Introduction
Nasal polyps are associated with irritation and swelling of the lining of your nasal passages and sinuses. It is mostly inflammatory in nature. It forms a polyp when the inflammation lasts more than 12 weeks (chronic sinusitis). However, it’s possible to have chronic sinusitis without nasal polyps.
Nasal polyps themselves are soft and lack sensation, so if they’re small, there will not be any symptom. Multiple growths or a large polyp may block the nasal passages and sinuses.
Signs & symptoms
- Postnasal drip
- Running nose
- Stuffed feeling inside the nose
- Decreased or absent sense of smell
- Loss of sense of taste
- Facial pain or headache
- Pain in upper teeth
- A sense of pressure over the forehead and face
- Snoring
- Frequent nosebleeds
Causes
- Asthma
- Aspirin sensitivity
- Allergic fungal sinusitis
- Cystic fibrosis
- Bronchial asthma
- Allergic rhinitis
- Chronic rhinosinusitis
- Primary ciliary dyskinesia
- Alcohol intolerance
- Young syndrome
- Nonallergic rhinitis with eosinophilia syndrome (NARES) – Nasal polyps in 20% of patients with NARES
- Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis)
- Vitamin D deficiency
Pathophysiology
The exact pathogenesis of nasal polyposis is unknown. Polyp development has been linked to chronic inflammation, autonomic nervous system dysfunction, and genetic predisposition. The swelling occurs in the fluid-producing lining (mucous membrane) of the nose and sinuses. There’s some evidence that people who develop polyps have different immune system responses and different chemical markers in their mucous membranes than those who don’t develop polyps. Most theories consider polyps to be the ultimate manifestation of chronic inflammation; therefore, conditions leading to chronic inflammation in the nasal cavity can lead to nasal polyps.
Most studies suggest that polyps are associated more strongly with nonallergic disease than with allergic disease. Statistically, nasal polyps are more common in patients with nonallergic asthma. Several theories have been postulated to explain the pathogenesis of nasal polyps, one of them is Bernstein’s theory. In Bernstein’s theory, inflammatory changes first occur in the lateral nasal wall or sinus mucosa as the result of viral-bacterial host interactions or secondary to turbulent airflow. In most cases, polyps originate from contact areas of the middle meatus, especially the narrow clefts in the anterior ethmoid region that create turbulent airflow, and particularly when narrowed by mucosal inflammation. Ulceration or prolapse of the submucosa can occur, with reepithelialisation and new gland formation.
During this process, a polyp can form from the mucosa because the heightened inflammatory process from epithelial cells, vascular endothelial cells, and fibroblasts affects the bioelectric integrity of the sodium channels at the luminal surface of the respiratory epithelial cell in that section of the nasal mucosa. This response increases sodium absorption, leading to water retention and polyp formation.
Other theories involve vasomotor imbalance or epithelial rupture. The vasomotor imbalance theory postulates that increased vascular permeability and impaired vascular regulation cause detoxification of mast-cell products (eg, histamine). The prolonged effects of these products within the polyp stroma result in marked edema (especially in the polyp pedicle) that is worsened by venous drainage obstruction. This theory is based on the cell-poor stroma of the polyps, which is poorly vascularized and lacks vasoconstrictor innervation.
The epithelial rupture theory suggests that rupture of the epithelium of the nasal mucosa is caused by increased tissue turgor in illness (eg, allergies, infections). This rupture leads to prolapse of the lamina propria mucosa, forming polyps. The defects are possibly enlarged by gravitational effects or venous drainage obstruction, causing the polyps. This theory, though similar to Bernstein’s, provides a less convincing explanation for polyp enlargement than the sodium flux theory supported by Bernstein’s data. Neither theory completely defines the inflammatory trigger.
Patients with Cystic Fibrosis have a defective small chloride conductance channel, regulated by cyclic adenosine monophosphate (cAMP), which causes abnormal chloride transport across the apical cell membrane of epithelial cells. The pathogenesis of nasal polyposis in patients with CF could be associated with this defect.
