Removal of polyps in Sechenov's nose. Removal of polyps in the nose: methods (laser, shaver, loop), conduct, result. Advantages and disadvantages of endoscopic polyp removal

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Removal of polyps in the nose

Discomfort due to difficulty in nasal breathing and associated itching, sneezing, chronic fatigue, fatigue, decreased performance, headaches, difficulty falling asleep at night and waking up in the morning, etc. - such problems are faced by a large number of people around the world . There are many reasons for nasal congestion - it can be a simple runny nose due to an infectious process in the body, and rhinitis (allergic or medication), and sinusitis. As a rule, with proper medical treatment, the patency of the nasal passages is restored. However, there are times when things are not so simple. Nasal polyps are one of them.

Polyps in the nose: what is it

polyps are benign neoplasms arising from swelling and growth of the nasal mucosa and paranasal sinuses.

The disease in which they are formed is called nasal polyposis - this is a chronic progressive process, in the early stages of which the sense of smell is lost, nasal breathing is difficult, and later the nasal passages are blocked. In addition, a person may be disturbed by abundant discharge from the nose.

According to statistics, up to 4% of the total population of our planet suffers from polyposis. At the same time, men are twice as likely to experience this disease.

A nasal polyp, which is how formations in the nose are called in the medical language, easily moves and is practically painless (it is insensitive to touch). In size, polyps can be as small (for example, a pea of ​​5 mm) as large as several centimeters.

Nasal polyps: causes

As a rule, polyposis is a complication of allergic rhinitis and occurs in people suffering from hypersensitivity to airborne allergens. This may be an allergy to plant pollen, house dust, animal hair, fungal spores, etc.

So, reasons may be:

• allergic diseases of the respiratory system: rhinitis, hay fever, asthmatic bronchitis, asthma, etc.;
• Staphylococcus aureus toxins;
• fungal infection of the nasal mucosa;
• the special structure of the nasal cavity, when the nasal passages are too narrow;
• deviated nasal septum, which interferes with breathing and leads to the growth of the nasal mucosa;
• inflammation of the nasal mucosa: frontal sinusitis, sinusitis, ethmoiditis (sinusitis);
• cystic fibrosis - a systemic hereditary disease caused by a mutation of a certain gene, which affects the external secretion glands, disrupts the functions of the respiratory system;
• improper response of the immune system.

Read about correcting a deviated septum:

Stages of the disease

There are three stages of polyposis:

• 1st- less than half of the nasal lumen is closed;
• 2nd- polyps "blocked" a significant part (more than half) of the nasal space;
• 3rd- the nose does not breathe, there is no free space in it.

How to recognize: symptoms

You should be alert for symptoms such as:

• difficult nasal breathing that does not go away for a long time;
• persistent runny nose, mucous or purulent discharge from the nose;
• frequent sneezing (this may be due to the fact that polyps tickle the cilia of the nasal mucosa);
• loss of sensitivity to smells;
• headaches due to difficulty breathing;
• frequent exacerbations of bronchial asthma;
• nasal speech;
• snoring at night.

Is it possible to heal on my own

As a rule, the question “To treat or not?” is not worth it for people with polyps in the nose. However, it is not uncommon for a person to suffer from nasal congestion, unaware of the presence of polyps, and try to improve airway patency with nasal drops. In fact, if this is really polyposis, then no drops from polyps in the nose will help, only the correct treatment prescribed by the doctor is necessary.

If nasal polyps are irregular in shape, hurt and bleed, it is urgent to see a doctor, because they may be an intranasal tumor.

What to do if you suspect polyps

The first thing to do is to contact an ENT doctor for examination and prescribing competent treatment.

If the specialist on the results of the examination suggests an allergic process, the patient is redirected to an allergist. If the initial assumption is confirmed, the patient will be recommended conservative treatment, not surgery. Surgical intervention in this case can only exacerbate the allergic process and provoke the development of bronchial asthma. Of course, this does not apply to cases of advanced polyposis (for example, in the third stage), when the airway is completely impaired. In this case, complex therapy is indicated first, then surgery, after which treatment with anti-inflammatory drugs. Immunotherapy with the use of modern antiallergic drugs and topical corticosteroids can minimize the risk of new polyps and reduce the size of existing ones.

It is important to understand that the above conservative treatment is relevant only for the allergic nature of the disease. If this is not the reason, it is possible to surgically remove polyps even at earlier stages of polyposis.

