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ENT

Nasal Polyposis

Separating Myth from Science
Does your nose constantly drip or feel blocked? Are you no longer enjoying the aroma and taste of your favourite foods? You could be suffering from nasal polyps. Dr David Chin, Senior Consultant Ear Nose Throat Surgeon at Ascent ENT Alvernia Holdings Pte Ltd, separates the myths from the facts.

SYMPTOMS AND CAUSES
Nasal polyps are noncancerous yellow grape-like structures in the sinuses and nasal passage, resulting from severe swelling of the mucosal lining of the sinuses due to chronic inflammation. Symptoms range from sinus congestion in mild cases to complete nasal obstruction, a thick nasal discharge and loss of smell in severe cases. Some patients may even have asthma.

Recent research suggests that the chronic inflammation behind nasal polyps could be the result of a build-up of dysfunctional processes in the immune system. This can lead to increased production of inflammatory chemicals, abnormal mucus production and swelling of the tissues lining the sinuses.

Dr Chin shared that many patients worry about cancer when they are told they have nasal polyps. Others have had surgery to remove nasal polyps only to see them return, perpetuating the idea that there is no effective treatment for this condition.

TWO COMMON MYTHS
There are two common misconceptions about the treatment of nasal polyps that make successful treatment elusive, according to Dr Chin. The first is that antibiotics are the most important part of medical treatment. The second is that the goal of sinus surgery is to remove polyps and aspirate pus from blocked sinuses.

Dr Chin shared that nasal polyps often go hand-in-hand with infection.

“In patients with infected nasal polyps, the mucosal lining of the sinuses is not efficient in clearing bacteria, resulting in a vicious cycle of nasal polyposis enabling infection and infection, adding fuel to the fire,” said Dr Chin. While antibiotics may be used to control the burden of bacteria, they do not resolve the underlying inflammatory disorder. To date, there is insufficient scientific evidence that short-term antibiotics are effective in treating chronic sinusitis, with or without nasal polyps1.

Corticosteroids (aka steroids) have powerful anti-inflammatory effects. After a course of oral steroids, patients often improve dramatically and nasal polyps become smaller. The relief, however, only lasts for a few months.

“The problem is that steroids control but do not cure nasal polyps, just as medicines for diabetes mellitus can control blood glucose but cannot cure the underlying problem. Due to the many side effects and risks, oral steroids are not suitable for repeated use over long periods,” said Dr Chin.

For steroids to be used as a regular treatment, they should be delivered directly to the sinuses (topical treatment), thus avoiding exposure to the rest of the body. This is possible once the pathways to the sinuses are opened widely by surgery.

“The goal of sinus surgery in nasal polyposis, therefore, is to achieve the widest access to the sinuses for topical treatments while preserving the vital structures,” explained Dr Chin. “If surgery is done to remove polyps while ignoring this aim, the polyps are likely to recur.”

Fortunately, surgery for nasal polyps can be done entirely through the nostrils – part of a spectrum of operations known as Functional Endoscopic Sinus Surgery (FESS). Following surgery, the patient and ENT specialist work together as a team to prevent the recurrence of nasal polyps. This doctor-patient relationship may last for years. Therefore patients must discuss and agree with their doctor on the treatment strategy before embarking on this journey.

PROMISING NEW TREATMENT
More recently, a new breed of therapeutics known as biologics has joined the fight against nasal polyps. These agents target specific processes in the inflammatory pathway. Administered as subcutaneous injections once a month, they offer hope for patients who relapse despite optimal surgery and medical treatment.

“Scientific research has allowed us to better understand nasal polyposis, to revolutionise the way we perform surgery and devise strategies to control pathways in the disease,” said Dr Chin. “While the cure for nasal polyps is elusive, there are very good options to improve and maintain the quality of life for the vast majority of patients with this condition.”

That’s good news for people with nasal polyps. And hopefully, that elusive cure is not too far away.

This article is taken from our My Alvernia Magazine Issue #45. Click here to read the issue on our website.