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Nasal Polyps understanding Nasal Corticosteroids & Surgery Options
Nasal polyps may cause no difficulties, or they may be severe enough to need treatment with drugs or surgery. These soft growths appear in the lining of nasal passages. While the most common polypoid grows are not cancerous, a few growths that occur inside the nose that look like polyps, are actually warts that grow in the nose and sinuses. These are called inverting papillomas and can be pre-cancerous and a biopsy is often times recommended. Now we clearly understand which type of nasal growths we are dealing with and what steps need to be taken. Inflammatory polyps, which are most commonly seen inside the nose, can lead to infections, a loss of the sense of smell, and difficulty breathing if they block the nasal passages.
Nasal polyps produce symptoms like chronic stuffiness, headaches, snoring, and pressure in the forehead. If you have these symptoms, doctors use a variety of tests and tools to determine if you have polyps.
The most basic diagnostic tool is simply a physical exam with a light. A more sophisticated form of this is called a nasal endoscopy. The endoscope has a light and a small magnifier or camera on the end of a thin tube. When the tube is inserted into your sinuses, the doctor can easily see if polyps are present.
For polyps that are beyond the reach of an endoscope, you may need a CT scan. This computerized image will let your doctor see what is going on deeper in your sinuses. It also provides a clearer picture of how much inflammation may be present.
Exploring your nasal passages with an endoscope or CT scan also lets your doctor check to see if polyps are really what you are suffering from. Other types of blockages may cause similar symptoms, so it is important to rule those out. If you have abnormalities in the way your sinuses are formed, or God Forbid, if you have cancerous growths, then your treatment options will be different.
After your doctor physically examines your nasal passages, there are other tests that may be run to check for any factors that may be contributing to the formation of polyps.
Allergies may cause your nasal passages to be chronically inflamed, which can lead to polyp formation. A simple skin-prick test on your forearm or back can check for various allergies. Blood tests can also give information about any antibodies to allergens that you have in your bloodstream.
Cystic fibrosis is another condition that may make polyp formation more likely. Cystic fibrosis is inherited, and is most commonly diagnosed by means of a sweat test. This noninvasive test checks for the salt content of the person’s sweat. It is typically saltier in people that have the condition. Cystic fibrosis affects the secretory glands of the body, including those that produce sweat, mucus, saliva, and digestive juices.
A vitamin D deficiency is one more contributing factor to nasal polyps. Any deficiency can be detected with a blood test, so this is a simple factor to rule in or out.
Polyps often go along with chronic sinusitis, which can be difficult to treat. Sinusitis usually requires long-term treatment that tackles symptoms resulting from allergies or other problems that trigger inflammation.
The specific goal of treatment for polyps is to make them smaller, so they no longer block the nasal passages, or to completely get rid of them. This may be accomplished with either drugs or surgery.
Treatment With Medication
Since medications are the least invasive treatment choice, your doctor will usually start here. Drugs have the potential to eliminate even large polyps, so if they work for you, you will not have to move on to surgery.
A nasal spray is often the first option for drug treatment. The spray delivers nasal corticosteroids, which combat the irritation and swelling in your nasal passages. If the corticosteroids shrink or eliminate your polyps, they may be the only treatment you need. These steroid sprays work best when the lining inside your nose is clean and free of thick retained secretions. I always recommend a saline nasal rinse before using the steroid nasal sprays.
Nasal corticosteroids include familiar drugs like Flonase Allergy Relief, Rhinocort, Nasacort and many others.
If a nasal spray is not effective in shrinking or eliminating nasal polyps, the next step is to try an oral form of corticosteroid. A common choice is prednisone. Your doctor may prescribe prednisone in combination with a nasal spray or as a stand-alone treatment. Oral corticosteroids may have unpleasant side effects, so you will usually only use them as a short-term treatment.
When neither nasal sprays nor oral medications give sufficient relief, your doctor may try an injectable corticosteroid.
Aside from corticosteroids, there are other medications that may give you some relief from polyps and chronic inflammation in your nasal passages. For example, dupilumab is an antibody that is often used to treat polyps. This is an injectable medication that can shrink polyps and help reduce sinus congestion.
If your doctor finds that allergies or chronic infections are contributing to your sinus problems, you may be prescribed medications to control these conditions. Antihistamines can battle the swelling and congestion from allergies, and targeted antibiotics can knock out bacterial infections. Reducing the chronic inflammation from allergies or infections is one more step toward eliminating nasal polyps.
Treatment With Surgery
Unfortunately, medications do not always give you the level of relief you need from polyps in your nasal passages. In this case, surgery may be your best option.
Endoscopic surgery uses the same type of endoscope that is used to evaluate your polyps during the diagnostic phase. It is a narrow, flexible or rigid tube that’s inserted into your nasal passages and sinuses. The endoscope has either a magnifying lens or a camera on the end of it and a light that illuminates the nasal cavity.
During endoscopic surgery, small tools are used along with the endoscope. The scope is used to see the nasal cavities, and the tools are used to remove any polyps. If there are other types of blockages in your sinuses, your doctor may be able to remove them, too.
Besides removing specific tissues, like polyps, your doctor may also use endoscopic surgery to generally enlarge the passages from your nasal cavities to your sinuses. This makes you more comfortable and may reduce the risk of recurrence of your symptoms.
Endoscopic surgery may sound unnerving, but it is a minor enough procedure that it is usually done on an outpatient basis and sometimes can even be performed in our in-office surgical suite. Post-surgical care consists of using a saline solution to rinse your nasal passages and clear them of any post-surgical debris. Over the longer term, your doctor may recommend using a nasal corticosteroid spray to help keep your original symptoms from coming back.
Treatments of the Future
Researchers are exploring newer treatments that offer hope for people who do not find relief from either drugs or surgery. These treatments are called biologics such as the prementioned dupilumab or Dupixent.
Biologics are substances that can directly target specific cells or molecules, like proteins, that are responsible for your symptoms. This sort of targeting provides a more precise, effective treatment than general anti-irritants and anti-inflammatories, so researchers hope that it can knock out the toughest cases of nasal polyps.
How to Prepare for Your Doctor’s Appointment
Your first appointment for nasal polyps will likely be with your primary care doctor, but you may be referred to a specialist in ENT disorders for your final diagnosis and treatment. Depending on the specifics of your case, an allergist may be called in, too.
You should be prepared to tell the doctors what your symptoms are and when they started. You should also have a list of any other medical conditions you have and what treatments you may be under. This is especially important if you have allergies or asthma.
If you expect to undergo any tests during your appointment, be sure to find out if you need to prepare. For example, you may need to fast for some duration before the tests.
When your appointment includes a procedure like an endoscopy or endoscopic surgery, be sure you understand what to expect during and after the process. Write down any follow-up appointments that you’ll need. Have your doctor explain how the treatment will affect your symptoms and what you can expect long term. Also ask the team at your ENT doctor’s office to explain any and all fees you may be responsible for accruing during your care. At Sinus and Allergy Wellness Center, we try our best to be as transparent as possible regarding fees and medical costs. Remember everyone’s insurance coverage is different and it is impossible for us to answer for your insurance provider.
With the variety of choices available for the treatment of polyps and inflammation in your nasal passages, your doctor can help you determine the best option for a successful resolution of your case.