Causes of polyps in the nose and treatment. Nasal polyps: how dangerous are they and how best to treat them? Symptoms and photos

Nasal polyps are benign formations, which are formed from the mucous membrane of the paranasal sinuses and in appearance resemble bunches of grapes. Nasal polyps in adults are predominantly found in men: 2-4 times more common than in women.

The advanced form of polyps can become serious illness, because the sense of smell is lost, the nasal passages are closed, the openings of the paranasal sinuses are blocked, which contributes to the development of inflammation and other diseases of the ENT organs. That is why it is very important to start treatment in a timely manner.

About what contributes to the appearance of polyps, what are their symptoms and how to treat polyps in the nose will be discussed in this article.

Stages of development of nasal polyps:

first stage: polyps in the nose are closed only upper part nasal septum;
second stage: the connective tissue grows strongly and overlaps most spaces in the nasal septum;
third stage: polyps cover the entire space.

Causes of nasal polyps:

allergic process;
fungal infection;
improper metabolism of arachidonic acid;
disruption of the paranasal sinuses and the entire nasal cavity;
chronic inflammation with secretions of pus;
salicylic acid intolerance syndrome;
cystic fibrosis.

Polyps in the nose. Symptoms and signs.

The main symptom is nasal congestion. Polyps squeeze blood vessels and disrupt the blood supply to the tissues, so they, the tissues, become more susceptible to infection, and as a result, there are frequent inflammations of the pharyngeal (adenoiditis) and palatine tonsils (chronic tonsillitis, tonsillitis), as well as inflammation of the middle ear (otitis media).

Loss of smell is also one of the main symptoms of nasal polyps. Violation of the sense of smell occurs due to the fact that the polyp blocks the proportion of the nasal mucosa responsible for the sense of smell, and if the disease is started, even the operation will not be able to return the perception of smell.

In the event that the polyps in the nose are large, the voice becomes nasal. The opening of the auditory tubes may also close, resulting in impaired speech formation and hearing loss.

Nasal polyps in children easy to identify: open mouth, drooping lower jaw and smoothed nasolabial folds. Prolonged difficulty breathing can lead not only to a change in the shape of the face and dental system but also to abnormal development of the chest.

Dangerous presence of nasal polyps in infants, because sleep and sucking are disturbed, which leads to inflammation of the bronchi and lungs, malnutrition and weight loss.

In older children and adults, there is headache arising due to circulatory disorders, there is a violation of the gastrointestinal tract, appear poor appetite, vomiting and diarrhea.

So, the symptoms of polyps in the nose are:

difficulty in nasal breathing;
runny nose and sneezing;
headache;
fatigue;
impaired sense of smell;
nasal discharge.

Diagnosis of polyps in the nose.

Detection of polyps does not present great difficulties: for this, an x-ray is performed or CT scan(CT) of the paranasal sinuses, which allow you to determine the degree of damage.

It is worth noting that the final diagnosis is made after an instrumental examination (posterior rhinoscopy) and palpation of the nasopharynx with a finger.

Polyps in the nose. Treatment.

Treatment of nasal polyps can be conservative or surgical.

Conservative treatment includes:

treatment of infectious diseases of the nose and paranasal sinuses;
treatment, which consists in eliminating factors that stimulate the growth of nasal polyps: exclusion of contact with household, pollen, medicinal, epidermal and occupational allergens; fungal and infectious agents; the exclusion of all non-steroidal anti-inflammatory drugs, as well as foods containing natural salicylates, food additives and dyes;
drug treatment with local anti-inflammatory drugs, antihistamines, membrane stabilizers mast cells or antibiotic therapy;
immunocorrective therapy;
specific immunotherapy with non-bacterial or bacterial allergens.

In case if cure nasal polyps conservative methods treatment fails, resort to surgical treatment, which has the following indications:

gross violations of the function of breathing through the nose;
purulent-inflammatory processes of the nose and paranasal sinuses.

Preparation for the operation.

Operational nasal polyp removal includes Exploratory survey patient, and in particular, a blood test is done, general and biochemical analysis. Tell your doctor about all the drugs you are taking this moment medicines to report chronic diseases of cardio-vascular system, if any. In addition, you should talk about the presence of allergies to drugs, food and plants.

Operation.

Removal of polyps in the nose is carried out under general anesthesia, and the essence of the operation is to excise the polyp with a laser or a surgical instrument.

Note that during the operation, the paranasal sinuses are washed, which helps prevent the recurrence of nasal polyps. Injected into the nasal passages to stop bleeding gauze swabs which are removed after a few days.

After the removal of polyps, antibiotics are prescribed for the purpose of prevention and infectious complications.

Complications after surgery:

bleeding;
infectious complications;
adhesions and adhesions in the nasal passages;
recurrence of nasal polyps.

Nasal congestion - main feature nasal polyps. The fact is that the blood vessels are compressed by polyps, as a result of which the blood supply to the tissues is disrupted. Because of this, tissues are more susceptible to infections, resulting in the occurrence of private inflammation of the pharyngeal and palatine tonsils(tonsillitis, chronic tonsillitis), as well as inflammation of the middle ear (otitis media).

Signs of polyps in the nose

The fact of loss of smell will also testify to polyps in the nose. The sense of smell is disturbed due to the fact that polyps block the part of the mucous membrane in the nose that is responsible for the sense of smell. If nothing is done, then it will be difficult to restore the sense of smell even with the help of surgical intervention.

If the polyps in the nose are large, then the person begins to nasalize. In addition, in some cases, the opening of the auditory tubes is closed, which leads to impaired speech and hearing problems.

In children, polyps in the nose can be easily detected: a slightly open mouth, smoothed nasolabial folds, sagging of the lower jaw. Difficulty breathing for a long time leads not only to a change in the dental system and the shape of the face, but also to a violation in the development of the chest.