In any case, the examination, diagnosis and appointment of the necessary treatment is the task of an experienced specialist. For you, the main well-known principle should be - do no harm to yourself. Self-medication is fraught with consequences.

Polyps in the nose: treatment

The modern approach to the treatment of polyposis is a combination of surgical and therapeutic methods. First, neoplasms in the nose are removed by surgical intervention, after which the doctor prescribes anti-relapse treatment.

In the operating room, one of the following polyp removal techniques can be used:

• traditional with a loop and other tools;
• endoscopic using a shaver (debrider);
• laser ("evaporation" of polyposis tissue).

With timely treatment, the patient will be able not only to get rid of such unpleasant manifestations as impaired sense of smell and difficulty in nasal breathing, but also to avoid serious pathologies in the future.

Traditional loop surgery is characterized by pain and high trauma, which leads to bleeding and a long recovery period. Also, the disadvantage of this method is the limited ability to remove some polyps: those that are in the nasal cavity can be removed, but, as a rule, neoplasms originate in the paranasal sinuses and after their removal with a loop after 1-2 years, there is a high risk of relapse.

One of the most minimally invasive and effective methods to date is endoscopic removal of polyps using a shaver or debrider. Benign neoplasms are removed completely, the risk of recurrence is reduced by 50%, healthy tissues are less injured.

Pros and cons of endoscopic surgery

Like any surgical intervention, this method has both its advantages and disadvantages.

Pros:

• no incisions;
• high accuracy due to the control over the progress of the operation on the monitor;
• minimal injury to healthy tissues, provided by the accuracy of devices such as a shaver or debrider;
• minimal bleeding.

Minuses:

• The disadvantage of this method, like others, is the possibility of relapse. Re-growth of polyposis tissue occurs in 50% of patients. In this case, it can only be noted that this occurs several years after a successful operation.

Nasal polyps: surgery

Polypotomy using an endoscope and a shaver (debrider) is a high-precision, low-traumatic and low-pain alternative to the traditional method of removing polyps with a loop. The modern approach allows you to remove polyps with maximum preservation of the sinus mucosa. The main thing is to choose a reliable clinic, where there is an experienced surgeon and appropriate instruments.

During a surgical intervention, an endoscope with a camera is inserted into the patient's nostril, as a result of which the doctor receives an image on the monitor screen and can control the entire operation process. With the help of an endoscope, you can determine the size and number of polyps, their location.

Then a debrider (shaver) is used, which draws the polyposis tissue into its tip and shaves off the neoplasm at the base.

The duration and complexity of the intervention depend on the clinical picture, the number of polyps and whether neoplasms are removed in one or two sinuses.

After removing all the polyps, special tampons are inserted into the nasal passages, which are removed the next morning.

Video

Contraindications

You can not perform surgical removal of polyps from the nose:

• with exacerbation of bronchial asthma, obstructive bronchitis, allergic rhinitis;
• during the period of seasonal hay fever in people who are allergic to pollen;
• with heart failure, coronary heart disease;
• with acute infectious diseases;
• with serious diseases of the internal organs.

An operation is also undesirable for a cold, even a slight malaise, high blood pressure - all this can affect both the course of the surgical intervention itself and the course of the recovery period.

rehabilitation period

The rehabilitation period is aimed at restoring the nasal mucosa. After the tampons have been removed from it, blood accumulates in the nose, a fibrin plaque forms, and crusts form. During this period, DO NOT blow your nose, eat hot food. It is only necessary to very carefully remove the mucus from the vestibule of the nose, as well as the crust.

As a rule, the nose breathes well almost immediately, it can take a month to restore the sense of smell.

Anti-relapse treatment

Since none of the methods excludes the possibility of recurrence of the disease, postoperative appropriate treatment is necessary:

• washing the sinuses of the nose with various pharmaceutical products intended for this;
• taking antihistamines;
• hormonal aerosols (dosed);
• diet (especially during the flowering period of plants that cause allergies).

If the polyps were not the result of an allergy to pollen, after drug treatment, homeopathic and folk remedies can be used for prevention.

These are benign formations from the mucous membrane that gradually grow, making nasal breathing difficult. They are formed both in the nasal cavity and in the paranasal sinuses. Upon closer examination, they look like outgrowths in the form of peas or grapes of a grayish-pearl color. They can be either single or multiple. Depending on the localization, there are choanal polyps, which close the entrance to the nasopharynx from the side of the nasal cavity, and polyps, located directly in the nasal cavity and paranasal sinuses. Basically, polyps grow from the cells of the ethmoid labyrinth, which are located in the upper parts of the nasal cavity.

