How are Nasal Polyps Diagnosed ?
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In some situations, a physician can make a nasal polyp diagnosis by examining the nasal passages. This may include nasal endoscopy, which entails placing a small camera into the nose to get a better look at the nasal passages. More commonly, however, a CT ("cat scan") of the sinuses is needed to make a diagnosis.
Since other diseases are often present when a person has nasal polyps, further diagnostic tests may need to be performed.
Drug treatments may include:
- Nasal corticosteroids. Your doctor is likely to prescribe a corticosteroid nasal spray to reduce inflammation. This treatment may shrink the polyps or eliminate them completely. Nasal corticosteroids include fluticasone (Flonase, Veramyst), budesonide (Rhinocort), flunisolide (Nasarel, others), triamcinolone (Nasacort AQ) and beclomethasone (Beconase AQ).
- Other corticosteroids. If a nasal corticosteroid isn't effective, your doctor may prescribe an oral corticosteroid, such as prednisone, either alone or in combination with a nasal spray. Because oral corticosteroids can cause serious side effects, you usually take them for a brief period. Your doctor may recommend a corticosteroid injection instead or an oral corticosteroid.
- Other medications. Your doctor may prescribe drugs to treat conditions that contribute to chronic inflammation in your sinuses or nasal passages. These may include antihistamines to treat allergies, antibiotics to treat a chronic or recurring infection, or antifungal medications to treat symptoms of fungal allergies.
If drug treatment doesn't shrink or eliminate nasal polyps, your doctor may recommend surgery. The type of surgery depends on the size, number and location of the polyps.
Surgery options for nasal polyps include:
- Polypectomy. Small or isolated polyps can often be completely removed using a small mechanical suction device or a microdebrider - an instrument that cuts and extracts soft tissue. The procedure, called a polypectomy, is performed on an outpatient basis.
- Endoscopic sinus surgery. You may need surgery to remove polyps and to correct problems with your sinuses that make them prone to inflammation and the development of polyps. The surgeon inserts an endoscope, a small tube with a magnifying lens or tiny camera, into your nostrils and guides it into your sinus cavities. He or she uses tiny instruments to remove polyps and other obstructions that prevent the flow of fluids from your sinuses. This surgery is usually performed as an outpatient procedure.
After surgery, you'll likely use a corticosteroid nasal spray to help prevent the recurrence of nasal polyps. Your doctor may also recommend the use of a saltwater (saline) rinse to promote healing after surgery.
You may help reduce your chances of developing nasal polyps or recurring nasal polyps after treatment with the following prevention strategies:
- Manage allergies and asthma. Follow your doctor's treatment recommendations for managing asthma and allergies. If your symptoms aren't easily and regularly under control, talk to your doctor about changing your treatment plan.
- Avoid irritants. As much as possible, avoid things that are likely to contribute to inflammation or irritation of your sinuses, such as allergens, airborne pollutants and chemicals.
- Practice good hygiene. Wash your hands regularly and thoroughly. This is one of the best ways to protect against bacterial and viral infections that can cause inflammation of the nasal passages and sinuses.
- Humidify your home. Use a humidifier if you have dry air in your home. This may help improve the flow of mucus from your sinuses and may help prevent blockage and inflammation.
As with any operation under general anaesthetic, there is a very small risk of complications related to your heart and the lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
If there is a lot of bleeding during your operation, the surgeon may leave the packs inside your nose for an extra day. If there is a lot of bleeding after the packs are removed, then the surgeon will put them back in, either with a local or a general anaesthetic. Sometimes in people with narrow nasal passages, the sides of the nose may stick together as they heal with bands of scarred tissue which are called adhesions. The adhesions can often be freed by the surgeon when he sees you in the outpatient clinic. In some people, polyps can come back again. This may happen within a year, or may occur several years later. It is impossible to say whether your polyps will come back again, only time will tell. As long as you follow the advice above, you are unlikely to have any problems when you get home. There is a small risk that your nose may bleed. If this is just a spot or two you should not worry. If your nose bleeds for more than an hour, come back to the ward.
There is a small risk of infection at the area of the operation. If you develop increasing pain in the cheek bone or the nose, a headache or a temperature, it probably means that an infection is developing and you will need medical attention promptly. Taking antibiotics for a week or two usually solves the problem.
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