Nasal polyps: why the sense of smell disappears and how to avoid regrowth - treatment in Tashkent

What is a polyp and where does it come from?

The mucous membranes of the nose and sinuses are designed to warm, moisturize and purify the air. With prolonged inflammation, it is rebuilt: fluid accumulates between the cells, the tissue swells, becomes heavier and sags under its own weight, forming a smooth, mobile formation on a stalk. Most often this occurs in the area of ​​the ethmoid labyrinth - a system of small cells in the upper part of the nose, between the eye sockets. From there, the polyps descend and gradually fill the nasal passages.

The nature of inflammation in polyposis is special. A large number of eosinophils—cells involved in allergic and special types of inflammatory reactions—accumulate in the polyp wall and produce substances that support edema. This is not a bacterial infection, so antibiotics do not affect the polyps themselves, and courses of antibiotics prescribed due to constant congestion give only a temporary effect when a purulent process occurs. Polyposis is a chronic inflammation of one’s own mucosa, and treatment is aimed specifically at it.

• Polyps are almost always bilateral and multiple - this is a typical picture of polypous rhinosinusitis
• A unilateral polyp is rare and always requires a separate examination, because other formations can masquerade as it
• Polyps do not hurt and usually do not bleed: their mucous membrane is poor in nerve endings
• They do not turn into a malignant tumor - this is a common fear that has no basis
• In children, polyps are rare, and if they are detected, cystic fibrosis must be excluded
• Polyposis is more common in men and usually begins between the ages of 40 and 60.

The sense of smell is the main and most underestimated symptom

The olfactory zone occupies a small area in the very upper part of the nasal cavity. In order for a person to smell the smell, the molecules of the substance must rise there with the flow of air - and it is precisely this path that the polyps block in the first place. Therefore, the sense of smell with polyposis often deteriorates before it becomes truly difficult to breathe. A person notices that he has stopped smelling coffee, perfume, smoke, and then the taste of food becomes flat: what we call the taste of a dish is 80 percent formed by smell, and only the basic sensations remain - sweet, salty, sour, bitter.

• A gradual decrease in the sense of smell, and then its complete absence, is the most characteristic sign of polyposis
• The feeling that food has become tasteless, but the ability to distinguish between salt and sugar is preserved
• Nasal congestion that does not go away with vasoconstrictor drops is an important difference from ordinary rhinitis
• Sensation of a foreign body in the nose, sometimes a feeling that something is moving when tilting the head
• Nasal voice, mouth breathing, snoring, dry throat in the morning
• Thick mucus running down the back of the throat and constant coughing
• Heaviness and pressure in the forehead, bridge of the nose and cheeks without severe pain
• Frequent exacerbations of sinusitis with purulent discharge

The loss of smell is perceived as a household inconvenience, but it also has a practical safety aspect: a person does not smell gas, smoke from a fire, or spoiled food. Separately, it is worth mentioning the quality of life - studies show that persistent anosmia significantly reduces mood and is often accompanied by decreased appetite and loss of interest in food. This is why restoring the sense of smell is considered one of the main goals of treatment, and not a pleasant side effect. And here the time factor is important: the longer the olfactory zone was blocked, the less chance of full recovery.

Asthma and aspirin intolerance: why it's connected

There is a characteristic combination of three conditions that doctors know well: nasal polyposis, bronchial asthma and intolerance to aspirin and other non-steroidal anti-inflammatory drugs. This combination is not accidental - it is based on a metabolic disorder that regulates inflammation in the respiratory tract. When taking aspirin and similar drugs, the metabolism shifts towards substances that cause bronchospasm and swelling of the mucous membrane, so in such people a regular painkiller tablet can cause a severe attack of suffocation.

• Polyposis and asthma are diseases of the same mucosa: the upper and lower respiratory tracts react in a similar way
• Approximately a significant proportion of patients with polyposis develop bronchial asthma over time, and vice versa
• The first sign of intolerance is nasal congestion, watery eyes, redness of the face or an attack of suffocation 30-120 minutes after taking the painkiller.
• With such intolerance, polyps grow faster and return more often after surgery
• A patient with this combination needs to know the list of prohibited drugs and report it to any doctor, including a dentist.
• Asthma control improves when polyposis is controlled, and vice versa - treating them in isolation is ineffective

