Although it is not possible to trace a precise and unequivocal cause, it is assumed that the formation of nasal polyps is related to diseases such as: allergy, asthma , cystic fibrosis , chronic sinusitis (above all), immunodeficiency and connective tissue diseases , administration of some drugs, smog.
The characteristic symptoms caused by nasal polyps are: ageusia , anosmia , headache , nasal congestion , difficulty breathing , facial pain , rhinorrhea , watery eyes , itchy eyes and snoring .
The diagnosis of nasal polyposis is ascertained by subjecting the patient to one or more investigative tests. Among the most validated diagnostic techniques we remember: medical history , ENT examination, skin allergy tests , haematological tests, tests on nasal and olfactory respiratory function. Sometimes, imaging ( CT or MRI) and endoscopic tests are also needed.
Cystic fibrosis testing is indicated for childhood nasal polyposis .
- Drug therapy (for small polyps): corticosteroid drugs (to be sprayed into the nose or taken by mouth), antihistamines (for the treatment of allergy-dependent nasal polyps), antibiotics or antifungals (in case of bacterial /fungal superinfections)
- Surgical therapy: Polypectomy or endoscopic sinus surgery
What Is A Nasal Polyp?
Nasal polyps are small benign growths that grow along the nasal mucosa or inside the paranasal sinuses. Generally painless, nasal polyps tend to progressively increase in volume, thus obstructing the airways and hindering normal breathing . It is assumed that nasal polyps are the final result of an inflammatory process of the nasal mucosa, in turn triggered by secondary pathological conditions, such as asthma, recurrent infections, hypersensitivity to some nebulized drugs, allergies or alterations of the immune system .
The curious term “polyp” recalls the appearance that the degenerated naso-paranasal mucosa takes on during this disorder: it appears shiny, clear and soft, just like an octopus.
The nasal polyp is a soft pedunculated edematous manifestation , which can appear in any portion of the nasal mucosa or paranasal sinuses. The inflamed nasal mucosa transforms into a tissue with a gelatinous consistency – similar to that of grapes – and a translucent and pale appearance , giving rise to an excrescence known as a polyp . Nasal polyps are distinguished based on their cellular composition: thus, nasal polyps consisting predominantly of neutrophilic cells
are defined as ” neutrophils “, and ” eosinophils ” when eosinophilic leukocytes represent the main components.
Nasal Polyps: How Common Are They?
Although nasal polyps can appear at any age , adults are certainly the most affected category. It is estimated that 2-4% of the global population suffers from this disorder, with a clear male prevalence (the male female ratio is 2/4:1).
Multiple benign polyposis occurs in patients over the age of 20, and is extremely common in males over forty. In children, however, nasal polyps are a rather rare phenomenon: when they occur in children, it is recommended to subject the patient to a test for cystic fibrosis.
Nasal polyps can recur even after drug or surgical treatment.
Nasal Polyps: What Are The Causes?
The etiolopathological mechanism of nasal polyposis has not yet been demonstrated with certainty. Although nasal polyposis – for many centuries – has been considered a pathological entity in all respects, it is still not possible to draw a definition based on clear and unambiguous assumptions.
However, most researchers hypothesize that nasal polyps are the ultimate manifestation of repeated chronic inflammation on the nasal mucosa. For this reason, it is considered possible that some pathological conditions may predispose the patient to nasal polyposis:
- Cystic fibrosis: nasal polyps in children are a sign of cystic fibrosis
- Chronic rhinosinusitis/sinusitis ( bacterial or fungal)
- Immunodeficiency diseases:
- Churg-Strauss syndrome : it is a systemic vasculitis affecting small blood vessels
- Primary ciliary dyskinesia : congenital disease linked to alterations in the structure and functionality of the cilia of the respiratory mucosa
- Selective IgA deficiency : rather frequent congenital defect affecting the immune system characterized by reduction in plasma levels of IgA
- Connective tissue diseases (rare)
- Immoderate intake of some drugs, in particular aspirin and salicylates
- Chronic inhalation of irritants ( e.g. smoke , smog)
- Alcohol intolerance _
- Infections from Aspergillus , Fusarium or other molds
Nasal Polyps: Symptoms
Symptoms of nasal polyposis occur when the size of the polyps increases to the point that they impede breathing. In this regard, nasal congestion ( stuffy nose ) and breathing difficulty are the two main symptoms of nasal polyposis.
The clinical picture is often complemented by a series of secondary symptoms:
- Altered ability to smell ( anosmia )
- Taste alteration (hypogeusia/ ageusia )
- Facial pain
- Runny nose ( rhinorrhea )
- Eyes watering
- Perception of pressure on the forehead and face
- Itchy eyes
The disease can sometimes be asymptomatic , especially when the size of the nasal polyps is negligible.
In more serious cases, nasal polyps can give rise to serious complications, such as obstructive sleep apnea , spread of the infection to the eye, meningitis , aneurysms and asthma attacks . Given the real risk of a collapse of the clinical picture, it is strongly recommended to seek immediate medical advice in case of serious breathing difficulties , double vision , sudden worsening of symptoms, high fever and significant swelling around the eyes.
However, it is important to underline that serious complications from nasal polyposis are quite rare: in the vast majority of cases, small nasal polyps regress spontaneously or with specific pharmacological treatment. Large polyps instead require surgical excision.