Nasal polyposis has been known for thousands of years. It is a relatively common disease, but medicine is still searching for an appropriate therapeutic approach.
Nasal polyps are stalk-like growths that form on the mucous membrane of the nose and paranasal cavities. Nasal polyposis is a medical problem that is thousands of years old. Thus, the history of nasal polyposis goes back to the distant past, since records of this disease are found in papyri that are 5000 years old. 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. It is precisely because of these unknowns that modern treatment is not sufficiently effective.
How common are polyps of the nose and paranasal sinuses?
Nasal polyposis is a relatively common disease with a prevalence of about 5% in the overall population. It is twice as common in men than in women. 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.
Nasal polyposis is often associated with many chronic systemic diseases of the respiratory system as well as some other systems. 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. There are studies that show that 30 to 70% of patients with nasal polyposis also have asthma or chronic obstructive pulmonary disease (COPD). Considering this fact, the opinion is that nasal polyposis is a local manifestation of some generalized inflammatory disease.
How do polyps form?
There are many causes and mechanisms of the formation of polyps. As already mentioned, the cause of nasal polyposis is still unclear. We could call the two big, “old” theories of origin infectious and allergic.
The first, infectious, says that nasal polyposis develops during some bacterial inflammation in the mucous membrane of the nose and sinuses. The second, the allergic theory, starts from the fact that allergic processes in the mucous membrane stimulate the formation of polyps. But both theories leave plenty of room for speculation. 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.
What are the characteristic symptoms of nasal polyposis?
The quality of life of patients with nasal polyposis is extremely impaired. The dominant symptom is nasal congestion, which makes breathing through the nose difficult or completely impossible. 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. There are watery eyes, headaches, snoring and speaking through the nose. 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.
How is the diagnosis made?
The diagnosis is made on the basis of anamnestic data, otorhinolaryngological examination and CT imaging in patients who are planned for surgical treatment.
How is nasal polyposis treated?
The goals of nasal polyposis treatment are:
- establish nasal patency and ventilation and drainage of the paranasal cavities
- restore the sense of smell and
- prevent the return of the disease
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. In cases of advanced hard polyposis, surgical treatment is undertaken.
About surgery and biological therapy
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.
Unfortunately, nasal polyposis is a disease that tends to recur. That is why the dominant therapeutic approach is a combination of corticosteroid therapy and surgical treatment, as one complements the other. And it is precisely this approach that gives the best results.
Great hopes in the treatment of nasal polyposis are placed in biological therapy. 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. Time will tell how justified the hopes are.
This text was created in collaboration with portal “ADIVA – your portal for health”
