Nasal Polyps - OAWHealth

Nasal Polyps

By Dr. Loretta Lanphier, ND, CN, HHP, CH

By definition, a polyp is “any overgrowth of tissue from a surface.”  When they are found in the nasal cavities, polyps can interfere with normal functions such as breathing and smelling, and will often mimic the symptoms of other respiratory problems. Sometimes they are present and you may not even be aware of them, but they can be a source of chronic irritation for many people.

What Are Nasal Polyps?

Nasal polyps are growths that form in the lining of your nose or in your sinuses. They can take any number of shapes, with droplet, round, and irregular being the most common. They are generally soft and pearly in color, and often have a consistency described as “jelly-like.” Nasal polyps are always noncancerous (benign), so cancer is not a concern if you have nasal polyps. A polyp may be found alone, or they may form in clusters, similar to the way grapes grow on a stem.

Nasal polyps may occur in individuals of any age, but they are most often found in folks over the age of 40. They are also more common in people of all ages who suffer from chronic respiratory conditions such as asthma, sinus infections, allergies such as hay fever and others, and cystic fibrosis.

What Are the Signs and Symptoms of Nasal Polyps?

It is no wonder that nasal polyps are often mistaken for other ailments such as allergies or sinus infections, because the symptoms of both are very similar. Signs generally include:

  • Persistent stuffy nose (usually one side at a time)
  • Runny nose
  • Mouth breathing (especially in children)
  • Snoring
  • Lowered sensitivity to smell
  • Chronic sinus infections
  • Headaches
  • Feeling of fullness in the head

The symptoms one experiences from nasal polyps may be dependent on where they form. If they grow in the nasal passages, breathing may become congested and more difficult. However, some polyps form closer to the opening of the sinus cavities, and do not obstruct breathing as much. But this type can cause some unique problems of their own. Sometimes they will block mucous from flowing freely out of the sinuses, which can affect the sense of smell, and cause dull headaches as well as a feeling of fullness in the head. Blockage of the sinus passages can eventually lead to infection, resulting in a fever, bloody discharge from the nose, and pain in some cases.

What Causes Nasal Polyps?

In order to fully understand why nasal polyps form, perhaps we need to review some basic knowledge about our noses. This impressive organ does a whole lot more than affect our appearance. As with most of the systems in our body, our noses and related organs form a complex network that performs many important functions. In a nutshell, the nose is responsible for filtering, warming, and moistening the air we inhale, as well as interpreting scent-related data and passing it along to our brain.

Structurally, the nose is made up of three main components:  bone, cartilage and mucous membranes. The nasal cavity is separated by the septum, a divider that is both bone and cartilage. Each side of the cavity is lined with several “shelves” called turbinates. Both the septum and turbinates are covered with mucous membranes that work in conjunction with tiny hairs called cilia to filter out dirt and bacteria from your nose. The sinuses, four hollow cavities located above and behind your nose, are also loaded with mucous linings.

The mucous membranes are equipped with a “thermostat” that measures both the temperature and humidity of the air you inhale. If the air is too dry or too cold, the membranes swell and narrow the nasal passages, thereby slowing the flow of air and enabling it to be sufficiently moistened and warmed before reaching your lungs.

Another critical function of the nose involves the sense of smell. It is estimated that the average nose can differentiate between about 10,000 different odors. This is accomplished by the olfactory nerves inside your nose. These nerve endings send messages to the brain that enable it to identify the various smells. The sense of taste is also highly dependent on the sense of smell. If your ability to smell is diminished, you will lose the majority of your sense of taste as well.

OK. Now that we “knows about noses,” what does all this have to do with nasal polyps? These growths are not actually a “disease,” but rather they are the result of chronic inflammation of the nasal passages and sinuses. This ongoing irritation results in the overproduction of mucous, which can directly lead to the formation of polyps. Another reason that polyps form is because chronic irritation also causes the blood vessels of the mucous linings in the nose and sinuses to become “waterlogged,” so to speak. The inflammation causes them to become abnormally permeable, resulting in the accumulation of water in the cells of the area. At that point, gravity may kick in, and cause polyps to arise.

