. Monday, October 6, 2008
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The next time you look in the mirror, admire your nose. Why? Because apart from its good looks, your nose is a sophisticated tool. Not only does it trap particles and pollutants from incoming air, it adjusts the temperature and moisture of the air as well. Your nose is also the window to two of your senses. It’s what enables you to smell a rose or to fully enjoy a tasty meal.

If you have nasal polyps, however, the entire system can break down, says Jeffrey P. Kirsch, M.D., an otolaryngologist/head and neck surgeon at Tulane University Medical Center in New Orleans. Nasal polyps are small, noncancerous growths within the nose or sinuses. “Some people may have 50 to 100 polyps,” says Dr. Kirsch. “They come in clusters, like grapes.”

Still a Mystery

This doesn’t mean that things resembling the California raisins will soon be protruding from your nostrils. Nasal polyps usually grow too deep in the nose for you to see or touch them, Dr. Kirsch says. In fact, you can have polyps for years and not even know it.

Trouble begins when they grow large enough to block one of both of your nasal cavities. When that happens, your sense of smell can go haywire. Nose breathing becomes difficult, and you may notice a distressing post-nasal drip––a consequence of having a surplus of mucus–producing nasal tissue. In addition, polyps can contribute to a breathing disorder called obstructive sleep apnea, which not only can disturb your sleep but also may even contribute to your risk for high blood pressure or an enlarged heart.

Although nasal polyps were first described some 3,000 years ago, doctors still aren’t sure what causes them. They do know that one in three people with polyps also have allergies or allergic-type symptoms. People with asthma, aspirin sensitivities and cystic fibrosis often get polyps, and men get them twice as often as women.

When you take your stuffed-up nose to your doctor, he may recommend a procedure called nasal endoscopy––an examination with a pencil-size instrument called a fiber-optic endoscope––to see what’s wrong. Since nasal polyps can resemble some types of cancer, he may take a tissue sample as well. When polyps are small and your symptoms slight, your doctor may counsel patience. If the polyps are more advanced, however, you have several options: drugs, surgery or a combination of the two.

Easy to Treat, Hard to Beat

“The initial treatment of choice usually is nasal steroids,” Dr. Kirsch says. Prescription drugs such as betamethasone, sprayed in the nose, sometimes will quickly shrink nasal polyps, allowing normal or near-normal airflow through the nasal passages. “We may give oral steroids to get the ball rolling and then switch to nasal sprays,” he adds.

However, nasal polyps will often resume their growth once the drugs are discontinued. Consequently, many people will use nasal steroids several times a day, often for years. Unlike oral steroids, research has shown that long-term use of steroid nasal spays is quite safe in most patients, says Dr. Kirsch.

When steroids don’t do the trick, surgery may be recommended, he adds. Most of the time, the procedure is quite simple. Under either local or general anesthesia, the surgeon snags the polyps with tiny snares and forceps. Once the polyps are removed and the nasal lining tissue has healed, a marked improvement in symptoms may be seen. The procedure usually takes between 1 and 3 hours and is generally very safe.

There is a catch, however, while polyps are easily removed, they frequently grow back, Dr. Kirsch says. Researchers at Brown University/Rhode Island Hospital in Providence studied 167 people with nasal polyps, 143of whom had polypectomies. Of these, 57 required a second operation, and 11 eventually required six or more operations! “The recurrence rate is very high, and some people require surgery every few years,” Dr. Kirsch says. “In general, we usually start with a trial of medication. If that doesn’t work, then surgery can be considered.”


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