Nasal polyps are scientifically called as chronic sinusitis. It is a complex disease involving moderate to severe inflammation in the nasal mucosa and paranasal sinuses. The global epidemiology report is difficult to report because of the variability of this disease. However, in the USA the incidence rate is estimated to 15.5% (1) and one of the important factors to be noted is the period of the nasal polyps among the affected individuals prevails approximately 12 weeks (2). Lack of suitable model is one of the main hurdle and reason to find the precise etiology and pathophysiology of this disease.

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What Leads To Nose Polyps?

Researchers learning all the characteristics of this disease to determine its pathogenesis; several studies say it is a multifactorial disease (3). Though they enlist numerous reasons, its etiology remains unknown. Genetic factor, immunological, environmental, mucosal factor, allergic responses, impaired mucociliary clearance, vitamin D deficiency, immune dysfunction, aspirin sensitivity, impaired epithelial defense, and microbes are some of the factor identified, but further solid evidences or research is necessary to determine their role.

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However, Wang et al., (2005) reported the consequence of genetic factors in the pathophysiology of nasal polyp disease. He identified the gene “cystic fibrosis transmembrane conductance regulator” responsible for mutations which result in cystic fibrosis. Wang et al., reported the high prevalence of nasal polyp in cystic fibrosis (4). Hereditary factor and environmental factor has important role in the pathogenesis of nasal polyps (5).

Another study says that chronic rhinosinusitis with nasal polyp often associated with asthma and allergic rhinitis. But, the key molecular mechanism and the involvement of immunological cells are not fully assumed (6).

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Can Nose Polyps Be Cured?

The condition of this disease can be cured, but it’s challenging and time consuming process. One of the main characters of this disease is development of tissues lining of the nasal passages. It looks like sac-like structure which is challenging to clear up. Decrease in size of the tissue growth or shrink and complete elimination is possible with medications.

Therapeutics. Therapeutics research for nasal polyps is much small. Nasal corticosteroids and oral corticosteroids can eliminate the sac-like tissue growth. Injection of corticosteroids is also recommended if the inflammation is severe. Combination of drug therapy is used to manage the long-term polyps sufferers (7). Some promising future work is carried by scientist on monoclonal antibody (anti-interleukins (IL)) and their role in reducing polyps. Anti-IL has potential role in elimination of eosinophilic cells and polypolyps (9); because, eosinophils cause tissue damage and growth of polyps. Many trail molecules are effective in removal of microbial pathogens involved in the upper airways and sinuses. Antimicrobial peptides, endotoxin-binding molecules, and enzymatic mediators has fundamental role in minimizing the infection rate (10).

Surgery. Endoscopic surgery is also recommended to remove the blockage and polyps. To prevent reoccurrences nasal corticosteroid is treated after surgery. Endoscopic removal of tissues increases the flow of sinuses fluid out (8).

How Can We Avoid Nasal Polyps?

Good hygienic practices, proper management of asthma and allergic diseases, avoiding polluted environments and nasal irritants can decrease the chances of developing nasal polyps.

Conclusion

Nasal polyps is a multifactorial malady. It occurs at any age and male are more affected than females. Genetic factor, immunological, environmental, mucosal factor, allergic responses, impaired mucociliary clearance, vitamin D deficiency, immune dysfunction, aspirin sensitivity, impaired epithelial defense, and microbes are some of the factor identified in cause of the polyps. Complications in sinonasal epithelial cell barrier, and contact to pathogenic bacteria, and dysregulation of the host immune system play noticeable parts in malady pathogenesis. This ailment can be cured, but its challenging and time consuming process. Therapeutics and surgery are supportive in curing the nasal polyps.

References:  

  1. Prevalence of selected chronic conditions: United States, 1990-1992. Collins JG. Vital Health Stat 10. 1997 Jan; (194):1-89.
  2. Settipane G.A. Lund V.J. Bernstein J.M. Tos M. Epidemiology of nasal polyps. In: Settipane G.A., editor; Lund V.J., editor; Bernstein J.M, editor; Tos M., editor. Nasal Polyps: Epidemiology, Pathogenesis and Treatment. OceanSide Publications, Inc.; Providence, Rhode Island: 1997. pp. 17–24.
  3. Genetics of chronic rhinosinusitis: state of the field and directions forward. J Allergy Clin Immunol, 131 (2013), pp. 977-993
  4. Increased prevalence of chronic rhinosinusitis in carriers of a cystic fibrosis mutation Arch Otolaryngol Head Neck Surg, 131 (2005), pp. 237-240
  5. European position paper on rhinosinusitis and nasal polyps 2012 Rhinology 2012 Suppl., 23 (2012), pp. 1-298
  6. Chronic Rhinosinusitis with Nasal Polyps. J Allergy Clin Immunol Pract. 2016 Jul-Aug;4(4):565-72. doi: 10.1016/j.jaip.2016.04.012.
  7. Nasal Polyps, Epidemiology, Pathogenesis and Treatment, edited by G. A. Settipane, V. J. Lund, J. Bernstein, M. Tos. Oceanside Publications Inc., Providence, Rhode Island, 1997
  8. Long-term results of functional endoscopic sinus surgery. Senior BA, Kennedy DW, Tanabodee J, Kroger H, Hassab M, Lanza D. Laryngoscope. 1998 Feb; 108(2):151-7.
  9. Anti-IL-5 treatment reduces deposition of ECM proteins in the bronchial subepithelial basement membrane of mild atopic asthmatics.
  10. Host-microbial interactions in patients with chronic rhinosinusitis. Hamilos DL J Allergy Clin Immunol. 2014 Mar; 133(3):640-53.e4.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: June 17, 2019

This article does not provide medical advice. See disclaimer

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