Polyposis rhinosinusitis (PRS) is a fairly common disease. According to world literature, its prevalence in the population is from 1 to 4%, according to European data (EPOS), it affects from 1 to 6% of the population. In Russia, according to some authors, up to 5 million people suffer from ORS and there is a tendency for the number of detected cases to increase annually.

The main reasons for the formation of polyps

The development of the polyposis process occurs with concomitant diseases:

• Bronchial asthma. In this disease, there is an "aspirin triad of symptoms":
  • bronchial asthma
  • intolerance to non-steroidal anti-inflammatory drugs.
• Cystic fibrosis and Kartagener's syndrome. With the course of these diseases, the movement of cilia located on the apical surface of the mucosal cells slows down. This changes the constant flow of mucus in the nose, causing congestion and chronic inflammation of the mucous membrane, changes in its structure and the formation of polyps.
• Chronic, bacterial and fungal rhinosinusitis. According to studies, with a fungal infection, polyps form in 85% of cases.
• Disturbed structure of the nasal cavity. With a curvature of the septum, chronic vasomotor or hypertrophic rhinitis, the patient's nasal breathing is incorrect: that is, something blocks the path for the air flow, and it changes its direction. There is a constant mechanical load on the areas of the mucous membrane, chronic inflammation occurs, and polyps are formed.

Stages of development of the polyposis process

Symptoms of polyp formation

The most obvious symptoms:

• difficulty in nasal breathing;
• discharge from the nose is mostly mucous, thick. If there is an interaction with an infectious agent and we are talking about purulent-polypous rhinosinusitis, then purulent discharge also occurs;
• headache;
• fast fatiguability;
• decrease in working capacity;
• sleep disturbance, snoring;
• sneezing and itching in the nose.

Methods for diagnosing nasal polyps

Diagnosis begins with an examination by a doctor, followed by video endoscopy. The endoscope allows you to visualize much more than is possible to see with a conventional illuminator. There are also X-ray methods of research: computed tomography, magnetic resonance imaging. They help to see polyps in the nasal cavity and paranasal sinuses.

Features of treatment in children

Polyps are more common in adults than in children. But in childhood, as in any pathology of a chronic nature, doctors show a minimum of radicalism in relation to treatment, surgical treatment is in the background. And if surgery is still required, then it will be minimally invasive. If the child is under 15 years old and he is shown polypotomy, it will be gentle - with a laser, radio waves, endoscope or shaver, without opening the paranasal sinuses.

Children are treated conservatively, in addition to the appointment of local and general drugs, the treatment includes washing the nasal cavity by the method of movement. In the process of washing, allergens, bacteria from the nasal cavity and paranasal sinuses are washed away, and inflammation is reduced.

Conservative treatment of nasal polyposis

Conservative methods of treatment are indicated for patients in the presence of the initial and second stages of polyposis or if there are contraindications to surgical treatment. In addition, after surgery, in order to prevent recurrence, it is necessary to conduct periodic courses of conservative therapy.

In case of illness in children, conservative treatment takes precedence over other methods.

Surgical treatment of polyposis

Polypotomy is an operation to remove polyps, which can be supplemented by surgery on the paranasal sinuses, depending on the indications.

The amount of intervention depends on the localization and prevalence of the process. In the case of the development of polyposis, polypotomy is sufficient only in the nasal cavity. But if there is localization in the paranasal sinuses, then in such cases we are talking about an extended surgical intervention - it is necessary to remove polyps from the paranasal sinuses, which increases the volume of the operation. Such a surgical intervention will be called polysinusotomy in conjunction with polypotomy. During the operation, the surgeon under the control of the endoscope will be produced:

• removal of polyps;
• expansion of fistulas of the paranasal sinuses;
• deleting content;
• opening of the cells of the ethmoid labyrinth.

Contraindications for removal of polyps

• pregnancy;
• severe general somatic condition of the patient;
• bleeding risks leading to profuse blood loss (coagulopathy).

Polyp removal methods

Removal of a polyp loop

The operation is performed under local anesthesia. The main tool is a metal Lange loop, adjustable in width. First, local anesthesia is done, then the loop is put on the polyp and cut off at the base of the leg.

A significant drawback of the operation is that the polyp is not completely removed, because of this there is a high probability of recurrence. Also, during this operation, bleeding is possible, and the operation itself is not painless: when the doctor inserts a loop into the nasal cavity and puts it on the polyp, the loop touches the other walls and nasal septum. For the patient, this can be quite sensitive, despite the effect of local anesthesia.