It is very dangerous if polyps in the nose occur in baby, because his sucking and sleep begin to be disturbed, which causes inflammation of the lungs and bronchi, weight loss and malnutrition.

In adults and adolescents, there is a pronounced headache that occurs due to impaired blood circulation. There may be irregularities in gastrointestinal tract, there are vomiting, diarrhea, poor appetite.

The main symptoms of nasal polyps include:

Headache;
sneezing and runny nose;
Difficulty nasal breathing;
Weakness and fatigue;
Discharge from the nose;
Smell disturbance.

Nasal polyps are benign, round, and painless lesions that occur due to an overgrowth of the nasal mucosa. In appearance, they look like peas, bunches of grapes.

Nasal polyps are the most common complication chronic rhinitis. About 3-4% of the population suffers from nasal polyposis. According to statistics, more than 70% of patients are men. In adults, antrochoanal polyps most often occur, in children - ethmoidal.

The disease is manifested by abundant mucous secretions and constant nasal congestion. If the patient uses vasoconstrictor drops, breathing will not improve, so the person has to constantly breathe through the mouth, resulting in dry air entering the lungs that is not sufficiently cleaned of allergens and dust. This, in turn, causes respiratory diseases. As a result, polyposis can shorten a person's life by several years.

Causes of nasal polyps

In development infectious diseases the mucous membrane becomes a breeding ground for various microorganisms, due to which it begins to exfoliate upper layer sheath cells. During this, a burning sensation in the nose, congestion begins to occur in a person, the voice changes. Mucous discharge is observed, which is the result of the active work of the mucous glands, and exudate (a fluid formed during inflammation). With normal immunity and proper treatment complete recovery occurs in 7-14 days. The mucous membrane is restored and performs its functions again.

If the treatment of the disease is not carried out, then it is usually delayed and goes into chronic form. A prolonged inflammatory process adversely affects the immune system and the functioning of the mucous membrane, which tries to normalize the performance of its functions by increasing the area. As a result of this, the mucous membrane grows and thickens due to the growth of connective tissues. Often this process is observed in the paranasal sinuses. After some time, the overgrown (hyperplastic) mucous membrane begins to emerge into the nasal cavity from the opening of the pachus. This is called a polyp.

Causes of polyps:

Persistent infections and colds that are accompanied by a runny nose;
Allergic rhinitis due to inhalation house dust, animal hair, fungal spores, plant pollen, odors household chemicals etc.;
Chronic sinusitis(frontal sinusitis, ethmoiditis, sinusitis and other inflammations of the paranasal sinuses);
A severely deviated nasal septum that interferes with normal breathing and leads to the growth of the mucous membrane;
Hereditary tendency to the occurrence of polyps;
Pathological reactions immunity.

Some diseases affect the occurrence of polyps: cystic fibrosis, asthma, nasal mastocytosis, aspirin intolerance, Young's syndrome.

According to the place of localization, polyps are divided:

Ethmoid. The development of polyps comes from the mucous membrane that lines the ethmoid labyrinth. Appear on both sides of the nasal septum. Characteristic for adults;
Anthrochoanal. Appear from the maxillary sinus mucosa. Located on one side. Characteristic for children.

From the size of polyps and the changes caused by them, it is customary to divide three stages:

The first - only a small part of the nasal space is closed by polyps;
The second is active growth. connective tissue, which covers almost the entire lumen of the nasal cavity;
The third is complete blockage of the respiratory passage.

Risk factors for nasal polyps

Any disorder that causes chronic inflammation in the nasal passages and sinuses can be the cause of nasal polyps. Such violations include:

Asthma. A disease that causes narrowing and inflammation of the airways;
Fungal allergic sinusitis;
Allergic reaction to aspirins or other painkillers (naproxen, ibuprofen, etc.);
Cystic fibrosis. The result of this genetic disorder is the secretion and production of viscous and thick mucus in organism;
Churg-Strauss syndrome. Enough rare disease which causes inflammation of the blood vessels.

Many scientists suggest that certain genetic characteristics of the body may make a person more prone to developing nasal polyps.

Possible complications due to nasal polyps:

Exacerbation of asthma;
Obstructive sleep apnea. Enough serious violation in which breathing often stops during sleep;
Sinus infections. Nasal polyps make a person susceptible to sinus infections, which can be recurrent or chronic;
The infection can spread to the eye sockets, leading to swelling of the eyes, reduced mobility of the eye muscles, loss of visual acuity and blindness;
Formation of blood clots (aneurysms). Nasal polyps interfere with blood flow in the veins that surround the sinuses, leading to blood clots and increasing the chance of a stroke.
Meningitis. The infection spreads to the fluids and membranes that surround the spinal cord and brain.

If you managed to get rid of nasal polyps, then you need to immediately take measures to prevent them.

Avoid exposure tobacco smoke and others chemical irritants. Try to avoid getting dust into Airways. Do not forget about the rules of hygiene, ventilate and humidify the room in which you are most of the day, rinse your nose with solutions. It is best to completely eliminate the use of spicy and salty foods, alcohol and coffee. Watch your diet. Give preference to fresh natural products. Include fish in your diet vegetable oils, dairy products. Minimize your salt and sugar intake. Drink carrot juice and viburnum berries.

Go in for sports, do gymnastics in the morning. Massage of the trigeminal nerve, which is located on the side of the wings of the nose, is also recommended. At these points, you need to scroll your fingers 10 times in one direction and in the other. Just the trigeminal nerve is responsible for the efficiency of the nasal cavity.

Nasal polyps are benign growths round shape, which are the result of the growth of the mucous membrane lining the nasal cavity. If we compare these formations in appearance with other bodies, then they may look like mushrooms, like peas, or like bunches of grapes.

