Nasal polyps

Benign and edematous growths, nasal polyps are usually multiple, mobile, and bilateral. Nasal polyps may become large and numerous enough to cause nasal distention and enlargement of the bony framework, possibly occluding the airway. They’re more common in adults than in children and tend to recur.

Causes

Nasal polyps are usually produced by the continuous pressure resulting from a chronic allergy that causes prolonged mucous membrane edema in the nose and sinuses. Other predisposing factors include chronic sinusitis, chronic rhinitis, and recurrent nasal infections. Approximately 1 in 4 people with cystic fibrosis has nasal polyps.

Signs and symptoms

Nasal obstruction is the primary indication of nasal polyps. Such obstruction causes anosmia, a sensation of fullness in the face, nasal discharge, headache, and shortness of breath. Associated signs and symptoms are usually symptomatic of allergic rhinitis.

Diagnosis

The following tests are used to diagnose nasal polyps:

❑ X-rays of sinuses and nasal passages reveal soft-tissue shadows over the affected areas.

❑ Examination with a nasal speculum shows a dry, red surface, with clear or gray growths. Large growths may resemble tumors.

Nasal polyps occurring in children require further testing to rule out cystic fibrosis and Peutz-Jeghers syndrome.

Treatment

Generally, treatment consists of a corticosteroid (either by direct injection into the polyps or by local spray) to temporarily reduce the polyp. Treatment of the underlying cause may include an antihistamine to control allergy and antibiotic therapy if infection is present. Local application of an astringent shrinks hypertrophied tissue. However, medical management alone is rarely effective.

Consequently, the treatment of choice is polypectomy, which is usually performed under a local anesthetic. The use of surgical lasers is becoming more popular. Continued recurrence may require surgical opening of the ethmoid and maxillary sinuses and evacuation of diseased tissue.

Special considerations

❑ If the patient has allergies, administer an antihistamine as needed.

❑ Prepare the patient for scheduled surgery by telling him what to expect postoperatively — for example, nasal packing for 1 to 2 days after surgery.

After surgery:

❑ Monitor the patient for excessive bleeding or other drainage, and take steps to promote comfort.

❑ Elevate the head of the bed to facilitate breathing, reduce swelling, and promote adequate drainage.

❑ Change the mustache dressing or drip pad, as needed, and record the consistency, amount, and color of nasal drainage.

❑ Intermittently apply ice compresses over the nostrils to lessen swelling, prevent bleeding, and relieve pain.

❑ If nasal bleeding occurs — most likely after packing is removed — have the patient sit upright, monitor his vital signs, and advise him not to swallow blood.

CLINICAL TIP: Compress the outside of the patient’s nose against the septum for 10 to 15 minutes. If bleeding persists, nasal packing may be necessary.

❑ For more postoperative patient-teaching information, see Nasal polyps: Recovering after surgery. 

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Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Handbook of Diseases, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

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