However, Lange's loop surgery also has advantages. It can be performed under local anesthesia, the operation is budgetary for both the patient and the clinic - hence the prevalence of this method in public health structures.

Radio wave method for removing polyps in the nose

This method of surgical intervention is close to the removal of the Lange loop. But, despite the similarity of the methods, radio wave removal of polyps in the nasal cavity has a greater advantage: at the time of cutting the polyp, the radio wave immediately coagulates the polyposis tissue and reduces the risk of bleeding to zero. Also, the advantages of this operation include the ability to perform it on an outpatient basis and avoid the installation of nasal tampons in the nasal cavity after the operation.

The disadvantage of removing polyps with a radio wave is the risk of recurrence - the polyp is also cut off at the base. Radio wave polypotomy implies the removal of only large and medium-sized polyps.

Laser removal

Laser polypotomy involves surgical intervention under the control of the endoscope. The operation is performed on an outpatient basis and, most often, under local anesthesia. This is the best method for removing polyps in children.

Under the control of the endoscope, a laser knife is brought to the place where the polyp needs to be removed. Further, under the action of a heating beam, it is evaporated and reduced in size.

The advantages of this method are in the speed, efficiency and accuracy of execution. Laser polypotomy has a minimum of contraindications and is available to almost everyone.

Difficulties may arise if there are many polyps and they vary in shape and size. In this case, it will be difficult to remove them all. Another disadvantage is that the impact of laser polypotomy is limited to the nasal cavity. That is, if the formations are in the paranasal sinuses, they are not removed with this method.

All methods are performed without intervention on the paranasal sinuses and their fistulas, but can be supplemented with endoscopic polysinusotomy.

Removal of polyps in the nose with a shaver (endoscopic method)

The endoscopic method is the latest technology. Endoscopy is performed under general anesthesia and, in addition to the thorough removal of polyps, it makes it possible to open all the cells and sinuses of the nose, from where they grow, prolonging remission for years. Before the operation, the patient undergoes computed tomography in order to accurately establish the localization of the process. Careful removal of polyposis tissue from the paranasal sinuses using the endoscopic method, supplemented by polysinusotomy, is a significant advantage over other methods. It allows you to extend the period of remission for years or even for life.

In endoscopy, a shaver polypotomy is used. A shaver or otherwise microdebrider is a tool that has a cutting and suction function. When removed, it cuts the polyposis tissue and sucks it up at the same time. This operation is much faster, since there is no need to evacuate the removed tissue from the nasal cavity. Shaver polypotomy allows you to remove the source of polyp formation. The endoscopic method is the least traumatic for the patient and the most convenient for the surgeon.

Comparative characteristics of methods for removing polyps in the nose

Local anesthesia

In children older than 7 years and adults, it is possible to perform polypotomy under local anesthesia. Before the operation, a sedative is administered intramuscularly to the child. An anesthetic solution (10% lidocaine solution), vasoconstrictor drugs are sprayed or applied to the nasal cavity to relieve swelling from the mucous membrane and a better view. After that, a less concentrated anesthetic solution (2% lidocaine or ultracaine) is injected into the mucous membrane of the nasal cavity to enhance the effect of anesthesia. During the operation, the patient is conscious and perceives everything around. Local anesthesia is indicated only in the case of surgical interventions limited to the nasal cavity - polypotomy.

General anesthesia (narcosis)

In children under 7 years old, polypotomy is performed under general anesthesia, so the intervention takes place without pain and, which is especially important for a child, without psychological stress. The clinic uses drugs of a high safety class, they are non-toxic, do not give complications, so anesthesia is easily tolerated even in childhood and feels like normal sleep. Also, under anesthesia, endoscopic polysinusotomy (FESS) and polypotomy, in case of a large amount of intervention, are performed in children and adults. The type of anesthesia is chosen by the operating doctor together with the anesthesiologist according to indications.

Anesthesiologists

The clinic employs experienced anesthesiologists, specialists from the Children's Clinical Hospital. N.F. Filatov, who have scientific degrees of candidates and doctors of medical sciences. Our specialists use the German Drager anesthetic apparatus, the latest generation of medicines. All this allows for removal under general anesthesia (anesthesia) that is safe for the patient's health with a quick recovery in the postoperative period.