According to statistics, these formations are the most frequent complication rhinitis chronic nature. In the world, according to various sources, from 1 to 4% of people suffer from them, most of their carriers are male. They develop growths 4 times more often than women. If we turn to the structure of the outgrowths, then anthrochoanal polyps predominate in children (formed from the mucous membrane lining the maxillary sinuses), and in the adult population, ethmoid polyps (formed from the mucous membrane lining the ethmoidal labyrinth).

The main danger of having polyps in the nose is that, if left untreated, they can shorten the patient's life by 6 years. The fact is that any vasoconstrictor drops will not be able to facilitate nasal breathing with polyps. For this reason, a person will have to breathe through his mouth all the time, which significantly increases the risk of developing various diseases respiratory tract, and also increases the likelihood of developing asthma.

Symptoms of polyps in the nose

Symptoms indicating the formation of polyps on the nasal mucosa are as follows:

Breathing through the nose is either difficult or impossible. A person experiences a feeling of constant congestion. Such difficulties are due to the fact that the tissues of the mucous membrane have grown and blocked (either completely or partially) the respiratory lumen of the nasal passage.

When a secondary infection joins, the mucous glands begin to work hard. For this reason, the patient has increased mucus production, in advanced cases it may have purulent impurities.

The person starts sneezing more often. This protective reaction of the body is explained by the fact that the polyp irritates the cilia that cover the walls of the nasal mucosa. They mistake it for a foreign body and try to clear their nose with the help of a sneeze.

Headache. They are due to a number of factors. First, the body, including the brain, begins to suffer from a lack of oxygen. Secondly, significantly overgrown formations put pressure on the nerve endings, causing a natural pain reaction. Thirdly, headache may be due to inflammatory process flowing into paranasal sinuses nose (in the sphenoid, maxillary, ethmoidal labyrinth or in the frontal sinus).

Olfactory dysfunction. With significantly overgrown polyps, there may be a complete loss of sensitivity. This symptom is due to the fact that the overgrown connective tissue disrupts the functioning of the receptors that are responsible for the perception of odors.

Overgrown polyps can affect the taste sensations of the patient, cause an unpleasant aftertaste in the mouth.

IN childhood education can cause the formation of malocclusion. If a polyp appears in a child in the first year of life, then this makes it difficult for him to feed, since he cannot suck and swallow food normally. As a result, the baby suffers from chronic malnutrition, which leads to weight loss and general malnutrition.

Voice changes, nasal development. As a result of the fact that the flow of air through the nasal passages is disturbed, the patient begins to speak through the nose. In addition, it is known that the nose is the organ that is involved in the formation of the voice.

The severity of symptoms depends on what stage the growth is in:

At the first stage, the outgrowth is small, therefore, it covers only the upper nasal septum. The patient experiences a slight nasal congestion, which is often perceived as a normal ARVI. However, already at the initial stages, a polyp can provoke the development of otitis media, tonsillitis or adenoiditis.

The second stage of polyposis is characterized by further growth of connective tissue. The patient begins to experience difficulties with smell, his voice changes, nasality is acquired. When the formation reaches the auditory tube, speech begins to be distorted, hearing deteriorates. If you do not seek help at this stage, pathological changes may stay forever.

The third stage is characterized by complete blockage of the nasal passage, the symptoms are gaining full strength. When the infection is attached, the body temperature rises. In addition, patients suffer from headaches, from fatigue. The quality of life is significantly reduced by constant discharge from the nose.

Causes of polyps in the nose

Before turning to the enumeration of the causes leading to the appearance of polyps, one should understand the mechanism of their occurrence. When it enters the human body viral infection the multiplication of pathogenic microorganisms. This provokes the exfoliation of cells of the nasal mucosa. The person begins to suffer from congestion, difficulty breathing, nasal discharge. If the immune system is functioning normally and the person is receiving adequate treatment, then in about a week there will be a complete recovery.

When the process is chronicized, local immunity fails, and the mucous membrane, in order to increase resistance, seeks to increase the occupied areas. The only possibility- to realize it - to begin to grow and condense. Most often, this process occurs in the paranasal sinuses. At one point, there is little space for the mucosa, and it enters the nasal cavity, and a polyp is formed.

Therefore, the specific reasons leading to the growth of the nasal mucosa are:

Infections and colds that are accompanied by a runny nose and occur quite often;

Chronic inflammation occurring in the paranasal sinuses - frontal sinusitis, ethmoiditis, sinusitis;

Runny nose allergic origin(hay fever);

Diseases such as: bronchial asthma, cystic fibrosis, Young's syndrome, Churg-Strauss syndrome, nasal mastocytosis, Kartagener's syndrome, aspirin intolerance;

Hereditary predisposition to polyposis;

Too narrowed passages of the nose, violations in the structure of the nasal septum;

Pathological failures in the immune defense.

That is, nasal polyps are a polyetiological disease, which is influenced by the anatomy of the nose, chronic inflammation of its sinuses and allergies.

Why are nasal polyps dangerous?

The danger of the growth of the nasal mucosa in the first place lies in the development of complications. When natural breathing through the nose is not hindered in any way, moistening and warming of the air entering the lungs occurs. In addition, dust particles are removed from it, which remain on the mucous membrane, and then are naturally excreted. Polyps do not allow air to pass freely through the nasal passage, which forces a person to breathe through the mouth.

As a result, the air does not have time to warm up properly, which provokes diseases such as:

Pneumonia;

Laryngitis;
Pharyngitis;

Laryngotracheitis.

As a result of the fact that there is a violation of the natural communication between the sinuses, the patient suffers from chronic sinusitis.

The larger the growth, the more it presses on the blood vessels of the nasopharyngeal tissue, thereby causing inflammation of the tonsils and the formation of adenoids, an increase in the palatine tonsils with symptoms of angina. Also, circulatory disorders can lead to the development of a clinic of chronic tonsillitis. As for violations of the auditory tube, the increased pressure on it leads to the development of otitis media or eustachitis.