Survey

1. Эндоскопия полости носа — main метод: врач видит полипы, оценивает их размер, распространённость и состояние соустий пазух. Небольшие полипы в глубине носа при обычном осмотре без эндоскопа часто не видны.
2. Компьютерная томография околоносовых пазух — показывает, насколько заполнены пазухи, и служит картой для хирурга; это обязательное исследование перед операцией.
3. Оценка обоняния — простые тесты с набором пахучих веществ, позволяющие объективно измерить степень нарушения и потом отследить динамику.
4. Аллергологическое обследование: аллергия не является прямой причиной полипоза, но часто сопутствует ему и усиливает отёк.
5. Исследование функции внешнего дыхания — для выявления скрытой бронхиальной астмы, которая нередко обнаруживается именно на этом этапе.
6. Анализ крови с оценкой уровня эозинофилов, помогающий понять тип воспаления и подобрать терапию.
7. Потовая проба или генетическое исследование при полипах у ребёнка — для исключения муковисцидоза.
8. Гистологическое исследование удалённой ткани — выполняется всегда, особенно важно при одностороннем процессе.

Treatment: why a spray is more important than surgery

The logic of treating polyposis is unusual for many patients: the basis is not surgery, but long-term local anti-inflammatory therapy. Surgical intervention removes the already grown tissue and restores patency, but does not change the nature of inflammation in the mucosa. Therefore, surgery without subsequent treatment almost inevitably ends in regrowth.

• Intranasal hormonal sprays are the basis of treatment. They act locally, are practically not absorbed into the blood and, when used correctly, are safe for long-term, many-year use
• The effect of the spray develops gradually over several weeks, so it should not be assessed after three days and abandoned
• Rinsing the nose with large volume saline solutions is an important addition that mechanically removes mucus and inflammatory mediators; performed before the spray, not after
• Short courses of systemic hormones orally are prescribed only by a doctor in cases of severe exacerbation; they give a quick effect, but are not suitable for permanent use
• Endoscopic surgery - in case of significant growth, lack of effect from therapy, complications and complete blockage of breathing
• Biological therapy with drugs that target specific inflammatory mechanisms is a modern option for severe forms, especially in combination with asthma
• Antibiotics are used only for bacterial exacerbation, and not for the treatment of polyposis itself.

Separately, about the technique of using the spray, on which the result directly depends. The bottle is held in the hand opposite the nostril into which it is sprayed, and the stream is directed towards the outer wall of the nose and slightly upward - that is, towards the outer corner of the eye, and not into the septum. Spraying into the septum is not only less effective, but is also the main cause of spray-induced nosebleeds. After injection, there is no need to sharply inhale air: a strong breath carries the drug into the throat instead of leaving it on the mucous membrane.

Operation and life after it

Modern surgical treatment of polyposis is performed endoscopically, through the nose, without external incisions. The surgeon removes the polyps and at the same time opens the blocked sinus openings to restore their ventilation and create access for the medicine. This second point is more important than it seems: after the operation, the hormonal spray and rinsing reach those areas where they simply did not penetrate before, and therefore work more effectively.

1. Операция чаще проводится под общим обезболиванием, длится ориентировочно от 40 минут до полутора-двух часов в зависимости от объёма.
2. Тампоны или гемостатические материалы находятся в носу обычно 1-2 суток; современные рассасывающиеся материалы удалять не требуется.
3. В первые 1-2 недели сохраняются отёк, корки и сукровичные выделения — это нормальное течение заживления.
4. Промывание носа солевым раствором начинают в ранние сроки по назначению врача и продолжают несколько недель.
5. Гормональный спрей возобновляют, как правило, через 1-2 недели после операции — и принимают дальше постоянно, а не курсом.
6. Плановые осмотры с эндоскопией и очисткой полости носа критически важны в первые месяцы: от них зависит, не зарастут ли открытые соустья.
7. Обоняние восстанавливается медленнее дыхания — иногда в течение нескольких месяцев, и не всегда полностью.

The likelihood of relapse must be discussed honestly, because low expectations destroy adherence to treatment. Polyps return in a significant proportion of patients, and most often this occurs where anti-inflammatory therapy has been stopped. When polyposis is combined with asthma and aspirin intolerance, the risk of regrowth is even higher. But this does not mean that treatment is pointless: properly selected continuous therapy allows you to keep the disease under control for years, maintain breathing and smell, and avoid repeated operations. It is reasonable to perceive polyposis not as a one-time breakdown that is repaired once, but as a chronic condition that requires regular care - much the same as hypertension or asthma.