Certain factors or conditions increase your risk of developing nasal polyps, most of them related to chronic inflammation of the nasal passages and sinuses. Some of the more common ones include:

  • Cystic Fibrosis:  Children with this disease are very prone to get nasal polyps. This tragic illness, which is often fatal, is characterized by many chronic respiratory problems, including lung and sinus infections. The resulting nasal polyps only serve to make matters worse. In some cases, cystic fibrosis patients can develop significant nasal polyps that can actually alter their facial structure and result in abnormally wide-set eyes and double vision.
  • Allergic Fungal Sinusitis (AFS):  This condition is thought to be the result of very fine particles of environmental fungi that the patient experiences an allergic reaction to. The reaction causes great amounts of thick fungal debris mixed with mucous to accumulate in the sinuses, often necessitating surgical removal. One of the byproducts of AFS is the formation of nasal polyps.
  • Churg-Strauss Syndrome: Also known as allergic granulomatosis, this rare vascular disease involves inflammation of the blood vessels (vasculitis) and contributes to asthma in some patients as well. When the vasculitis occurs in the naso/sino area, polyps can easily form.
  • Asthma
  • Chronic Sinus Infections (sinusitis)
  • Chronic Hay Fever
  • Allergies to aspirin and other NSAIDs:  Medicines like aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs are known to trigger both nasal polyps and asthma in some individuals.  If you have both nasal polyps and asthma, be especially careful about using aspirin. Some patients can experience sudden attacks resulting in severe shortness of breath after taking aspirin or compounds containing aspirin.

The major complications or side effects of nasal polyps are:

  • Sinus infections, either acute and/or chronic. This can set off a vicious cycle that results in more nasal polyps, which causes more infections, and so on.
  • Sleep Apnea:  Blocked nasal passages due to nasal polyps can trigger this potentially dangerous condition that disrupts a person’s normal breathing patterns while sleeping. Patients may stop and start breathing numerous times during their sleep cycles.

What Treatments Are Available for Nasal Polyps?

If you experience chronic respiratory problems and infections, you may be suffering from the effects of nasal polyps. The first logical step is to have your health care provider or a doctor do a physical exam of you to see if they can be identified. Some polyps can be seen with the naked eye, but smaller ones or those up higher in the nasal passages or near the sinuses may only be found using specialized tools. Generally, a decongestant is administered via soaked cotton balls inserted in the nose several minutes before the exam. This reduces the amount of mucous, and makes the polyps more visible.

If polyps are present and significant enough to cause ongoing problems, they can be removed through a surgical procedure called a nasal polypectomy. A more major form of surgery is sometimes suggested when problematic polyps have blocked and inflamed part or all of your sinuses. Both of these procedures are appropriate in some cases, but as is the case with any surgery, a second or even third opinion is definitely a good idea before proceeding.

While these surgeries may help initially, if the underlying conditions that cause the irritation and stimulate the formation of excess mucous are not dealt with, the nasal polyps will return. Controlling indoor and outdoor pollutants and allergens as much as possible is a huge step in the right direction. There are an abundance of nasal sprays and other medications that are often prescribed for chronic respiratory problems, which can indirectly help with nasal polyps as well. However, many prescription and over-the-counter drugs contain cortisone or substances such as benzalkonium which can actually create a bigger problem than they are supposed to solve. If used too much, they will begin to irritate the very tissues they were intended to treat. This phenomena even has a name:  rhinitis medicamentosa, and ironically can be more difficult to treat than the original issue. In this case, the cure is truly worse than the cause.

A great homemade treatment that will not cause unwanted side effects is a simple saline solution. Mix ¼ teaspoon salt with about 8 ounces of warm water. You can use an ear bulb to deliver it into your nostrils, or just cup some in your hand and sniff it into your nose. After a few moments, blow your nose to clear it of mucous. Do not keep or reuse the solution after 24 hours.

One additional note about children and nasal polyps:

  • If your child suffers from both nasal polyps and hay fever, sometimes skin testing can be of value. It is a non-invasive way of determining likely allergens that is not uncomfortable for most children to undergo.
  • If you have a young child with multiple nasal polyps, you may want to consider having them tested for cystic fibrosis, especially if there is any family history of it. Cystic fibrosis is an inherited condition that can be diagnosed via a simple sweat test that analyzes the sodium and chloride content of the child’s perspiration. If present, this critical illness should be identified as early as possible.

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