Diagnosis of a polyp in the nose

To suspect that the patient has a polyp in the nose, the doctor can nasal voice even if the patient himself does not complain of difficulty in nasal breathing. If a polyp is formed in childhood, then the very appearance of the child will tell the doctor about this. In such children, the mouth is constantly open, the lower jaw droops, the folds of the nasolabial triangle are smoothed out.

To clarify the diagnosis, a rhinoscopy is performed, during which the doctor examines the nasal cavities using a special mirror. Polyps outwardly represent fleshy grape-like or single growths.

To assess the stage of their development, a CT scan of the paranasal sinuses is sometimes prescribed. This procedure is mandatory for those patients who are scheduled for surgery. It is the results of the tomogram that will give information to the surgeon about the volume of the future operation. If a CT scan is not possible for any reason, then the patient should undergo an x-ray.

In addition to identifying the presence of polyps, co-infection should be ruled out or confirmed. To do this, bakposev is taken from the nose and throat, pharyngoscopy, otoscopy and microlaryngoscopy are performed. Blood sampling is also required clinical analysis. If there is a suspicion of allergic nature origin of growth, it is advisable to conduct allergic tests.

All diagnostic procedures appointed by an otolaryngologist.

Answers to popular questions

Do nasal polyps need to be removed? Polyps are terrible for their complications, such as sleep apnea, exacerbation of asthma, sinus infections. Surgical intervention is the only way removal of nasal polyps. However, it is worth highlighting such modern ways removal, such as laser removal and endoscopic removal shaver. Concerning conservative therapy, then it is aimed, first of all, at eliminating the cause of their growth. It is carried out as a preparatory stage before the operation.

Is it possible to warm polyps in the nose? It is impossible to heat polyps. It is not only absolutely effective procedure, but to some extent even dangerous, since the risk of burns of the mucous membrane is high. It should not be confused with the removal of a polyp by thermal action using quartz fiber. This procedure is performed by a doctor in a hospital setting.

Is treatment possible without surgery? Treatment without surgery can be aimed at preventing the recurrence of polyps, or if there are specific contraindications to its implementation. However, it is important to understand that if a polyp has already formed in the nasal cavity, it will not be able to eliminate itself without surgical intervention.

Treatment of polyps in the nose

Conservative therapy of nasal polyposis is intended, first of all, to eliminate those factors that influence the increased growth of the mucous membrane. It could be whole complex procedures offered by modern medicine: laser therapy, injection treatment, therapeutic heating, medication.

Only a surgeon-otolaryngologist can choose the optimal treatment regimen. Sometimes required additional consultation allergist-immunologist.

So, conservative treatment comes down to:

Exclusion of the influence of provocateur factors that have positive impact thickening and growth of the mucous layer. It is important to exclude contact with all kinds of allergens (household, pollen, medicinal, professional).

It is necessary to eliminate all infectious and inflammatory processes in the nasopharynx in a timely manner.

It is important to follow a diet, with the exclusion of allergen foods, as well as spicy and salty foods. Coffee and alcohol are banned. It is highly desirable to stop taking NSAIDs, as well as food containing preservatives, dyes, salicylates.

Regular rinsing of the nasal cavity using saline solutions is useful, for example, Dolphin, Aqua-Maris, Marimer, Gudvada, Physiomer, Allergol Dr. Thais, Otrivin-More.

Helps to restore nasal breathing gymnastics proposed by Strelnikova, breathing according to the Buteyko method, self massage trigeminal nerve.

Antiallergic and immune correction.

Another way to treat polyps without surgery is thermal exposure, when the formations are heated with a quartz fiber inserted into the nose. The temperature at the same time reaches 70 degrees, which leads to the rejection of polyps, after an average of three days. If the patient is not able to blow their nose on their own, the doctor will remove exfoliated polyps with tweezers.

Such treatment is advisable to carry out if a person has the following contraindications:

Hypertension;

Heart failure;

Blood clotting disorders;

respiratory failure;

Bronchial asthma of severe course.

Treatment hormonal drugs performed if any surgical intervention completely excluded. In high doses, the patient receives oral corticosteroids for 3 weeks. Or they are injected directly into the growths. However, this method of treatment threatens with a high risk of relapse.

Besides, hormone therapy dangerous for its complications, including addiction of the body, immunosuppressive effect, inhibition of the adrenal glands. effect from hormonal drugs comes very quickly, but after a while the patient will again feel worse. If you practice such therapy often, then human health will deteriorate significantly.

Medical polypotomy

It is necessary to dwell in more detail on the treatment of polyposis with hormones. Most often, doctors use prednisone for this. Its action is based on a decrease in the rate of cell division, which prevents the mucous membrane from sagging further, and the outgrowth itself is destroyed over time. This technique is called drug polypotomy. However, in order to achieve positive effect, the patient will need to take very high doses of prednisolone daily and for a long time. It will get rid of polyps, but will lead to others serious problems with health, for example, to a stomach ulcer, to obesity, a drop in immune forces, etc.

Therefore, there is another option for polypotomy with the help of hormonal agents - this is their introduction directly into the outgrowth itself. Thus, it is possible to achieve the destruction of the polyp and avoid serious complications from taking hormones inside. The choice of a specific drug and its dosage is carried out for each patient individually.

The patient is given up to two injections with an interval of two weeks. This contributes to the death of the overgrown tissues of the mucous membrane, and it is removed from the body during blowing. If the technique of conducting medical polypotomy was not violated, and the dosage and the drug itself were chosen correctly, then this will lead to a significant improvement in the patient's well-being after 30-60 days.

A well-designed rehabilitation program will delay the next recurrence of the disease for several years. Unfortunately, it is impossible to completely eliminate the risk of re-growth of the mucosa.

