Nasal polyps: what are the causes and how they are treated

It is one of the most common pathologies encountered by the otolaryngologist. Nasal polyps are small, drop-shaped blooms that develop in the nose and can make normal breathing difficult. They have one benign natureso they are not cancers, and affect up to 4-5 percent of the general population.

«Polyposis is a pathology chronic inflammatory disease of the nasal mucosa which can only affect the nasal cavities or can also involve the paranasal sinuses, that is, those air chambers located around the eyes, nose and cheeks that act as a “sounding board” for our voice, operating as a sort of megaphone for the amplification of sounds », explains Dr. Fabrizio Salamanca, otolaryngologist at the Visconti di Modrone Medical Center, Milan. “Among other things, that adhesive mucus is also produced in the paranasal sinuses which serves to trap germs, contaminants, allergens and other particles from outside, so as to expel them when we blow our nose.”

What are the causes of polyps in the nose

In practice, nasal polyposis appears as an edema (swelling) of the mucous membranes – nasal and / or paranasal, as we have said – which over time gives rise to growths of a gelatinous, translucent and clear consistency: “It is a benign pathology”, reassures the expert. “The triggering causes are not yet completely clear, but certainly there is ahyperactivity of the nasal mucosa. If hyperactivity is allergicusually the polyposis is massive, because it affects both the nasal cavities and the paranasal sinuses, and is often associated withasthma. In other cases, however, the hyperactivity is non-specific, so that the anomalous and excessive activity of the structures of the nose is set in motion by an unidentified stimulus, such as humidity, wind or light, but the final result it’s the same clinical picture “. Among the non-specific forms there is a particular typology, the so-called ASA syndromewhere the patient presents simultaneously nasal polyposis, asthma and a violent intolerance to acetylsalicylic acid (the common aspirin).

What are the symptoms of nasal polyposis

In the long run, these growths prevent the patient from breathing well and the sense of nasal obstruction increases, as if the nasal cavities were “occupied”: “Furthermore, the sense of smell decreases, especially when polyps grow in the upper part of the nose, where the olfactory area is located: in front of this region an obstacle that prevents the air from reaching the olfactory receptors, so odors are not perceived very much », describes Dr. Salamanca.

«Also typical is rhinorrhea, the classic runny nose, sometimes ‘dripping’ in the back, down in the throat, with a very annoying sensation». And in the long run? If no action is taken, the polyps tend to grow, increasingly hindering breathing and smell, but also implementing the so-called remodeling: “Inside the nasal cavities and paranasal sinuses, these growths begin to crumble the bone walls, causing more or less complex problems. Furthermore, they can predispose to recurrent bronchitis, tracheitis and sinusitisas well as violent headaches even on the occasion of a common cold ».

How is it diagnosed

In most cases, nasal polyposis is detected during a normal ENT examination, when – through the nasal specula, particular surgical instruments used in the sector – the specialist is able to view the patient’s nasal cavities. “An endoscopic investigation may follow, he said rhinofibroscopy, which uses rigid or flexible optical fibers connected to a monitor to evaluate in more detail the characteristics of the polyps, their site of onset and the overall space, allowing the images to be “photographed” to document the clinical picture “, describes Salamanca. At that point, one is prescribed CT scan of the facial massif without contrast medium and sometimes, if it is necessary to make a differential diagnosis with respect to other pathologies, an MRI.

How is nasal polyposis treated

The proposed therapy is primarily pharmacological, based on cortisone: depending on the case, the specialist can recommend a local therapy (through nasal sprays or aerosol) or systemic, administered orally or intramuscularly.

“Obviously, the lion’s share is there surgery, especially when the pathology is extensively extended to the paranasal sinuses. It must be said, however, that nasal polyposis is a chronic disease, for which it has a high risk of recurrence: with surgery the polyps are removed, but not the cause that determined them. Having said that, a post-operative cortisone treatment can decrease the risk and surgery itself has made great strides in recent years, becoming more and more minimally invasive, curative and eradicating ».

A big news

The big news in the sector is represented by biological drugsthat is to say monoclonal antibodies (to be injected under the skin once a week for a certain period of time) which are showing extraordinary results even without surgery: «Since these are very expensive therapies, however, the number of patients who can benefit from them is still very small. For example, the national health service makes them available to those who present a sum of problems, such as having asthma, not responding to cortisone therapy or perhaps not being able to follow it due to diabetes, glaucoma or other diseases. – morbidity that contraindicates it, having already undergone several operations or suffering from cardiovascular or other pathologies that do not allow a further surgical approach », concludes Dr. Salamanca.

“Biological drugs they must be prescribed and monitored by an allergistbecause nasal polyposis is a complex disease that requires multidisciplinary treatment: ENT, allergist And pulmonologist they must join forces to find the best possible solution ».