11 October, 2022
Nasal polyposis, an underestimated disease with limited treatment options
Nasal polyposis is a chronic inflammation of the paranasal sinuses. Due to this inflammation of the mucosa, whitish formations appear inside the nostrils, which are called nasal polyps. These are benign polyps, but they can grow to the point of completely obstructing the nostrils.
WHAT IS NASAL POLYPOSIS AND WHAT ARE ITS SYMPTOMS?
“When the inflammation of the nasal mucosa lasts more than three months, it is when we consider that there is nasal polyposis. Some of the symptoms caused by this disease are nasal congestion, runny nose or runny nose, facial pain and loss of smell”, explains Dr Isam Alobid, otorhinolaryngology consultant and coordinator of the Multidisciplinary Unit of Basic Surgery of Skull at the Hospital Clínic de Barcelona and otorhinolaryngologist at barnaclínic+.
“Some of the symptoms of nasal polyposis are nasal congestion, runny nose or runny nose, facial pain and loss of smell”
Dr Isam Alobid, otorhinolaryngology consultant and coordinator of the Multidisciplinary Skull Base Surgery Unit at the Hospital Clínic de Barcelona and otolaryngologist at barnaclínic+
This disease has a high negative impact on both the quality of life and sleep of patients, which indicates that as a result of it they are lacking in energy and also have low self-esteem. “In studies that we have carried out with patients with nasal polyposis, they call for greater awareness of both society and doctors about the burden of this disease and, among other issues, they point out how the impact on their lives is underestimated, the lack of coordination of medical care and the limitation of treatment options”, highlights Dr Alobid.
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CAUSES OF NASAL POLYPOSIS: AN ORIGIN STILL UNKNOWN
Despite the great scientific advances that have been made in the study of nasal polyposis, both its aetiology and pathogenesis remain controversial today. Initially, it was believed that the cause of nasal polyposis was allergies, but later studies have shown that this is not always the case. “Among the causes that can produce this chronic inflammation of the nasal mucosa, fungi, viruses, allergic reactions and toxins have been considered, among other things, but there is still a lack of research that clarifies the origin of nasal polyposis”, adds the expert.
“Among the causes that can produce this chronic inflammation of the nasal mucosa, fungi, viruses, allergic reactions and toxins have been considered, among others, but there is still a lack of research that clarifies the origin of nasal polyposis”
Dr Isam Alobid
In one in four cases of nasal polyposis it is associated with asthma, although the reason for this relationship is unknown. In one in three cases there is a related allergy. “The fact of not knowing what causes inflammation has limited the development of treatments, although new biological treatments have begun to appear that may represent an alternative for patients”, continues Dr Isam Alobid.
TREATMENT OF NASAL POLYPOSIS: LONG-TERM LACK OF EFFICACY
The proper treatment of nasal polyposis begins with medical therapy based on intranasal corticosteroids. In some cases, and exceptionally, oral corticosteroids can also be applied, but never more than twice a year. However, this treatment is not always effective. There are patients who do not respond to corticosteroids or who, after a while, generate resistance to this treatment and end up producing a total occupation of the nose. In these cases, surgical intervention is necessary.
“In these cases, the most indicated is nasal endoscopic surgery. It is a minimally invasive technique that allows the sinuses to be opened and the inflammatory tissue to be removed”, comments Dr Alobid. This type of intervention has shown good postoperative results in long-term studies, with a follow-up of more than twelve years of patients.
“In patients who do not respond to nasal polyposis treatment with corticosteroids, endoscopic nasal surgery is the most indicated. It is a minimally invasive technique that allows the sinuses to be opened and the inflammatory tissue to be removed”
Dr Isam Alobid
In them it has been possible to see how an improvement in nasal symptoms, nasal polyps score, sense of smell and opacification of the paranasal sinuses is maintained. A positive, albeit moderate, correlation has also been seen between the percentage of eosinophils, a type of white blood cell, in the blood and symptoms. “On the other hand, this long-term study that we carried out has also served to see a recurrence rate of polyps of more than 80%, which reaches 100% in the subgroup of patients with asthma,” says Dr Isam Alobid.
TYPES OF SURGERY FOR NASAL POLYPOSIS
The different surgical treatments for nasal polyposis that currently exist are the following:
- Polypectomy: It consists of the removal of nasal polyps, both those of the nose and those that have formed in a possible post-surgical cavity. It is a simple type of intervention that is performed without altering the patient’s bone anatomy.
- Minimal surgery: In this intervention, what is sought is to eliminate the minimum tissue compatible with clinical improvement, conserving the mucosa.
- Functional surgery: The goal of this surgery is to restore the physiology of the nose.
- “Full House” surgery: In this case, a complete opening of the sinuses is produced, which includes an ethmoidectomy — an intervention in which the ethmoid is removed, which is a bone with air cavities that communicates with the nose — anterior and posterior, an antrostomy — which consists of opening the maxillary sinuses through an incision made under the upper lip of the middle meatus — and frontal opening.
- Extended surgery: Used in the same context as “Full House” surgery, but could also include extension beyond the sinuses, i.e., the base of the skull, the orbit, the pterygopalatine fossa and the infratemporal fossa.
- Radical surgery or “Reboot”: Also used in the same context as extended surgery, but could include significant removal of inflamed or non-functional mucosa.