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.

Causes and incidence

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.

Nasal polyps are more common in adults than in children and tend to recur. They’re also commonly seen in patients with long-term allergic rhinitis. About 1 in 4 people with cystic fibrosis have 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 clinical features are usually the same as those of allergic rhinitis.

Diagnosis

Diagnosis of nasal polyps is aided by the following tests:

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

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

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

Treatment

Generally, treatment consists of corticosteroids (either by direct injection into the polyps or by local spray) to temporarily reduce the polyp. A short course of oral corticosteroids (such as prednisone) may be beneficial. Treatment for the underlying cause may include antihistamines to control allergy, and antibiotic therapy if infection is present. Local application of an astringent shrinks hypertrophied tissue. However, medical management alone is seldom 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, sphenoid, and maxillary sinuses and evacuation of diseased tissue.

Special considerations

❑ Administer antihistamines, as ordered, for the patient with allergies. Prepare the patient for scheduled surgery by telling him what to expect postoperatively, such as nasal packing for 1 to 2 days after surgery.

After surgery:

❑ Monitor for excessive bleeding or other drainage, and promote patient 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 — sit the patient upright, monitor his vital signs, and advise him not to swallow blood. Compress the outside of his nose against the septum for 10 to 15 minutes. If bleeding persists, nasal packing may be necessary.

To prevent nasal polyps, instruct patients with allergies to avoid exposure to allergens and to take antihistamines at the first sign of an allergic reaction. Also, advise them to avoid overuse of nose drops and sprays.

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

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Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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