Nasal polyps are morphological formations localized in the nasal cavity, but can sometimes be found in the maxillary sinus and ethmoid cells. The basis for the development of nasal polyposis is the existence of an inflammatory process in the nose of any genesis. Polyps do not grow from any part of the nasal and sinus mucosa. They have a predilection place on the nasal duplication mucosa, where there is low tissue pressure and loose connective tissue is present.
The patient came to the Atlas General Hospital with Professor Aleksandar Trivić for examination with symptoms of lost sense of smell, increased secretion and difficulty breathing.
Nasal polyps – symptoms
Prof. Dr. Aleksandar Trivić: “ What issues do you have? ”
Patient: “ I generally have no pain. I have a problem with my sense of smell. This problem first appeared about ten years ago. That’s my long-standing issue. I didn’t pay much attention because I was a professional athlete and I spent many years in the pool. I thought it was chronic sinusitis and that chlorine was affecting my sense of smell. However, in the last year, I have not had any sense of smell at all, and that led me to come to you. ”
Prof. Dr. Aleksandar Trivić: “ Do you have difficulty breathing through your nose and also have increased secretion? Do you have a feeling that more nasal discharges are going through your throat? ”
Patient: “ I am breathing with difficulty. The secretion are more at the back of the throat. When the weather changes, when there are periods of allergies, then I feel bigger changes. “
Prof. Dr. Aleksandar Trivić: “ Are you allergic to something? ”
Patient: “ I did some allergy tests a long time ago and they were positive. ”
Prof. Dr. Aleksandar Trivić: “ How do you sleep and breathe at night? ”
Patient: ” I really don’t feel any problems.”
Prof. Dr. Aleksandar Trivić: “ Do you snore at night since you do not breathe through your nose? ”
Patient: “ No. I breathe through my nose, but with a difficulty. “
Nasal polyps – diagnostic procedures
Prof. Dr. Aleksandar Trivić: “ Turn your head towards me to perform the examination. I can see polyps in both of your nasal cavities. As a result, your breathing is difficult and your sense of smell is weakened. I see you’ve already made some CT images of the sinuses. ”
Patient: “ I have. ”
Prof. Dr. Aleksandar Trivić: “ The scanner is the gold standard for sinus diagnostics. Everything grayish that you see in the video is a pathological change- polyps. Polyps in both ethmoid sinuses even involve the sphenoid sinuses located in the center of the skull. In other sections, you see your polyps, which are a big issue for you. Everything should be black in the video, not gray, because black represents air. You were given one type of conservative therapy, so the polyps receded a bit. You have space to breathe, but this will certainly require some surgical treatment and removal of polyps from the nose and from all the paranasal sinuses, that is, the cavities that are there.
The operation that is recommended today, and has been performed in our country for some twenty years, is endoscopic sinus surgery that is performed without incisions. As many as fifty percent of patients pass without any tamponade after this surgical intervention, and in a large number of cases, everything is normal for the patients. What is inconvenient, for us and for you, is the ability for polyps to return. Polyps return in some thirty percent of patients. Are you an asthmatic and are you allergic to aspirin, salicylates? ”
Patient: ” No. ”
Prof. Dr. Aleksandar Trivić: “ Initially, all patients with this issue require one local therapy with intranasal corticosteroids. The therapy is applied for about a month – two, and sometimes three, because patients must be aware that intranasal corticosteroids give the results only after fifteen to twenty days of use. Many patients give up after a few days because they think the therapy is not helping them. You have to be persistent in that. You are definitely a candidate for endoscopic sinus surgery. ”
Nasal polyp surgery
Prof. Dr. Aleksandar Trivić: ” It is a surgery where we use endoscopes, with camera monitoring and magnification, to enter all paranasal cavities, all sinuses, and try to remove the complete pathological contents of the sinuses. When it comes to this patient, we are talking about nasal polyps.
There used to be a different operation that was less comfortable for the patient, the so-called endonasal polypectomy and Caldwel Luc. An incision of one centimeter was then made in the oral cavity, the bone of the anterior maxillary sinus was pierced, and then the contents of the maxillary sinus were emptied through that incision. After that, that cavity was filled with three to four meters of gauze. We have no cuts today. We do this endoscopically, with a minimally invasive method. It is significantly easier for the patients because over fifty percent of patients do not have any tamponade, and the other fifty percent have one tampon in the nose, which we call a “Swedish tampon”. It is a finger-sized tampon that the next day, after the surgery, we pull out and the patient goes home and breathes through his nose. ”
Professor Trivić warned that polyp surgery in patients who have asthma and allergy to aspirin does not make sense because polyps return in the first year after the intervention. However, for most, this operation gives exceptional results and the patients are “regenerated”.
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