Examination
Depending on the site, the doctors will use exploratory devices like an endoscope to closely examine the polyp. This step ensures that they fully note the growth characteristics before a polyp removal procedure. Since the insertion of the device could be uncomfortable, they could give you local anesthesia. Your doctor may also take a sample or biopsy of the polyp before completely cutting it out.
- Polypectomy/ Polyp Removal Surgery
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What Is An Endoscopic Polyp Removal
Removal of nasal polyps used to be an extensive procedure. Now, with modern endoscopic techniques, they can be safely removed as an office procedure. In our office, under IV sedation, a small telescope is used to visualize the polyps and a special suction instrument can be used to vacuum the polyp away. This is typically done in conjunction with balloon sinuplasty and a sinus wash to clear the associated sinus infection.Dr. Daniel Slaughter explains what it means to have nasal polyps and how it can be treated at Sinus & Snoring Specialists.
Why Operate Or Remove Nasal Polyps
There has been fundamental shift in the how the medical community has addressed nasal polyp related sinus disease. Not so long ago, patients were offered a nasal polypectomy . This offered very little change to the underlying pathologic process or disease course. Ultimately, many patients had repeated removal of their nasal polyps without the underlying disease being controlled or modified. Over the past 10 years, there has been a concerted effort to change this in our profession. Much of what we offer patients today is about effectively delivering anti-inflammatory therapies to the sinus cavities to control the underlying disease process. Many patients feel a significant benefit from corticosteroid therapies when given orally , however, the effect disappears when they cease. Patients are often asked to use simple nasal sprays that are loaded with the identical type of corticosteroid or even a more potent form to find that the simple sprays offer little benefit. This phenomenon is simply a result of where the medication is reaching. Simple nasal sprays DO NOT deliver the medication into the sinus cavity.
The location of the disease process in nasal polyps: not an area reached by simple nasal sprays
Why we create a simple neo-sinus cavity through surgery in nasal polyposis
A corticosteroid non-responsive sinusitis/nasal polyposis patient after surgery and corticosteroid therapy :
A poor response to corticosteroid therapy.
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General Overview Of The Service:
Nasal polyps are pale grey round swellings. In the nose they are formed when areas of the lining of the nose cavity become swollen with fluid. If the polyp is found on one side only and is pink and fleshy in appearance, then it might be malignant . Polyps can interfere with breathing. The first indication is usually a blockage in the nose. This is often accompanied by persistent sneezing and a runny nose. Very mild cases may be treated with the appropriate medication, but otherwise a polypectomy is needed.
How Are Nasal Obstructions Treated
Not all patients can be cured of nasal polyps, but several treatments can help:
- Steroid sprays to shrink polyps and improve symptoms.
- Oral steroids .
- Injections under the skin to deliver a medicine called dupilumab.
- Outpatient surgery to place a tiny stent. It props open the nasal passages and delivers steroids or other medications.
- Outpatient surgery using endoscopy to remove polyps when other treatments dont work.
Your healthcare provider also may prescribe antibiotics if you have an infection.
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Other Nonsurgical Treatments For Nasal Polyps
There are additional nonsurgical treatments for nasal polyps that don’t include steroids. These include:
- Antibiotics: Though rare, antibiotics may be prescribed to treat nasal polyps. If they are prescribed, it’s usually because there is an additional concern of bacterial infection.
- Leukotriene inhibitors: Montelukast, a type of leukotriene inhibitor often used to treat asthma, has shown some benefit in treating nasal polyps, particularly for people with aspirin sensitivity.
- Biologics: Dupilumab, a new type of biologic monoclonal antibody, was approved by the Food and Drug Administration in 2019 to treat chronic rhinosinusitis with moderate to severe nasal polyps. It is given as a biweekly injection.
How The Service Is Done:
A nasal polypectomy is an operation to remove polyps from within the nose. It is done through the nose, so you wont have any incisions on the outside. There are 2 main techniques for removing nasal polyps. The technique chosen depends mostly on where the polyps are located in your nose. If they are easily seen and reached from the front of your nose, then you will have an intranasal polypectomy using small graspers. If the polyps are smaller and located in the roof of the nose or in the sinuses, an endoscope will be used to get a better view of the nasal cavity in a procedure known as an endoscopic nasal polypectomy.
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Nasal Polyp Surgery Recovery Tips
- You may experience some mild discomfort or pain after your nasal polyp surgery. Your ENT surgeon will prescribe you pain medication, if necessary, or advise you on appropriate over-the-counter pain relievers. Take only what your doctor recommends, as some over-the-counter medications may not be advisable.
- Congestion and clotting in the nasal passages can make you feel as if you have a bad cold for a few days. Be sure not to blow your nose for the first 2 weeks after your nasal polyp surgery. After 14 days, gentle blowing is recommended for a time.