Removal of polyps in the nose with a laser

Removal of overgrowth using a laser beam is one of the modern methods surgical intervention. It is carried out using laser equipment, as well as an endoscope with a camera.

Among the advantages of laser treatment:

The speed of the operation;

The absence of severe pain;

No risk of bleeding during surgery;

No risk of infection;

Visual control of performed actions;

Low probability of recurrence of the disease;

Short recovery period (no more than 4 days);

The possibility of an outpatient procedure.

Among the disadvantages of laser polyp treatment:

The inability to eliminate multiple growths;

The impossibility of opening the sinuses and removing the polypous tissue inside them, which can provoke a relapse.

Contraindications and indications for the removal of polyps in the nose with a laser

Among the contraindications for laser therapy:

Obstructive bronchitis;

Multiple polyposis growths;

bearing a child;

Flowering season of plants.

The indication for intervention is a single nasal polyp with concomitant symptoms. In addition, low trauma makes it possible to perform surgery in patients suffering from bronchial asthma.

How is the operation going?

On the day when the procedure is performed, the patient must refrain from eating. The essence of the operation is as follows: the doctor introduces local anesthetic, after that, an endoscope equipped with a camera, as well as laser equipment, is brought to the site of the existing growth. The beam heats the cells of the polyp and they begin to evaporate. Bleeding does not occur due to instant sealing of blood vessels (coagulation).

After the operation is completed, the person remains under medical supervision for another day, although sometimes he is allowed to go home after a few hours. Over the next 4 days, he needs to visit a doctor so that he controls the healing process of the nasal mucosa. During recovery period it is necessary to exclude alcohol, visit steam rooms and baths, and also refrain from high physical activity to minimize the risk of postoperative bleeding.

How much does the procedure for laser removal of polyps in the nose cost?

In a particular clinic, the cost of conducting laser removal will vary. But on average, the price is 16,000 rubles, which makes it quite affordable for the majority of the population.

Endoscopic removal of polyps in the nose with a shaver

Sinus surgery using a functional endoscope (Functinal Endoscopic Sinus Surgery) is latest technology with state of the art endoscopic equipment. Thus, surgeons were able to perform a low-traumatic intervention with extremely low risk the development of complications. With this procedure, the formation will be completely removed from the body, reduces the risk of re-growth by 50%. In addition, healthy tissues are not affected at all.

There are several options for performing an intervention using endoscopic equipment:

Endoscope + instruments (does not allow cleaning out the smallest cells, as well as those that are deeply located);

Endoscope + shaver;

Endoscope + shaver + navigation (optimal method).

However, despite all the advantages of such an intervention, it is impossible to implement if:

Serious violations of the internal organs;

Infection in the acute phase;

Exacerbations of allergies, bronchial asthma or obstructive bronchitis;

IHD or heart failure;

SARS, hypertension, malaise require some delay in intervention.

Advantages and disadvantages of the method

Among the advantages of endoscopic treatment with a shaver:

No need for incisions, the procedure is performed endonasally;

Full control of the doctor's own actions;

Gaining access to hard-to-reach areas of the nose;

Absence of traumatization of healthy tissues;

No bleeding;

The rapid onset of relief, which is claimed by up to 80% of patients;

Implementation of the operation in a hospital, a short stay in the hospital ward (from 3 days to a week).

Among the shortcomings of the procedure:

Impossibility to eliminate true reason the occurrence of growth, which causes the risk of its reappearance (in 50% of cases).

How is the operation going?

The field where the intervention will take place is observed by the doctor on the monitor. To implement the procedure, the doctor will need:

The shaver itself (debrider or microdebrider), which will draw in the outgrowth and cut it off at the very base;

Optical endoscope with different level inclination;

Headlight;

Nasal mirrors.

The procedure will require the introduction general anesthesia, as this makes it possible to fully open the anastomosis, as well as improve drainage. Although the recovery time after the operation is somewhat longer than with other methods of polyp removal, the risk of recurrence in this case is much lower. If it does occur, it is significantly delayed in time.

When the anesthesia kicks in, a special plastic tube will be inserted into the patient's mouth to allow them to hold their breath. The nasal sinuses are opened with the help of special tools, then all polyps and modified tissues are removed from them. During FESS, there is an excellent opportunity to correct the nasal septum if it is curved, as well as to perform tissue biopsy. Upon completion of the intervention nasal cavity overlaps cotton swabs. They can be removed after 12 hours.

Preoperative preparation

The forthcoming intervention needs some preparatory program. Pass all the tests required by the doctor and undergo a CT scan of the sinuses. In addition, a coagulogram, blood tests for biochemistry and the clinic may be prescribed. It is important to determine the need for prior endoscopic examination, which will give the surgeon information about the upcoming operation and optimize it.

One week before the intervention. With severe polyposis, the patient is prescribed prednisone for 7 days. Daily dose is 40 mg. If an active infection is detected, then it must be eliminated. It is important to completely exclude the use of non-steroidal anti-inflammatory drugs, aspirin and vitamin E. This is due to the fact that they have bad influence on the quality of blood clotting.

One day before the operation. The patient can have dinner, but the food should not be heavy. When 6 hours remain until the moment of intervention, then any food and drink is prohibited. If you are thirsty, you can rinse your mouth.

Postoperative period

At this time, comes to the fore competent hygiene nasal cavity. The fact is that after the intervention, the activity of the ciliated epithelium decreases, the mucosa is damaged and unable to produce a protective secret in full. It's getting favorable environment for bacterial growth. After removing the cotton wool, crusts, blood and fibrin deposits form in the nose.

You can only remove the crusts that are on the eve of the nose, it is strictly forbidden to blow your nose or eat hot food. The success of the operation is evidenced by headache and pain in some facial areas. The sense of smell can be restored within 30 days.

In the postoperative period, complications may develop: bleeding, polyp recurrence, adhesion formation and infection.

