Learn from Dr. Davis about the cause, diagnosis, and treatment options (surgical and non-surgical) for nasal polyps. This video does contain an actual surgical video clip. An appointment with Dr. Davis can be made at 253-770-9000 or at
Nasal polyps are the result of long-term inflammation in the lining of the sinuses what happens over time is the tissue that lines the sinuses in our nasal cavity become very inflamed and the tissue grows it grows and creates these masses called nasal polyps we don’t really know the cause although it definitely relates to inflammation and that can be from an allergy
It can be from a sensitivity but it’s kind of similar to that asthma model in asthma we don’t know what the root cause is what we do know is that an asthma that chronic inflammation that lines the lured airway and the lungs creates problems and obstructions and patients have to use daily steroid therapy to calm that tissue down the polyps as a result of inflammation
Cause blockage of the nose and that can lead to nasal obstruction or congestion can lead to a loss of smell function that can lead to sinus infections because the polyps can block the natural openings to the sinuses so that the sinuses don’t function very well when someone is told they have me as a pulps it’s important to make sure that the right diagnosis has
Been made often these patients will see an otolaryngologist sometimes an allergist and a nasal endoscopy will be performed and this is a very simple safe relatively painless procedure that takes about a minute or so once the nose is numbed up and that allows the ent surgeon to look deeper inside the nose where the polyps generally grow once nasal polyps have
Been confirmed then usually some additional workup is necessary to generate a full picture of what is going on with that patient this involves sinus ct scan and often also some blood work so that we can look for things such as eosinophils levels or elevated ige both things can be suggestive of an underlying inflammatory problem not just with the sinuses but also
With the rest of the body often patients with nasal polyps should be considered for allergy evaluation the reason is an allergy may be one of the underlying causes for that chronic inflammation and if we can identify what the patient is allergic to then we can treat that better either with targeted medical therapy or even with the haller g shots sometimes patients
Are also allergic to non-steroidal anti-inflammatory drugs like ibuprofen or aspirin that’s a specific situation called aspirin exacerbated respiratory disease and we can reverse that by treating patients with aspirin desensitization the first-line treatment for nasal polyps often entails a trial of medical management that can include nasal steroid sprays sinus
Irrigations oral steroids and on occasion even oral antibiotics quite often sinus surgery is needed to remove polyps and help ventilate the sinuses or open up the sinuses that have been blocked by the polyps we try to create an open floor plan of the sinus cavities and think of it like a house you want to remove the non structural non load-bearing walls inside the
House so that there was a nice wide open floor plan so that bad things can get out and good things like saltwater irrigations and topical medicines i’m steroids can get in and bathe that sinus tissue occasionally during surgery for nasal polyps all plays dissolvable stance called propel propel stance release mometasone a steroid directly to the sinus tissue that
Needs it most in a time-release fashion these stents help patients heal faster with less scar tissue with more open sinuses and it controls the inflammation while they deliver the steroids just as with asthma it’s important to treat patients after sinus surgery to help minimize the chance they come back one of the primary treatments we use now are topical steroid
Irrigations usually we use a drug called the destin i’d sometimes mometasone and we add that to the saline or salt water irrigation bottle and patients irrigate with this solution once or twice a day after surgery when the sinus openings are larger that allows the steroid solution to penetrate into the sinuses and bathe that inflamed tissue in hopes that that will
Be enough to calm down the inflammation there are treatment options available if the polyps come back and most of these treatment options are non-surgical one option is a steroid releasing implant called sonova it’s an implant that can be placed in the office into the ethmoid sinus cavity and over three months time it releases mometasone a special steroid to help
Decrease the inflamed tissue another option is a device called x hands it’s hance uses the patient’s own breath to blow fluticasone deeper into the nasal cavity than standard nasal steroid spray a new treatment option for patients our class of drugs called biologics these drugs are often administered by injection once or twice a month and traditionally these tribes
Were only used for patients with asthma now there is a drug called do pillow mab or de pepsin that the patient can deliver on their own at home twice a month then these drugs have been shown to significantly decrease polyp size as well as improve asthma symptoms these drugs are quite expensive and do require insurance pre-authorization sometimes revision surgery is
Necessary when all of the medical therapy doesn’t work oftentimes it’s necessary to go in and just remove the polyps so that the topical therapies can work again fortunately all of these different treatment options are very beneficial to the patients and what used to be a very challenging disease to control is now quite easier to control with all of these different
Medications and surgical options and procedural options that we have available to us today
Transcribed from video
Nasal Polyps: diagnosis and treatment options By Greg Davis MD ENT Surgeon