Anesthetics

Anesthesiologists use Sevoran, Diprivan, Esmeron, Enfluron, Isofluran, Dormicum and others. The choice of a specific drug is at the discretion of the anesthesiologist and depends on each specific case, test results and other factors.

Choice of method of removal and anesthesia

The choice of method for removing polyps depends on the indications and contraindications. Before surgery is scheduled, the patient undergoes an examination and does a computed tomography. Next, the doctor carefully examines the location of the process. If it is limited to the nasal cavity and the cells of the ethmoid labyrinth, polypotomy is prescribed under local anesthesia, along with hormonal preparations necessary for remission. If the process is in all paranasal sinuses, a polysinusotomy is performed under general anesthesia.

With contraindications to anesthesia, the volume of the operation is reduced. Surgical intervention will only be aimed at removing polyps from the nasal cavity and improving nasal breathing.

Contraindications may be:

• pregnancy;
• severe chronic (congenital or acquired) somatic diseases.

The decision to perform the operation under anesthesia is made after a thorough examination of the patient together with the therapist and anesthesiologist.

The operation time is interconnected with the prevalence of the process. If this is a single polyp, then under local anesthesia the operation will take no more than 15 minutes, and if the polyposis process is localized not only in the nasal cavity, but also in the paranasal sinuses, the duration of the operation can be one hour or more.

Our clinic uses the best methods of surgical interventions for nasal polyposis and polypous rhinosinusitis:

• radio wave polypotomy
• laser polypotomy
• endoscopic shaver polypotomy (using a microdebrider), if necessary, supplemented by interventions on the paranasal sinuses and their anastomoses (polysinusotomy, FESS-functional endoscopic sinus surgery).

The clinic employs otorhinolaryngologists who are proficient in all methods of surgical interventions. The volume of surgical intervention and the method of anesthesia is chosen by the doctor after examination and careful examination of the patient.

Rehabilitation after polypotomy

The postoperative period depends on the amount of surgical intervention performed on the patient. If a polysinusotomy was performed, then the patient's nasal cavity is plugged to avoid postoperative epistaxis. In the case of endoscopic shaver or laser polypotomy without opening the sinuses, tampons are not needed.

Rehabilitation takes up to one week, with any type of intervention.

With minimally invasive interventions, this period is reduced to 2-3 days, until the convergence of reactive postoperative mucosal edema. After surgery, it is recommended to limit physical activity for 2-3 weeks.

After the operation, topical steroids are prescribed, as a prevention of the resumption of growth of polyposis tissue. Patients with polypous rhinosinusitis should undergo a course of topical steroids several times a year.

Complications due to delayed treatment of polyps

First, complications are possible with bronchial asthma. If polyposis is actively developing and polyps grow, asthma attacks become more frequent and are much more difficult to bear. Secondly, it is a violation of nasal breathing, which adversely affects the entire body. Lack of oxygen leads to the development of chronic diseases. In this case, the person will develop problems with the heart and lungs faster. Also, lack of oxygen leads to chronic fatigue and developmental delay (if the patient is a child).

Polyps contribute to chronic inflammation in the nasal cavity, the rapid penetration of infection into the lower respiratory tract, and even a common cold for a person with polyposis can cause complications.

Very rarely, polyps may degenerate into malignant tumors. But in addition, there are diseases, such as inverted papilloma or other neoplasms of the paranasal sinuses, the symptoms of which pass under the guise of a polyposis process, carrying a significant threat.

Prevention of the polyposis process

The best prevention is a timely visit to a doctor and a comprehensive treatment of diseases that contribute to the possible appearance of polyps. If a person has the slightest violation of nasal breathing, this should be a signal for action. Any violation of the structure of the nasal cavity and a violation of the air flow in it can contribute to the development of polypous rhinosinusitis. People with asthma should visit an ENT doctor at least once a year, undergo an endoscopic examination and, if necessary, have a computed tomography of the sinuses.

The cost of removing polyps in the nose

The cost of removing nasal polyps in our clinic using local anesthesia is from 18,000 rubles beforeRUB 35,000 depending on the complexity of the operation.

Removal of nasal polyps under general anesthesia fromRUB 70,000. The doctor can tell the final cost of the operation by evaluating the amount of work and taking into account the peculiarities of the course of the polyposis process in the patient.

Removal of polyps in the nose with a laser- a minimally invasive operation, during which the destruction of polypous tissue is performed using a laser beam under the control of an endoscope. The indication for intervention is polyposis of the nasal cavity. The technique can be used in patients with bronchial asthma and patients with deviated nasal septum. The intervention is performed in a hospital under local anesthesia against the background of mandatory preoperative therapy and postoperative treatment to prevent recurrence. Removal of polyps in the nose with a laser is carried out without incisions. The formation is destroyed in the region of the stem and removed, the base of the polyp is coagulated.

