Nasal Polyps: Fun Times for All



Your nose has been plugged for some time, and one day in your usual habit of picking your nose you discover something you’ve never felt before.   It feels odd, unlike a typical booger, and you panic and scream, “Holy Cow!  I got a tumor!”

After friends and family around the dinner table come to your aid and inspect your nose with their cell phone flash-lights, providing a variety of not-so-helpful advice and making jokes at your expense, your Uncle Allen finally declares, “Yup, that’s one mighty big gray piece of something there, could be your brain or tumor.”  He scratches his arm pit, burps once or twice and continues, “Ya oughtta get that checked out—you might die or something.  Hey, what’s for dessert?”

Relax, nasal tumors are very rare, but Uncle Allen is partially correct in a round-about way.  You ought to get it checked out.

Sometimes this might be a normal structure such as your turbinate or a deflection of your septum.  But sometimes you might have something unnatural such as a nasal polyp.

So what the heck is a nasal polyp? 

Nasal polyps are grayish fronds of tissue that vary I size, caused by sinus inflammation.  Inflammation can be caused by a sinus infection, allergies or a combination of both.  The polyp contains a host of nice stuff like inflammatory cells and edematous soft tissue of which I won’t get into the details.   The vast majority of polyps are benign—malignancy or cancer, though possible, is really quite rare.  Polyps typically arise from the mucosa of the paranasal sinuses (“para-” means “around” and thus paranasal = “around the nose”).  The sinuses are airspaces in the face that empty into the nose.
 
Skull cut-away view showing paranasal sinuses and polyps
And by the way, nasal polyps are not the same as polyps found in the colon; that’s an entirely different disease process altogether.

Symptoms (what a patient experiences) include nasal congestion (nasal plugging or difficulty breathing from the nose), facial, sinus pain or headaches due to sinus involvement, decrease or lack of a sense of smell (which in in turn affects the sense of taste), postnasal drainage (drainage down the throat from the back of the nose), and rhinorrhea (a runny nose), unusual nasal secretions (ie, drainage from the nose that can be clear, yellow, whitish, brownish or green, or a mix of all of these), and sometimes a cough, which can be worse lying down.  Sometimes patients can have asthma symptoms such as wheezing (a noise generated from breathing due to a narrowing of the bronchial tubes), shortness of breath, or cough, related to a phenomenon called the nasal-pulmonary reflex, where inflammation of the nose and sinuses triggers spasming of the bronchial tubes leading to the lungs.
Endoscopic view of left nasal cavity, comparing normal vs. not-so-normal findings.

An examination of your nose is required to determine if you have a polyp or polyps.  The typical appearance is a grayish, smooth mass or tissue appearing as a single roundish-like finding or a multi-lobular mass in the nose.  Often polyps are not seen but discovered far into the sinus during sinus surgery.  As mentioned before, the vast majority are not tumors and not cancerous, but the bodies response to inflammation or infection or both. 

Treatment consists so of medical and surgical therapy, and doctors usually try medical therapy first, leaving surgery as a last resort.  Medical treatment includes steroids, usually nasal sprays used once or twice a day, and sometimes a limited course of an oral steroid taken in pill form.  This helps reduce the size of the polyp(s) to resolve or improve the symptoms.

Surgery is sometimes required usually via an endoscopic sinus surgery.  Most polyps arise from the sinuses and thus surgery of the sinuses to remove polyps and inflamed mucosa is required to treat the source of the disease.  Typically a patient needs a CT scan (Computed Tomography scan) of the sinuses in order to view the sinuses, the extent of sinus involvement, and to guide the surgeon during sinus surgery.  The removed tissue also is sent to the pathologist who will inspect the tissue under the microscope to confirm the diagnosis but also to make sure there is no unusual findings (such as cancer) that might lead to additional treatment.

The main lesson here?  When in doubt about something in your nose, have it checked out by your doctor. 

The second, almost equally important lesson?  Listen to your mother.  Stop picking your nose.  


©Randall S. Fong, M.D.



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