Nasal polyps are soft, non-cancerous growths that develop on the lining of the nasal passages or sinuses, often resembling small, teardrop-shaped grapes. They form as a result of chronic inflammation, frequently linked to conditions like asthma, allergies, or long-term sinus infections. While small polyps may not cause noticeable problems, larger growths or clusters can block the nasal cavity and the openings to the sinuses. This obstruction can lead to persistent symptoms, including difficulty breathing, a reduced sense of smell, facial pressure, and frequent sinus infections, making treatment necessary to restore normal function and quality of life. Treatment typically begins with medical management aimed at reducing inflammation and shrinking the polyps before considering surgical removal.
Shrinking Polyps Without Surgery
The initial approach to managing nasal polyps involves medical therapies designed to decrease inflammation and shrink the size of the growths, potentially avoiding the need for a procedure. Topical nasal corticosteroids, delivered via a spray or rinse, are the standard first line of defense. These medications deliver a localized anti-inflammatory agent directly to the nasal lining, reducing the swelling that causes polyps to enlarge. Regular use can significantly improve nasal breathing and relieve symptoms.
If topical treatments are not effective enough, a short course of oral corticosteroids, such as prednisone tablets, may be prescribed by a doctor. Oral steroids provide a stronger, systemic anti-inflammatory effect that can rapidly reduce the size of the polyps and ease symptoms like congestion and swelling. Due to potential side effects like high blood pressure or cataracts, these are generally reserved for short-term use, typically lasting between one to five weeks.
Beyond steroids, other non-surgical interventions offer additional symptomatic relief. Saline nasal rinses, using a salt and bicarbonate solution, are recommended to irrigate the nasal passages. This process washes away irritants and excess mucus, helping to clear obstruction. Newer treatments, such as biologic medications administered by injection, target specific inflammatory pathways and are used for severe cases that do not respond well to corticosteroids.
Endoscopic Surgery for Removal
When medication fails to adequately shrink the polyps or when the growths cause severe blockage, the definitive method is Functional Endoscopic Sinus Surgery (FESS). This minimally invasive technique is performed entirely through the nostrils. The primary goal of FESS is not only to remove the polyps but also to widen the natural drainage pathways of the sinuses to prevent future blockages.
The surgeon uses a thin, rigid tube called an endoscope, which has a light and a camera lens at its tip, allowing for a magnified view of the nasal and sinus anatomy on a monitor. This visualization is crucial for navigating the complex structures inside the nose. The procedure is typically performed under general anesthesia, ensuring the patient is asleep and feels no pain.
Specialized instruments are passed alongside the endoscope to perform the removal and widening of the sinus openings. For the removal of the soft polyp tissue, a microdebrider is commonly used, which is a powered instrument with a rotating tip that gently shaves and suctions the polyps away. This precise method allows the surgeon to clear the polyps and any associated inflamed tissue while preserving the healthy surrounding structures.
The procedure focuses on opening the sinuses, particularly the narrow channels where the polyps often originate, restoring proper ventilation and drainage. Depending on the extent of the disease, the operation usually takes about an hour, and patients are often able to go home the same day. The mechanical removal of the growths provides immediate relief from the obstruction that was impeding airflow and causing chronic symptoms.
Recovery and Preventing Recurrence
Following the FESS procedure, patients experience symptoms like nasal congestion, mild pressure, and some bloody drainage for the first few days. The surgeon may place dissolvable or non-dissolvable packing in the nasal passages to control bleeding, which is later removed during a follow-up visit. Patients must avoid activities that increase pressure in the nose, such as blowing their nose for at least 10 days, strenuous exercise, or heavy lifting for about two weeks.
The timeline for returning to normal activities varies, but most people can resume light work or daily routines within one week. Full tissue healing takes longer, often spanning six weeks to three months. Saline nasal rinses are important post-operative care, as they help to clear out blood clots, crusting, and debris. This process prevents scar tissue formation and promotes a clean environment for healing.
Preventing the recurrence of nasal polyps is essential because surgery addresses the growths but not the underlying chronic inflammation. Post-operative maintenance involves the continued, long-term use of topical corticosteroid sprays or medicated sinus rinses to keep inflammation suppressed. Regular follow-up appointments allow the specialist to examine the nasal passages with an endoscope and manage any signs of new polyp formation before they become problematic.