Polyps are benign growths of the nasal mucosa caused by structural changes in epithelial tissues. The occurrence of polyps is facilitated by allergic diseases (allergic rhinitis, hay fever, bronchial asthma), chronic inflammation of the paranasal sinuses (sinusitis, ethmoiditis, frontal sinusitis), anatomical disorders in the structure of the nasal cavity (narrow nasal passages, deviated nasal septum), etc. As polyps grow, they can block the nasal passages, cause difficulty or complete blockage of nasal breathing, cause constant runny nose or sneezing, purulent or mucous discharge from the nose, headaches, deterioration or disappearance of the sense of smell.

Specialists in the field of otolaryngology use several methods to remove polyps in the nose: using a laser, polyp loop, polypotomy, endonasal endoscopy, radio wave method, cryosurgery and other methods. The advantages of removing nasal polyps with a laser are low invasiveness of the operation, maximum sterility of the laser procedure, minimization of blood loss due to the coagulating effect of the laser, and endoscopic control of the surgical process. The limitations of the method are associated with the number of polyps; in the case of widespread polyposis, polypotomy is more often resorted to.

Indications and contraindications

The need for surgery is due to the possible malignancy of polyps, as well as the constant symptoms that cause and maintain these formations. Excision of polyps in the nose with a laser is indicated in the case of single formations that cause nasal congestion, difficulty in nasal breathing, impaired olfactory function, inflammation in the paranasal sinuses, discharge from the nasal passages, and snoring. The technique can be recommended for patients with bronchial asthma. The flexible light guide of the laser allows the removal of polyps even with a deviated nasal septum.

Contraindications to surgery are bronchial asthma and chronic obstructive bronchitis in the acute stage. Intervention is not performed during pregnancy and during the flowering period of plants that cause allergies. Before surgical treatment, rhinoscopy, CT or radiography of the paranasal sinuses are performed, a study of general clinical blood parameters and a coagulogram is prescribed, and desensitizing preparation is carried out.

Methodology

The procedure for removing polyps in the nose with a laser is carried out in an ENT hospital under local anesthesia and endoscopic control. The otolaryngologist on the monitor assesses the prevalence of the polyposis process. Under optical control, the doctor brings the laser light guide to the polyp. Under the action of a laser, polypous tissues instantly heat up, and coagulation of the mucosal vessels occurs at the same time. The laser has a dual effect: it cuts off dense old polyps like a surgical knife in the base area, and evaporates young polyposis tissues containing enough water. With the help of tweezers, the formations are removed from the nasal cavity. The operation lasts 15-20 minutes. If necessary, additional sessions of laser destruction are prescribed with an interval of 7-10 days.

After operation

Exposure to a laser beam eliminates bleeding and the formation of postoperative scars, and almost immediately improves nasal breathing. After the intervention, an endoscopic quality control of the operation is carried out, drug therapy is prescribed and a consultation with an allergist-immunologist. Removal of polyps does not eliminate the causes of polyposis sinusitis, therefore, relapses are possible in the long term.

The cost of removing polyps in the nose with a laser in Moscow

Excision of polyps using a laser and endoscopic techniques is a modern minimally invasive technique used by doctors of specialized centers and multidisciplinary medical institutions that have otolaryngology departments and have the appropriate equipment. The price of removing polyps in the nose with a laser in Moscow is determined by the organizational and legal status of a medical organization, the level of professionalism of the operating otolaryngologist, and the technical characteristics of laser and endoscopic equipment.

- These are benign rounded neoplasms, which are the result of the growth of the mucous membrane lining the nasal cavity. In appearance, they may look like mushrooms, peas or grapes.

According to statistics, nasal polyps are the most common complication of chronic rhinitis. In the world, according to various sources, from 1 to 4% of people suffer from them, most of the male carriers. They develop growths 4 times more often than women. If we turn to the structure of the outgrowths, then antrochoanal 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 ethmoid labyrinth).

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

Symptoms of polyps in the nose

Symptoms indicating the presence 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 take it for a foreign body and with the help of a sneeze they try to clear their nose;

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, it may be due to an inflammatory process occurring in the paranasal sinuses (in the sphenoid, maxillary, ethmoid labyrinth or in the frontal sinus);

Olfactory dysfunction. With significantly overgrown polyps, a complete loss of sensitivity to odors can be observed. 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 aromas;

Large nasal polyps can affect the taste sensations of the patient and even cause an unpleasant aftertaste in the mouth;

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

Change of voice, development of nasality. 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 directly involved in the formation of speech sounds.