- Avoid hot baths and drinking hot liquids, as these can promote nasal bleeding.
- Do not smoke. Smoking can increase polyp recurrence and delay healing. Avoid being in environments where you would be exposed to excessive smoke, dust, or other pollutants.
- Sleep with your head elevated.
- For the first week, avoid bending down or looking down for long periods of time because this can cause pressure within the nose.
- Do not perform strenuous exercise until your ENT surgeon releases you to do so.
- Use saline flushes to wash out clots and prevent excessive crust formation.
- Avoid alcohol consumption for 2 weeks after nasal polyp surgery since alcohol can thin the blood and contribute to nosebleeds.
Your doctor will provide you with detailed instructions on how to clean your nose and minimize nasal bleeding, as well as what to do in the event of a nosebleed . Most patients experience easier breathing shortly after nasal polyp surgery.
Check If You Have Nasal Polyps
Symptoms of nasal polyps include:
- constant need to swallow
- reduced sense of smell or taste
Nasal polyps can sometimes feel like a cold. But colds tend to clear up within a few days, whereas nasal polyps will not get better unless they’re treated.
If your polyps block your sinuses you may also have symptoms of sinusitis.
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What To Expect After The Surgery
If you swallowed any blood during the surgery, which commonly can occur, you may be nauseous and vomit following surgery. This is not a medical emergency and usually resolves after vomiting one time.
Your healthcare provider will arrange for you to be seen in a follow-up appointment to evaluate your healing and resolution of symptoms related to the nasal polyps. In some cases, your healthcare provider may use an endoscope to visualize the surgical areas at your postoperative visit.
When Is Surgery Considered For Nasal Polyps
If you have nasal polyps with symptoms that have not responded to other therapies, a nasal polypectomy may be considered to remove the polyps.
Before surgery, a computerized tomography scan of your head is typically performed to determine the extent and locations of polyps in your nasal passages and sinus cavities.
A nasal polypectomy should not be performed if you do not exhibit symptoms or if medications can control your symptoms.
Contraindications for this type of surgery include:
- Cardiac disease
These complications generally can be treated effectively, without lasting consequences.
You can have minor, limited bleeding at home after your surgery, and it typically resolves quickly. Your healthcare provider may tell you to contact their office during daytime business hours if bleeding occurs.
Uncontrolled bleeding is a medical emergency. You should seek emergency care if you experience heavy bleeding or bleeding that won’t stop.
Severe complications that may occur include eye, nasofrontal duct stenosis, and orbital problems.
You should get immediate medical attention for any severe headaches or vision problems.
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Functional Endoscopic Sinus Surgery
If a patient does not respond to medication, sinus surgery is the next best alternative for nasal polyps removal. The most common method of nasal polyps surgery is the functional endoscopic sinus surgery, or FESS procedure. In this minimally invasive procedure, the otolaryngologist inserts an endoscope through the patients nostril in order to remove nasal polyps and widen nasal passages. In her nasal polyps patient, Dr. Loftus prefers to perform a full house FESS in order to open all the sinuses. She does not recommend using balloon dilation because it does not clean out mucus or remove nasal polyps. Turbinate surgery is sometimes performed in conjunction with FESS. In this surgery, the otolaryngologist uses the endoscope to shave down the inferior turbinate, one of three body projections in the airway, to further open the patients airway. Dr. Loftus notes that turbinate reduction surgery may be unnecessary, as turbinate swelling is often a symptom of sinusitis once sinus swelling ceases, the inferior turbinate usually reduces naturally as well.
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Nasal Polyp Treatment Without Surgery
Sarah Bence, OTR/L, is an occupational therapist and freelance writer.
Nasal polyps are soft growths that can occur on the inside of the nasal canal or sinuses. Small nasal polyps can be harmless, but if a nasal polyp blocks the sinuses or airway, it can lead to infections, difficulty breathing, and other symptoms. Treatment is recommended in these cases.
While surgery to treat nasal polyps is an option, there are several treatments to consider before surgery. Corticosteroids are generally considered the gold standard pharmacological treatment for nasal polyps, and can be delivered by spray, oral medication, or injection.
Learn more about nonsurgical nasal polyp treatment, including prednisone for nasal polyps.
Guido Mieth / Getty Images
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Nasal Polyps At A Glance
If you have chronic inflammation in your nose, which is typically due to chronic sinusitis, the irritation and inflammation in your nasal passageways can lead to the development of polyps. Polyps are soft, noncancerous growths that form in the lining of the nasal passageways.
In many cases, polyps can be small enough that youre not even aware of their existence. In other cases, however, these growths can become large or numerous enough that they create problems.