Are Nasal Polyps Painful & Is It Painful To Have Polyps Removed?

A nasal polyp is a kind of tissue growth general found in the nasal sinuses and region lining the nasal mucosa with a characteristic of watery rhinorrhea and mucosal swelling. Nasal endoscopy is commonly used by otolaryngologist i.e. respiratory physician can easily identify the swelling and polyps. The root cause of the disease is unknown and its global prevalence is distinguished to be less than 4% (1). The usually affects adults and geriatric populations, and polyps related to children is mostly associated with cystic fibrosis. Gender wise male is more when compared to female ratio (2:1) (2).

Are Nasal Polyps Painful?

There are many cases of affected individuals who reported the symptoms of pain associated with headaches. According to western countries consensus official report, facial pain is one of the symptoms of chronic rhinosinusitis with nasal polyps (3). Polypolyps without pus has been found with pain among the patients (4). Endoscopic sinus surgery treatment has reduced their pain. The neurological cause is the reason for the pain and pressure among the group of rhinological patients. A tension-type headache like migraine, atypical facial pain, Wegener’s granulomatosis, and Churg–Strauss syndrome are all associated in some cases of polyps as a result of neurological cause (5). Facial pain is seen if there is an acute bacterial infection (6). Pain characterized largely as tender, aching, throbbing, tiring-exhausting, and heavy in chronic nasal polyps patients.

Is It Painful To Have Polyps Removed?

Nasal endoscopic sinus surgery is not a challenging surgical procedure and has a high rate of success. It is commonly done under topical anesthesia with sedation while removing polyps. Hence, no pain is experienced among patients. The patients would remain conscious and can respond or alert the surgeon if any pain or discomfort if they come across, but it occurs in rare cases. Preoperative steroid administration is must to in multi polyps patients to decrease the mucosal edema and for improving visibility during the surgical removal (6).

Postoperative Pain

Endoscopy sinus surgery is the backbone of current treatment for nasal polyps. Postoperative pain is common in all cases which range from mild to moderate because of surgical trauma. But, naturally, it gets resolved after a small period. Nausea sickness is seen as main post-operative difficulties. After surgery, it is necessary to clean the nasal cavity with saline to prevent recurrences. Otolaryngologist usually suggests intranasal steroids for a minimum period to avoid polyp outgrowths. In many cases, revision surgery was done typically after 12 months. Loss of eyesight, impairment to the internal carotid artery, cerebrospinal fluid leakage after inadvertent trauma to the skull base are some of the risk associated with endoscopy sinus surgery(7).

Conclusion

Pain associated with headaches is one of the major symptoms of chronic rhinosinusitis with nasal polyps. Location of pain and diagnosis is difficult in the case of multi nasal polyps. Pain in In chronic rhino polyps, pain is most commonly located around the eyes and characterized as “throbbing” and “aching” (9). Endoscopy sinus surgery is the only choice of current treatment for effective removal of pain associated polypolyps. Because of surgical trauma, postoperative pain occurs from mild to moderate respectively, but not severe.

References:  

  1. Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Hedman J. Int J Epidemiol. 1999 Aug; 28(4):717-22.
  2. Epidemiology of nasal polyps. Settipane GA Allergy Asthma Proc. 1996 Sep-Oct; 17(5):231-6.
  3. Nasal polyposis and facial pain. Clin Otolaryngol Allied Sci. 2001 Dec;26(6):510-3.
  4. Nasal polyposis and facial pain. C. Fahy N.S. Jones. Volume26, Issue6 December 2001, Pages 510-513.
  5. Fahy, C., & Jones, N. S. (2001). Nasal polyposis and facial pain. Clinical Otolaryngology and Allied Sciences, 26(6), 510–513.
  6. Marik P, Varon J. Requirement of perioperative stress doses of corticosteroids. A systematic review of literature.Arch Surg 2008;143(12):1222–6
  7. Surgical treatment of nasal polyps: past, present, and future. Stammberger H Allergy. 1999; 54 Suppl 53():7-11.
  8. DeConde AS, Mace JC, Ashby S, Smith TL, Orlandi RR, Alt JA. Characterization of facial pain associated with chronic rhinosinusitis using validated pain evaluation instruments.
  9. Int Forum Allergy Rhinol. 2015;5(8):682–690. doi:10.1002/alr.21539

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