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

The second stage of nasal 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 remain 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 increased 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 a virus or bacterium enters the human body, infectious agents multiply. This provokes the exfoliation of cells of the nasal mucosa. A person begins to suffer from congestion, difficulty breathing, copious nasal discharge. If it functions normally, and the person receives adequate treatment, then in about a week a full recovery occurs.

When the process becomes chronic, local immunity malfunctions, and the mucous membrane, in order to increase resistance to the disease, seeks to increase the occupied areas. The only way to realize this is to start growing and compacting. Most often, this process occurs in the paranasal sinuses. At some point, there is little room for dividing cells, and they go into 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 -, ethmoiditis,;

• 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:

  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 by a 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 tomography that will give information to the surgeon about the volume of future intervention. 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 for clinical analysis is also required. If there is a suspicion of an allergic nature of the growth, then it is advisable to conduct allergic tests.

  All diagnostic procedures are prescribed by an otolaryngologist.

  Answers to popular questions about nasal polyps

  Do nasal polyps need to be removed? Polyps are terrible for their complications, such as sleep apnea, exacerbation of asthma, chronic sinusitis. Surgery is the only way to remove nasal polyps. However, it is worth highlighting such modern methods of removal as laser burning and endoscopic resection with a shaver. As for conservative therapy, it is aimed, first of all, at eliminating the cause of the growth of the nasal mucosa. Therapeutic treatment acts as a preparatory stage before the operation;

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

  Is it possible to treat nasal polyposis without surgery? Treatment without surgery can be aimed at preventing the recurrence of polyps, or if there are specific contraindications to surgery. However, it is important to understand that if a polyp has already formed in the nasal cavity, then 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. This can be a whole range of procedures offered by modern medicine: laser therapy, injection treatment, therapeutic warming, taking medications.

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

  So, conservative treatment is reduced to:

  Exclusion of the influence of provocative factors that have a positive effect on the thickening and growth of the mucous layer. It is important to avoid contact with all kinds of allergens (household, pollen, medicinal, professional);

  Elimination of all infectious and inflammatory processes in the nasopharynx;

  Compliance with a diet with the exclusion of allergen foods, as well as spicy and salty. Coffee and alcohol are banned. It is highly desirable to refuse to take NSAIDs, as well as food containing preservatives, dyes, salicylates;

  Regular rinsing of the nasal cavity using saline solutions, for example, Dolphin, Aqua-Maris, Marimer, Gudvada, Physiomer, Doctor Theiss Alergol, Otrivin-Sea;

  Special gymnastics to restore nasal breathing according to Strelnikova, according to the Buteyko method, independent massage of the trigeminal nerve;

  Antiallergic and immune drug 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 ° C, which leads to the rejection of polyps after about 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:

  Blood clotting disorders;

  Bronchial asthma of severe course.

  Treatment with hormonal drugs is performed if any surgical intervention is 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 treating nasal polyps threatens with a high risk of recurrence.

  In addition, hormone therapy is dangerous for its complications, including addiction, immunosuppressive effect, inhibition of the adrenal glands. The result from the use of hormonal drugs comes very quickly, but after a while the patient will again feel worse. If such therapy is practiced frequently, then a person's health will be undermined.

  Medical polypotomy

  It is necessary to dwell in more detail on the treatment of nasal polyposis with hormones. Most often, doctors use prednisolone 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 was called "medicated polypotomy". However, to achieve a positive effect, the patient will need to take very high doses of prednisolone daily and for a long time. This will get rid of polyps, but will lead to other serious health problems, for example, stomach ulcers, 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. In this way, you can 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 with the help of hormones.

  Removal of polyps in the nose with a laser

  
  

  Burning out growths using a laser beam is one of the modern methods of 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 treatment of polyps in the nose:

  The inability to eliminate multiple growths;

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

  Indications and contraindications for the removal of polyps in the nose with a laser

  Among the contraindications for laser therapy:

  Obstructive bronchitis;

  Multiple polyposis growths;

  The period of 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 injects a local anesthetic, after which 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 the recovery period, it is necessary to exclude alcohol, visit steam rooms and baths, and also refrain from high physical exertion in order to minimize the risk of postoperative development.