Physical examination including nasal examination
Nasal endoscopy
Biopsy in rare cases
Treatments
Treatment of nasal polyps depends upon the cause of their development. Nasal polyps due to other diseases like cystic fibrosis etc. can be managed by treating the underlying medical condition. For patients with severe asthma and polyposis requiring surgery, postoperative admission for observation of respiratory compromise or spasm is determined on an individual basis.
Medications used in the treatment of nasal polyps are:
Corticosteroids – Oral and topical nasal steroid administration is the primary and most effective medical treatment for nasal polyposis
Antihistamines
decongestants
Immunotherapy– may be useful to treat allergic rhinitis but, when used alone, does not usually resolve existing polyps.
Antibiotics for bacterial superinfections.
Leukotriene receptor antagonists– are cytokines made from arachidonic acid in the presence of 5-lipoxygenase. When released, leukotrienes bind to the cysteinyl-leukotriene receptors CysLT1 and CysLT2, located on the surface of target cells. These receptors are thought to mediate eosinophil recruitment, bronchospasm, vasoconstriction, mucus secretion, and plasma exudation. In addition, it is believed that leukotrienes may play a role in the inflammatory response in nasal polyposis.
Surgical Care
Surgical intervention is required in multiple benign nasal polyposis or chronic rhinosinusitis with maximal medical therapy fails. Simple polypectomy is effective initially to relieve nasal symptoms, especially for isolated polyps or small numbers of polyps. In benign multiple nasal polyposis, polypectomy is fraught with a high recurrence rate.
Endoscopic Sinus Surgery (ESS) is a better technique that not only removes the polyps but also opens the clefts in the middle meatus, where they most often form, which helps decrease the recurrence rate. Complication rates are low with experienced surgeons. The use of a surgical microdebrider has made the procedure safer and faster, providing precise tissue cutting and decreased haemostasis with better visualization.
For lesions other than benign nasal polyps that result in a nasal polyp, the polyp should be biopsied or removed, depending on the disease process.
Prognosis
No significant mortality is associated with nasal polyposis. Morbidity is usually associated with altered quality of life, nasal obstruction, anosmia, chronic sinusitis, headaches, snoring, and postnasal drainage. In certain situations, nasal polyps can alter the shape of craniofacial skeleton because unremoved polyps can extend intracranially and into the orbital vaults.
Polyposis recurrence is common following treatment with medical or surgical therapy if multiple benign polyps are present. Single large polyps (e.g., antral-choanal polyps) are less likely to recur.
Complications
Nasal polyps can cause complications because they block normal airflow and fluid drainage, and also because of the long-term irritation and swelling (inflammation) underlying their development.
Potential complications include:
- Obstructive sleep apnoea.
- Asthma flare-ups.
- Sinus infections.
- Craniofacial abnormalities.
- Vision problems
Disease & Ayurveda
Nasarshas
Nidana
Causative factors for the vitiation of each dosha separately and together
Purvaaroopa
Not medntioned
Samprapti
When the vitiated doshas travel and get lodged inside the nasal cavity, develops mamsankura inside the nasal cavity. It can be single or multiple. In chronic cases, these arshas may be able to block the air circulation.
Lakshana
Mamsankura in naasa -Fleshy mass inside the nasal cavity
Divisions
Not mentioned
Prognosis
Kricchrasadhyam as sastrakarma is needed
Chikithsa
Samana
Lepanam with Rookshana dravyas
Aushadha-medicines to make the growth shrink
Sodhana
Sastra – extraction with sharp instruments
Kshara – cauterisation with alkali
Agni – cauterisation with heat
Nasya-Sigruaadi
Commonly used medicines
Varanadi kashayam
Guggulupanchapalachoornam
Kanchanaraguggulu
Dasamoolakadutrayam kashayam
Rasnadi choornam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
In nasal polyps, controlling allergic responses and phlegm in the body is the key point, which can be done with a lot of natural remedies. Along with taking measures to protect yourself from cold climate, doing the following can help reduce the discomforts:
Avoid any chance of allergic reaction
Steam inhalation with Tulsi(Holy basil) leaves
Application of diluted tea tree & chamomile oils
Nasal irrigation procedures such as neti
Intake of black pepper, garlic, ginger, turmeric etc. in diet
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Follow a regular schedule for headbath
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active
Yoga
Regular stretching and cardio exercises are advised to improve immunity and respiratory health. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
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