Nosna polipoza je znana že tisočletja. Je razmeroma pogosta bolezen, vendar medicina še vedno išče ustrezen terapevtski pristop.
Nosni polipi so pecljati izrastki, ki nastanejo na sluznici nosu in obnosnih votlin. Nosna polipoza je več tisoč let stara medicinska težava. Tako zgodovina nosne polipoze sega v daljno preteklost, saj zapise o tej bolezni najdemo v papirusih, starih 5000 let. In the era of Hippocratic medicine, the causes of this disease were thought about, and there were methods of surgical treatment in terms of resection or cauterization. Despite the fact that this clinical entity has been known for so long, it has not yet been fully clarified regarding the causes of its occurrence and the processes of development of this disease. Prav zaradi teh neznank sodobno zdravljenje ni dovolj učinkovito.
Kako pogosti so polipi nosu in obnosnih votlin?
Nosna polipoza je razmeroma pogosta bolezen s prevalenco približno 5 % v celotni populaciji. Pri moških je dvakrat pogostejši kot pri ženskah. Mostly, nasal polyposis is part of the clinical picture of “chronic rhinosinusitis with nasal polyposis”, although there are also polyps that arise outside the context of chronic inflammation of the mucous membrane of the nose and paranasal cavities, but these polyps are in the minority.
Nosna polipoza je pogosto povezana s številnimi kroničnimi sistemskimi boleznimi dihal in tudi nekaterih drugih sistemov. Thus, there is a connection with intolerance of aspirin and other non-steroidal anti-inflammatory drugs, with allergic and non-allergic asthma, cystic fibrosis, allergic fungal sinusitis and ciliary dysfunction syndrome. Obstajajo študije, ki kažejo, da ima 30 do 70 % bolnikov z nosno polipozo tudi astmo ali kronično obstruktivno pljučno bolezen (KOPB). Glede na to dejstvo je mnenje, da je nosna polipoza lokalna manifestacija neke generalizirane vnetne bolezni.
Kako nastanejo polipi?
Vzrokov in mehanizmov za nastanek polipov je veliko. Kot smo že omenili, je vzrok nosne polipoze še vedno nejasen. Dvema velikima, “starima” teorijama izvora bi lahko rekli nalezljiva in alergična.
Prvi, infekcijski, pravi, da se nosna polipoza razvije ob nekem bakterijskem vnetju sluznice nosu in sinusov. Druga, alergijska teorija, izhaja iz dejstva, da alergijski procesi v sluznici spodbujajo nastanek polipov. Toda obe teoriji puščata veliko prostora za ugibanja. For example, most chronic rhinosinusitis does not lead to polyposis, and the majority of hay fever allergy sufferers do not have nasal polyposis.
The latest research into the etiopathogenesis of nasal polyposis focuses on eosinophils, which are the key inflammatory cells in nasal polyposis.
Kateri so značilni simptomi nosne polipoze?
Kakovost življenja bolnikov z nosno polipozo je izjemno poslabšana. Prevladujoč simptom je zamašen nos, ki oteži ali popolnoma onemogoči dihanje skozi nos. Because of this mechanical obstruction of the nose, a disorder or complete loss of the sense of smell also occurs, a discharge from the nose is created that leaks into the nose and down the throat. Prisotne so solzne oči, glavoboli, smrčanje in govorjenje skozi nos. Patients suffer from symptoms related to nasal polyposis itself, but also from symptoms that are a consequence of constant mouth breathing, such as dryness and inflammation of the pharynx, then a weakened appetite due to a disturbed sense of the taste of food due to loss of smell, and discomfort in society due to a constant runny nose.
Kako se postavi diagnoza?
The diagnosis is made on the basis of anamnestic data, otorhinolaryngological examination and CT imaging in patients who are planned for surgical treatment.
Kako se zdravi nosna polipoza?
Cilji zdravljenja nosne polipoze so:
- vzpostaviti prehodnost nosu ter prezračevanje in drenažo obnosnih votlin
- obnoviti občutek za vonj in
- preprečiti ponovitev bolezni
Until recently, it was considered that the method of choice for the treatment of nasal polyposis was surgery, since there were no effective drugs against this disease.
Today, conservative treatment of nasal polyposis is relatively effective thanks to corticosteroid therapy, locally sprayed into the nose or systemically, i.e. taking corticosteroid preparations by mouth or by injection. V primerih napredovale trde polipoze se lotimo kirurškega zdravljenja.
O kirurgiji in biološki terapiji
Surgical treatment of nasal polyposis has been carried out for thousands of years, but only in the last hundred years has this operation transformed from extremely painful and potentially dangerous to an almost routine exact procedure. In the last four decades, the development of endoscopic sinus surgery (Endoscopic sinus surgery) has significantly improved the results of nasal polyposis treatment. It is a minimally invasive procedure, extremely exact in the sense that only the diseased tissue is removed, while the healthy mucous membrane is preserved.
Na žalost je nosna polipoza bolezen, ki se rada ponavlja. Zato je prevladujoči terapevtski pristop kombinacija kortikosteroidne terapije in kirurškega zdravljenja, saj se eno dopolnjuje. In ravno ta pristop daje najboljše rezultate.
Velike upe pri zdravljenju nosne polipoze polagamo v biološko terapijo. These are antibodies that block the activity of molecules that are responsible for inflammatory events in the mucous membrane of the nose and paranasal cavities. Kako upravičeni so upi, bo pokazal čas.
Besedilo je nastalo v sodelovanju z portal “ADIVA – vaš portal za zdravje”