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

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

  Endoscopic removal of polyps in the nose with a shaver

  

  Functional Endoscopic Sinus Surgery is a new technology that uses state-of-the-art endoscopic equipment. Thus, surgeons were able to perform a low-traumatic intervention with an extremely low risk of complications. With this procedure, the formation will be completely removed from the body, which reduces the likelihood of re-growth by 50%. In addition, healthy tissues are not affected at all.

  Having decided on such a procedure, preference should be given to endoscopic FESS. It is this operation that allows navigational control of the shaver (or microdebrider) operation. Only this approach allows you to clean the cavities of the lattice labyrinth completely. The importance of a global cleanup is to minimize the risk of recurrence. After all, if areas of polypous tissue remain, then after a short time (from 3 months to six months), it will grow again. As a result, new interventions and financial losses. In addition, attention should be paid to the doctor's experience with such modern equipment.

  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;

  Infections in the acute phase;

  Exacerbations of allergies, bronchial asthma or obstructive bronchitis;

  IHD or heart failure;

  Hypertension, severe malaise requires some delay in intervention.

  Advantages and disadvantages of the method

  Among the advantages of endoscopic treatment of nasal polyps 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:

  The inability to eliminate the true cause of the growth, which leads to 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;

  An optical endoscope with a different level of inclination;

  Headlight;

  Nasal mirrors.

  For the procedure, it will be necessary to introduce the patient into a state of 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 a tissue biopsy. Upon completion of the intervention, the nasal cavity is blocked with cotton swabs. They can be removed after 12 hours.

  Preoperative preparation

  The upcoming intervention needs a certain preparatory program. You should pass all the tests required by the doctor and undergo a computed tomography 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 a preliminary endoscopic examination, which will provide the surgeon with information about the upcoming operation and optimize it.

  One week before the intervention. With severe polyposis, the patient is prescribed prednisone for 7 days. The daily dose is 40 mg. If an active infection is detected, then it must be eliminated. It is important to completely eliminate the intake of non-steroidal anti-inflammatory drugs, aspirin and vitamin E. This is due to the fact that they have a negative effect on the rate 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 are prohibited. If you are thirsty, you can rinse your mouth.

  Postoperative period

  At this time, competent hygiene of the nasal cavity comes to the fore. 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. This becomes a breeding ground for bacteria. After removing the cotton wool in the nose, crusts are formed, consisting of blood, and a plaque of fibrin.

  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.

  In order to prevent re-growth of tissues, you should rinse your nose with saline solutions that were listed above, and also 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.

  No less important for the prevention of relapse diet. It acquires particular relevance during the flowering of plants. Therefore, for this period, you should stop eating potentially dangerous foods, 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.

  
  

  

  Education: In 2009 he received a diploma in the specialty "Medicine" at Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in the specialty "Otorhinolaryngology" (2010)

Microsurgical polypotomy

Microsurgical technique

General anesthesia

Operation time - 10-30 min

Hospital stay - up to 1 day

The cost of the operation: from 8,000 rubles. *

Removal of polyps using modern microsurgical equipment is one of the safest and most effective methods of polypotomy. The procedure is performed using local or general anesthesia, depending on the objective situation and the preferences of the patient. The surgeon introduces a mini-video camera and a radio wave device "Surgitron" into the nasal cavity, with the help of which he removes the polyp along with the leg. The use of microsurgical equipment allows you to fully control the course of the operation and significantly reduce the risk of damage to surrounding tissues. In addition, the surgeon has the opportunity to immediately coagulate bleeding vessels.

Shaver polypotomy

Traditional polypotomy

General anesthesia

Operation time - 40-60 min

Hospital stay - 1-2 days

The cost of the operation: from 5,250 rubles. *

(excluding the cost of anesthesia and hospital stay)

It is used only if it is impossible to use a microsurgical technique, when the patient has contraindications to it. The technique for removing polyps in the classical way is similar to the previous one, however, the surgeon does not have the opportunity to immediately stop the bleeding. Immediately after the procedure, tampons are installed and a bandage is applied. Classical polypotomy is performed in stationary conditions using endotracheal anesthesia. The operation lasts from 40 minutes to 1 hour.

The ENT surgeons of the Center are highly qualified specialists with significant experience in performing classical and microsurgical operations to remove polyps. Thanks to their professionalism, you will get rid of the discomfort associated with nasal congestion in a few days.

* the indicated prices are preliminary and may change if additional services are required, the price also does not include a preoperative examination.