To prevent re-growth of tissues, rinse the nose saline solutions, which were listed above, as well as use antihistamines, including: Loratadin, Claritin, Tsetrin, Zodak, Erius, etc.

In addition, the use of hormone-based aerosols is necessary:

Baconase

beclomethasone

Rinoclenil

Flixonase

Asmanex
Aldecin
Nasonex.

Diet is equally important for preventing relapse. It acquires particular relevance during the flowering of plants. Therefore, for this period, you should stop eating potentially hazardous products such as nuts and seafood.

The patient must visit the attending ENT doctor every 12 weeks. This must be done throughout the year. Besides, supervision at the allergist-immunologist is shown.

A nasal polyp, polyposis or polyps in the nose is a polyp-like growth of the mucous membrane of the nose or paranasal sinuses, often accompanied by an allergic rhinitis.

Since a runny nose is the main symptom of the disease, the disease is more often called polypous rhinitis, polypous rhinitis. It occurs more often in adults, the disease reaches its peak after 50 years.

Half of people with polyps suffer from chronic upper respiratory diseases, diseases bronchopulmonary system, have tumor formations of other organs. It should be noted that polyps in children are much less common, usually their appearance is hereditary.

Polyps may occur in maxillary sinuses and in the ethmoid labyrinth (ethmoidal). The maxillary sinuses are more often disturbed on the one hand and are detected in children. Ethmoid polyps appear on both sides, more common in adults.

Why do they appear

The reasons for the appearance of polyps in the nose are still unknown. With a greater degree of probability, we can say that the development of the disease is triggered by several causal factors simultaneously.

The main mechanism for the formation of polyps is an increase in the number of secretory glands. Experiments have shown that when the upper layer of the mucosa (epithelium) is damaged, it ruptures, edema and infiltration, middle layer mucosa, or mucosa proper.

As a result, it protrudes through a hole in the epithelium. And if the epithelium does not fully recover, then a polyp is formed from the mucosa itself, and glands that produce mucus are already growing on it.

Possible reasons

The growth of eosinophils in the blood, which is observed with allergies, allergic rhinosinusitis. The disease often occurs in allergic rhinitis, allergic, infectious and atopic bronchial asthma.
One hypothesis states that nasal polyps are caused by fungi in the surrounding air. Fungi enter the nose, after which eosinophils are sent to the mucous membrane to destroy pathogenic fungi. As a result, eosinophils produce toxic proteins that damage the mucosa, causing chronic inflammation, swelling, and polyp growth.
Some researchers do not exclude the role of bacterial infection.
Stimulation immune system staphylococci.
Secondary immunodeficiency.
Anatomical disorders of the ostiomeatal complex (anterior part of the middle turbinate).
It is possible that nasal polyps in a child are the result of a frequent viral infection.
It is possible that they appear in response to intolerance to non-steroidal anti-inflammatory drugs (Ibufen, Paracetamol, Ketorolac, etc.)
Autonomic imbalance nervous system(vegetative-vascular dystonia, migraine, etc.).

Polyps that appear in the nose have nothing to do with polyps of the uterus, colon. However, it has been observed that they are more common in people who have such hereditary diseases of the respiratory system as cystic fibrosis, Jung's syndrome, Kartagener's syndrome, mucosal immovable cilia disease.

Symptoms

More often, the disease occurs in the form of a chronic runny nose, while several additional symptoms can be noticed.

Nasal polyps symptoms:

Nasal congestion. The degree of congestion depends on the number and degree of growth of polyps. They grow rapidly and can completely block the nasal passages, causing their complete obstruction;
A person has attacks of a runny nose along with sneezing, snot flows from the nose, mucous, mucopurulent. Basically, a runny nose appears on dust, pollen and other allergens;
If the polyps began to grow in the nasopharynx, then the discharge may drain down back wall pharynx;
Violation of the sense of smell, sometimes it disappears completely;
Sinusitis (sinusitis, ethmoiditis);
Headaches of varying intensity, appear due to the development purulent complications polyposis, insufficient oxygen supply to the brain;
Facial pain or a feeling of constriction, which is aggravated by a runny nose.
People complain about the bad general state, sleep disturbance, heaviness in the head, decreased mental and memory abilities.

Attention, if the polyps are irregular in shape, hurt and bleed, you need to urgently seek medical help, it may be a malignant tumor.

Diagnostics

To make a diagnosis, the doctor examines the patient's complaints, examines the nose in the nasal mirrors, conducts a nasal endoscopy, examines the respiratory and olfactory functions. Polyps look like edematous areas of pale or pale pink, are practically insensitive, are more often found on both sides of the middle nasal passage.

The disease is widespread, therefore, the diagnosis of sinusitis, ethmoiditis, frontal sinusitis and sphenoiditis is often confirmed at the examination. All patients in whom polyps are detected for the first time, and those who need surgical treatment performed computed tomography (CT). It is performed from several sides.

How to treat

Given the fact that the causes of the disease are numerous and poorly understood, the approach to treatment in different patients is very different - one is enough to be treated with drops in the nose and pills, the other needs surgical and therapeutic treatment, the third will be helped or assisted only by operation.

Principles of treatment:

Eliminate polyps and runny nose.
Restore breathing through the nose and smell.
Prevent relapse.

First you need to eliminate the factors that stimulate the growth of polyps. Therefore, contact with pollen, fungal, household, medicinal and professional allergens should be avoided, food containing a lot of dyes and flavors should be excluded from the diet, aspirin and foods that are rich in salicylates should not be consumed - tomatoes, apples, raspberries, strawberries, oranges, grapes, currant.

Infections of the nose and paranasal sinuses should be treated.

Medications

Drugs, the effectiveness of which is beyond doubt, which has been repeatedly confirmed by clinical studies - glucocorticosteroids. This is the only medicine that can really slow down the growth of polyps, prolong remission with polypous rhinitis, polypous sinusitis.

