Polyposis

Polyposis

The nasal polyposis is a disorder that occurs in 1-4% of the population. This incidence increases significantly if they are considered some groups of people with different nasal diseases.

Nasal polyps arise from a swelling (inflammation) of the lining of the upper wall of the nasal cavity. (Fig. 1)

 polyposis fig1

 

From this area, called the anterior ethmoid, originate polyps that tend to expand and thus block the ethmoid cells, the paranasal sinuses (maxillary, frontal, sphenoid and in some cases) and the nasal cavities.
The first manifestation of the polyps is a widespread or circumscribed thickening associated with a mucosal swelling. If the causative factors continue to act, the next step is the formation of altered mucosa area, broad-based, more or less defined, from which they develop polyps. The appearance of these tumors is usually translucent, soft and yellowish color consistency, even if there are variations in relation to the type of patient and the extent of the disease. The diagnosis is made by a specialist otolaryngologist during the office visit to be carried out with nasal endoscopy. This instrumental method is necessary for a correct evaluation of the pathology, and also, if the endoscope is connected to a camera and a monitor, allows the physician to clearly illustrate the clinical picture of the patient. To assess the extent and severity of nasal polyposis Computed Tomography is required (TC) that enables you to analyze in detail the anatomical structures involved by the disease. (Fig. 2)

The symptoms of this disease are obstructed nasal breathing, fronto-orbital headache with sensation of fullness or pressure in the eyes, leaking clear or yellowish secretions from the nose (rhinorrhea), and the partial or total reduction of smell (hyposmia/anosmia).

 

Treatment of nasal polyposis

The treatment of nasal polyps provides medical treatment cycles associated with surgical treatment. Medical therapy is based on the administration of nasal washing with iso or hypertonic solutions, associated with cortisone drugs for local street (drops and nasal sprays) and when possible systemic (oral or intramuscular). For there are some patients, such as people with diabetes, hypertension or gastro-duodenal ulcer, in which the administration of systemic corticosteroids should be done carefully and under medical control. Very useful they are also courses of antibiotics (usually penicillin or macrolides) orally. In the cases of fungal superinfections they are associated cycles of anti-fungal drugs orally. But there are many cases in which the medical therapy is not sufficient to solve the symptom picture, and then it is necessary to intervene surgically. Currently the most widely used methods for the removal of nasal polyps include the use of nasal endoscopy associated with such instruments as the microdebrider or lasers that allow you to perform the surgery in a very accurate way. At Otologico Group they are executed routine interventions in endoscopy under the control of a sophisticated camera attached to a high-resolution monitor. It should be noted that even in cases where nasal polyps have been removed completely, the patient must undergo periodic post-operative checks especially in the months after surgery; They are also required in local therapies with spray nasal drops in order to obtain a more long lasting and healing. Despite endoscopic surgery through the considerable improvements in the therapy of this disease have been achieved, the incidence of relapses is still very high. The patient should then be informed about the fact that nasal polyps can reform itself. Also surgery with endoscopy should be performed in specialized centers and experienced as the sinuses are located in proximity to important anatomical structures such as the organ of sight (optic nerve and ocular globe) and the front part of the brain (lobo front).

 

Surgical complications

Diagnosis Complications can be divided into minor and serious. The first are: the formation of fibrous bridges (synechiae) in the surgical cavity and the ostium narrowing (opening) of the sinuses that promote relapse of the disease. Other minor complications are lesions of the inner wall of the orbital cavity that can cause emphysema orbital (collections of air around the eye), or temporary diplopia (double vision) and postoperative bleeding that may require further surgery or a more cluttered nasal packing. Very rare is the direct injury of the nasolacrimal duct that can cause increased lacrimation; This problem usually resolves spontaneously within a few days. Serious complications are fistula rhino-CSF (loss of cerebrospinal fluid from the brain to the nasal cavity), which if left untreated can cause meningitis or Pneumocephalus, the orbital bleeding that can cause temporary loss of vision or blindness and direct lesion one or both of the optic nerves which determines permanent blindness.