Anatomy / Physiology
What are nasal polyps?
Nasal polyps are not an infrequent finding in the nose. Typically they are simple nasal polyps that are related to swellings from the lining of the nasal sinuses and protrude into the nasal cavity. Their presence in the nasal cavity causes a blocked feeling in the nose and sometimes a feeling of intermittent blockage due to the possibility of a ball valve effect. These smooth, insensate swellings in the nose are usually not visible to the naked eye and require a careful examination in the ENT Outpatient environment with an endoscope.
Polyps are usually a change and reaction of the sinus mucosa in response to an allergen. They may swell more in response to an upper respiratory tract infection, or certain alcoholic drinks. It is not unreasonable to have a trial of intranasal steroids for polyps or occasionally an oral course of steroids but if persistent then it is reasonable to consider surgery.
If asymptomatic polyps are seen in the nose by chance then these usually do not require surgical treatment. However, the presence of a unilateral polyp in the nose does warrant an examination under anaesthetic and removal of this polyp for histological diagnosis. Very occasionally a unilateral polyp arises solely from the maxillary sinus (under the cheek). This requires a complete polyp removal and the attached lining to the maxillary antrum to prevent recurrence.
Unilateral nasal polyp (Antrochoanal polyp)
Gross bilateral intranasal polyps
Nasal Polypectomy Surgery
Surgery for this condition has improved significantly over the past few years with the use of powered instrumentation. Rather than the simplistic manual removal by just pulling the polyps out one can carefully suction and then debride the polyps out of the nose using a ‘microdebrider’ leaving as much normal anatomy possible behind in the nose.
This surgery is performed using the endoscope and is a variation on Functional Endoscopic Sinus Surgery and often is combined especially if the polyps have been causing obstructive symptoms leading to chronic sinusitis.
Similar risks are incurred especially as often the nose is filled with abnormaltissue and therefore this has to be removed before normal anatomy is identified. The risks to the skull base and the breach of it producing leakage of the fluid that bathes the brain together with orbital injury although rare are a possibility. Bleeding is not uncommon in very small quantities in the post operative periods and if significant require presentation to a local emergency department. Packing the nose postoperativeley may be performed sometimes to tamponade any initial bleeding.
Postoperativeley the patient should be sent home with a nasal douche and a course of intra nasal steroids to decrease the chance of the polyps coming back quickly. Polyps cannot be cured by surgery and the surgery is aimed at improving the nasal airway and aiding the delivery of intranasal steroids that will be preventative in the longterm future.