The preparations clearly and effectively relieve inflammation and the reaction of the immune system, reduce the swelling of the mucous membrane, the sensitivity of the nose to mediators allergic inflammation and physical stimuli.

Drops. initial stage nasal polyposis without severe nasal congestion is treated with nasal glucocorticosteroids in the form of drops and spray:
- Baconase;
- Nasobek;
- Tafen;
- Nazacort;
- Sintaris;
- Flixonase;
- Nasonex.
Drops must be used in postoperative period after the removal of polyps, but only after the complete or almost complete completion of the healing process, because hormones slow down the healing of tissues, contribute to bleeding, the formation of crusts.
Pills. Tablets can be used both separately and together with intranasal glucocorticosteroids. Indications for treatment with tablets:
- if drops and sprays do not help;
- severe nasal congestion;
- before surgical treatment;
- in the postoperative period;
- if there are contraindications to the operation, but it is needed;
- if soon after the operation the symptoms of polyposis reappeared.
Contraindications:
- untreated fungal, bacterial and viral diseases nose and paranasal sinuses;
- mucosal ulcers.
As tablets, it is better to take Prednisolone, it is recommended to choose tablets with a protected shell. They can be replaced with Dexomethasone injections. But courses of hormone treatment can be carried out no more than twice a year. It is forbidden to give injections to the site of polyp growth; cases of severe life-threatening complications are known.

Nasal lavage

To relieve symptoms, it is allowed to rinse the nose with saline solution with the addition of soda. It is not necessary to buy expensive sprays based on sea and ocean water. The nose should be washed during bouts of runny nose and colds. WITH preventive purpose- several times a day.

Antibiotics

If the level of IgE is not elevated, then in some situations it is possible to use antibiotics for a course of 4 or more weeks. Antibiotics always take place during exacerbation of sinusitis, purulent course of the common cold.

Physiotherapy

Physical procedures are not specific, used for treatment chronic rhinitis and sinusitis, including polyposis.

Procedure names:

infrared laser;
helium-neon laser;
magnetotherapy;
intranasal and intrasinus microwave treatment;
intranasal electrophoresis with drugs
for the treatment of polypous sinusitis, the Yamik catheter method should be used. With its help, it is very easy to deliver the medicine into the sinus.

It is difficult to say which of the methods is more effective, because they help each patient in different ways.

Operation

Polyps are treated surgically. The operation will not cure the disease, it will only relieve nasal congestion for a while, create access to medicines for polyps that are in the paranasal sinuses. In 70% of cases, polyps reappear.

Indications:

ineffectiveness of conservative therapy;
persistent nasal congestion.

Contraindications:

exacerbation of bronchial asthma, obstructive bronchitis;
flowering period of causally significant allergens at the time of surgery or postoperative period.

The operation lasts less than an hour, can take place both under general and local anesthesia carried out through an endoscope. The recovery period after surgery is several weeks.

Folk methods

IN clinical research on patients, the effectiveness of herbal medicine has not been proven. For people with allergies, treatment with plants is completely contraindicated.

But, if there is no allergy, then to improve the healing processes, it is possible to drip juice of sea buckthorn berries, oil infusion from celandine, combined drops from ledum, St. John's wort and propolis into the nose, rinse the nose with infusion of milkweed or horsetail.

Polyps in children and adults are diagnosed and treated the same way. But when treating children, one must be especially vigilant, since the disease can lead to serious chronic ailments that significantly disrupt the life of a child from an early age.

Benign neoplasms on the nasal mucosa are the most common complication of chronic rhinitis. According to statistics, from 2 to 4% of the total population of the planet face them. This problem may for a long time do not make itself felt by any symptoms, because it is quite difficult to diagnose. However, on final stages the symptoms of polyps in the nose are quite pronounced, most often you can get rid of them only with the help of surgery.

Why do tumors form?

Science has not yet found a definite reason for the appearance benign neoplasms, but she knows the mechanism of polyp growth. When pathogenic organisms often multiply in the upper respiratory tract, the mucous membrane reacts to them with a runny nose, so it removes from the body pathogenic microflora and protect it from infection.

However, if you do not treat a cold or constantly come into contact with allergens that cause hypersecretion of the mucosa, it will begin to deplete. To perform their functions, cells turn on natural defenses, they begin to grow. The replacement tissue is the nasal polyps. They may have different shape and size from a few millimeters to 4 cm. According to the location, it is customary to divide neoplasms into:

Ethmoid - most common in adult patients, salient feature of these tumors lies in the fact that they are based on the ethmoid mucosa of the nose and affect two of its sides at once.
Anthrochoanal - found mainly in children, located on the maxillary sinuses and most often only on one side.
Choanal - the rarest species, in terms of location it is similar to anthrochoanal polyps, but its peculiarity lies in the fact that the cause of development is a retinal cyst.

Features of neoplasms

Nasal polyps can have a variety of symptoms, but when they first appear, the patient may not feel anything at all. This is due to the peculiarities of the structure of neoplasms. In the early stages, they are quite small and invisible to the naked eye, especially if they grow in the paranasal sinuses. These are small, painless outgrowths. They are soft to the touch, look like jelly, can move easily, do not bleed and do not cause any discomfort to the patient at the beginning of the development of the disorder.

However, later nasal polyposis acquires unpleasant symptoms. Although the tumors remain insensitive, they may bleed, especially if the size is quite large.

Purulent and bloody issues from the nose are also a clear sign of illness, they constantly disturb the patient, no nasal sprays and drops help. People who are prone to the appearance of polyps should be especially vigilant about their well-being, this category includes patients with such diseases:

Signs of the disease

Nasal polyps begin to disturb the patient from the very beginning of the development of the disorder, but we don’t even think about how to determine their presence. The reason for this phenomenon is a good disguise of the disease, it can look like a common cold.

