Nasal Polyposis

Nasal polyposis is a chronic inflammatory disease of the upper airway. Nasal polyps represent benign neoplasms that mostly originate from the edematous mucosal linings of the sinuses that can expand into the nasal cavities and sinuses.

Polyps have their special formation mechanism associated with the mucous lining reaction towards chronic stimulation. This process can be compared with blisters formation as a result of wearing uncomfortable footwear

There are 3 stimulants that may cause the polyps growth:

1. 
   Nasal allergy – hypersensitivity against inhaled allergens like home dust, pollen, mushroom spores, pet hairs etc
2. Toxins of staphylococcus aureus. These microorganisms exist in the mucous membrane of 10% people.
3. Fungal infection of the nasal mucous membrane lining.

However even with one of the above reasons present, polyps growth is not always observed. People who develop nasal polyps have genetic disposition to it. Therefore polyposis is the mucous lining reaction towards chronic stimulation along with genetic desposition. 
Polyposis is a chronic and progressive disease. Once appeared, the polyp starts to grow slowly and after some time the process results into the clusters of polyps that obstruct nasal airway and create olfactory disorders. The patients suffering from polyposis usually complain about the slowly developing breathing problems that after a while become constant. Rather often the disease is associated with large amount of clear foamy mucous secretion. 
A polyp may originate from any part of the mucous lining, while most of them arise from the clefts of the middle nasal meatus and ethmoidal cells, prolapsing into the nose, with some polyps originating in the maxillary, sphenoid, or frontal sinuses. 

Diagnostics:
The most critical role in establishing diagnosis of nasal polyps is based on endoscopic investigation, which is an objective method to determine the process development. Computer CT scanning is a mandatory evaluation performed for all the patients that can show the extent of the sinuses involvement. Besides we perform Rhinomanometery, the investigation which helps to determine the degree of the nasal airway obstruction.

A large inflamed nasal polyp blocking 90% of the left cavity. The nasal breath is seriously complicated.

Small polyp that just emerged from under the middle turbinate. Nasal breath is not changed due to the small size of the polyp. However the polyp is blocking the passage between the middle turbinate and lateral nasal wall, thus impairing the maxillary sinus drainage and causing chronic sinusitis.

Large polyp, blocking 60% of the left nasal cavity. The nasal breath is seriously complicated.

Treatment:
Polyps formation is the result of the mucous lining chronic stimulation, allergic or infectious processes. They can be surgically removed a dozen times but we will never achieve the desired effect and the problem will reoccur unless we determine its origin. 
That is why the treatment of polyposis is performed according to the following algorithm:

1. 
   Diagnostics (bacterial and mycotic inoculation, allergodiagnostics, computer CT scanning of nasal sinuses).
2. Surgical treatment.
3. Anti-relapse treatment depends on the results of allergodiagnostics and inoculation.

Each of these steps is equally important. Even perfectly done surgery that removed all existing polyps will not help if the cause of the polyposis has not been determined and the disease will reoccur, it is just a matter of time.

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