Nasal polyps are not a common disease. It is usually seen in patients with chronic rhinosinusitis. True polyps are not cancer, just an abnormal sac-like tissue growth with pink color characteristic and fluid discharge. Rarely pain and pus associated with this disease and the reason for inflammation are still yet to be analyzed. Hay fever, drug particularly aspirin sensitivity, chronic sinusitis, microbial infections, cystic fibrosis, genetic factor are seen in patients with nasal polyps.

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How Do You Detect Nasal Polyps?

Diagnosis requires experiences and patients must get suggestion from respiratory physicians or otorhinolaryngologists. They are physicians who specialize in the treatment and management of diseases of the ear, nose, throat, and related bodily structures.

Nasal Endoscopic Test. It is a technique to look inside the nasal cavity and sinus region with the help of a thin flexible tube connected with light and camera. Endoscopes are inserted directly into the organ (minimal invasive) for physical and general examination of polys which is more enough for identification of the disease. Typically, this technique takes a minute for the diagnosis of polyps. During surgery, otorhinolaryngologists use this endoscopy for surgery to remove polyps without harming nearby tissues.

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Straightening the septum, removing blockage and polyps, clearing the major outflow pathway of the sinuses and opening of the ethmoid sinuses can be done with nasal endoscopy techniques.

The appearance of the turbinates, presence/absence of purulent secretions, yellow sub-mucosal nodules, septal perforation, crusting, and granulations in nasal polyps are diagnosed easily by nasal endoscopy techniques (1).

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Imaging Studies. CT scan (computerized tomography) studies can reveal the location of the polyps particularly when it is small in size. Swelling and large inflammation in deeper areas can be evaluated with the image. Structural abnormalities related to benign polypolyps are accurately measured by CT scan (2) and MRI techniques (3). It helps to distinguish between benign nasal polyps from malignancies form. The shape of the multiple clustered, single nodular, and single large lobulated are well diagnosed.

Allergy Test. Allergy test is done to diagnose allergies contributing to chronic inflammation of polyps. Skin prick test or biopsy analyze can show the allergy-causing agents (4). Biopsy of nasal polyp tissue in the US has revealed the hyper level of allergic reactions caused by eosinophils. Patients with nasal polyps and asthma often susceptible to allergens. Aspirin hypersensitivity and allergic fungal sinusitis are common in the cause of nasal polyps.

Blood Test And Routine Laboratory Investigations. Full blood count, differential white cell count, c-reactive protein, anti-neutrophil cytoplasmic antibodies (Wegener’s granulomatosis), thyroid function and thyroid auto-antibodies, nasal smear, and microbiological examination of sputum and sinus swabs help to determine the nasal polyps in patients (5).

Can Nasal Polyps Bleed?

One of the important presenting symptoms of polyps is, an obstruction seen in the nasal cavity. It remains to be constant but can vary depending on the position and size of the polyps. Bleeding is rarely observed in nasal polyps (6). During nasal endoscopy surgery, bleeding occurs and it is the surgeon duty to minimize the bleeding to avoid complications. Risk of vascular, orbital and intracranial complications, as well as procedural failure, are all noted in endoscopy sinus surgery. There are cases presenting post-surgical bleeding which increase the discomfort among patients.

Conclusion

The diagnosis of nasal polyps is based largely on symptoms with confirmation by nasal endoscopy techniques. Computerized tomography scans and magnetic resonance imaging can also support the diagnosis, but literature studies say it is abnormal largely among one-third of the population and hence many physicians not recommend for routine diagnosis (7). Histopathology, blood test and other immunological and routine biochemical test useful for analysis of this disease.

References:  

  1. Fergie N, Jones NS, Havlat MF. The nasal manifestations of sarcoidosis: a review and report of eight cases. J Laryngol Otol 1999; 113:893–8
  2. Jones NS. CT of the paranasal sinuses: a review of the correlation with clinical, surgical and histopathological findings. Clin Otolaryngol Allied Sci 2002; 27:11–7.
  3. Cooke LD, Hadley DM. MRI of the paranasal sinuses: incidental abnormalities and their relationship to symptoms. J Laryngol Otol 1991; 105:278–81
  4. Nasal polyps treatment: medical management. Mygind N, Lildholdt T Allergy Asthma Proc. 1996 Sep-Oct; 17(5):275-82.
  5. Fukase S, Ohta N, Inamura K, Kimura Y, Aoyagi M, Koike Y. Diagnostic specificity of anti-neutrophil cytoplasmic antibodies (ANCA) in otorhinolaryngological diseases. Acta Otolaryngol 1994; 511 (Suppl.):204–7.
  6. Newton JR, Ah-See KW. A review of nasal polyposis. Ther Clin Risk Manag. 2008;4(2):507–512. doi:10.2147/tcrm.s2379
  7. BSACI guidelines for the management of rhinosinusitis and nasal polyposis

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Sheetal DeCaria MD

Written, Edited or Reviewed By:

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Last Modified On: June 17, 2019

This article does not provide medical advice. See disclaimer

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