Constant nasal congestion does not particularly bother the patient, he uses vasoconstrictor drops and even at first feels some relief. Lightweight but constant runny nose- this is the first symptom of the disease.

There are also other signs of polyps in the nose, which we will consider in more detail.

Respiratory failure. The polyp causes a constant runny nose, due to nasal congestion, a person is forced to breathe through his mouth. This is very dangerous, as dry and unclean air enters the lungs. Allergens present in it can aggravate the patient's condition, insufficient moisture leads to drying of the bronchial mucosa, which causes a painful dry cough.
Anosmia is the loss of the sense of smell. It can be complete or partial when nasal polyps develop. This is due to the fact that in the neoplasm the work of receptors that perceive odors is disrupted. It is sometimes difficult to restore the former sensitivity even after a special operation.
Sneezing. This is a natural defense of the body, which is activated when foreign bodies enter the upper respiratory tract. A large polyp can irritate the cilia of the mucous membrane, it perceives it as a foreign body, and tries to remove it from the body with the help of sneezing.
Discharge from the nose. A runny nose in the first stage of polyposis is no different from a cold, except that it worries the patient all the time. Later, an admixture of pus and even blood appears in the mucus, which indicates the accession secondary infections which will be difficult to treat.
Headache. A large neoplasm can compress the nerve endings, which leads to a constant headache. This symptom can also cause oxygen starvation because the cells of the body cannot normally receive air through the nose.
Pain around the eyes. Especially often this symptom is manifested in antrochoanal polyps. Since the tumors are located in the paranasal sinuses, they can put pressure on the eyes, especially brightly. discomfort pronounced on pressure on the skin. With advanced disease, it may even be difficult to move the eyelids.
Sensation of a foreign body. The patient may feel a large polyp if it comes into contact with healthy areas of the mucosa. This is somewhat reminiscent of the presence of dried mucus in the nose, but mechanical cleaning does not provide any relief.
Loss of taste sensations. An overgrown neoplasm can affect not only the sense of smell, but also taste buds. This is due to a violation of the functions of receptors in hypertrophied mucosal tissue.
Hearing problems. A large polyp can partially or completely close the entrance that leads from the nasopharynx to auditory tube. This results in deafness or total loss hearing.
Problems with speech. In young children, polyps can cause speech developmental disorders. If the disease is found in an adult, then a nasal voice appears, the patient constantly says “in the nose”.
Snore. During sleep, the polyp can partially or completely block the nasal passage, which causes the appearance of characteristic sounds when inhaling and exhaling. In some cases, even a short-term cessation of the patient's breathing during sleep (sleep apnea) is possible.
Permanently open lower jaw. As the polyp gets bigger, it not only makes nasal breathing difficult, but impossible. This leads to the fact that a person is forced to breathe through his mouth, because his lower jaw constantly sags.
Change facial skull and dental system. Most often, such severe symptoms occur in children, as their bones are still being formed. A constantly open mouth leads to the fact that nasolabial fold smoothed out, the bite is disturbed, and sometimes there is even misdevelopment chest.
Fast fatiguability. In the presence of a polyp, breathing is disturbed and, as a result, the supply of oxygen to all cells. This leads to insufficient working capacity of the brain and muscles, a person cannot normally engage in either mental or physical activity.
Disorder of appetite and digestion. Appetite disappears due to the lack of taste sensations and smells, also from chronic fatigue. Indigestion is observed most often with the addition of secondary infections, because pathogenic microbes can penetrate the gastrointestinal tract.

Where to go

As soon as you find at least one of the symptoms, immediately go to an appointment with an otolaryngologist. This is a specialist who deals with the diagnosis and treatment of all diseases of the ear, nose and throat. With the help of endoscopy and rhinoscopy, the patient is examined, these methods allow you to visually evaluate the picture.

The doctor will also prescribe additional tests, these may be allergy tests, a blood test, a test for cystic fibrosis ( genetic predisposition to the appearance of cysts).

The hardware methods for identifying the problem include magnetic resonance and computed tomography, as well as radiology. These diagnostic measures help the doctor know the size, number, and location of the growths, even if they are not visible with an external examination.

After evaluating all factors and studying clinical picture The ENT chooses a method to fix the problem.

Forecasts

Depending on what method of treatment the doctor chooses, and on the characteristics of the patient's body, polyps may disappear forever or for long time. Most often, relapse occurs. This can be caused by individual predisposition and misdiagnosis.

If therapy was aimed not only at eliminating neoplasms, but also at treating the diseases that led to their appearance, then the risk of recurrence of tumors is minimal.

To consolidate the results obtained from treatment, doctors recommend that patients take a course homeopathic medicines or use folk remedies to prevent reoccurrence of the violation. Also, the patient must completely protect himself from diseases that can cause the growth of the mucosa. To do this, follow these rules:

maintain local immunity, walk more often in the fresh air;
vitaminize the diet;
eat more cereals, legumes, cereals;
take immunity-healthy foods such as honey, milk, etc.;
avoid hypothermia, always dress well in the cold season;
do not visit crowded places during epidemics;
do not contact with patients, so as not to get infected yourself;
protect yourself from negative impact allergens;
to refuse from bad habits;
fully rest;
playing sports, it tempers the body well.

Possible Complications

If you do not adhere to all these rules and do not go on time to preventive examinations to the ENT, polyps can give serious complications. This is the acquisition of new concomitant diseases, and joining severe infections, and other violations, up to a lethal outcome.

Untimely treatment of neoplasms can lead to the following consequences:

Let's summarize

The presence of polyps in the nose is quite difficult to recognize in the early stages, but it is quite possible if you follow the changes in the body well. If you find any signs of the disease, you need to go to the doctor and undergo a course of treatment, otherwise very serious complications may occur.

Go through preventive examinations in the ENT room on time and do not ignore medical care in case of illness, it will help to maintain health.