Surgery for nasal polyps, which is known as a nasal polypectomy, is usually considered when others forms of treatment do not provide any lasting relief from the symptoms. Surgical removal of a nasal polyp does not guarantee permanent eradication and there is a chance that the polyp can recur.
While you may not be keen on undergoing surgery, it is important to remember that your quality of life can improve significantly after the removal of the diseased tissue. With modern surgical methods, as much of the normal tissue lining the nasal cavity is retained and the process, while invasive, does not usually result in severe complications.
Indications for Nasal Polyp Surgery
Nasal polyps are initially treated with steroid nasal sprays, oral steroids or a combination of both. In severe cases, intranasal steroid injections are considered and this is fairly effective in reducing the polyp size thereby easing associated symptoms.
In cases where nasal polyps are associated with other conditions such as allergies, asthma or chronic sinusitis, the treatment should be directed at these conditions. If there is no or minimal relief of symptoms along with severe obstruction and infection and the polyp still persists after treatment, then surgery is usually advised.
A small percentage of nasal polyps may be cancerous or pre-cancerous and hence may need to be removed without considering the other indications mentioned above.
A patient with poorly managed asthma, cardiac and lung disease(s) and bleeding disorders may be unsuitable for a polypectomy. However, each case is considered on an individual basis before the final decision to operate or not is made.
Nasal polyps may co-exist with conditions like Churg-Strauss syndrome and cystic fibrosis. Special considerations will have to be made in each case but since a polypectomy is not an essential procedure unless the tissue is cancerous, it may not be recommended in these conditions.
Investigations before Polyp Surgery
- CT scan of the sinuses.
- Nasal and sinus endoscopy.
- Other tests are done only if required, such as :
- Allergy or asthma studies.
- Nasal smears or cultures for fungus and bacteria.
- Olfactory testing.
- Tests for cystic fibrosis.
Types of Nasal Polyp Surgery
Surgery for nasal polyps is usually performed as an outpatient procedure in an ambulatory surgery center and the patient is allowed to go home on the same day. Ideally it should be done by an otolaryngologist (ENT specialist). Either a polypectomy or endoscopic sinus surgery may be done, depending upon the number, size and location of the polyp.
Polypectomy is usually performed under local anesthesia and is usually done to remove small polyps which are easily visible and can be reached through the nostrils without difficulty.
A nasal speculum is used to hold open the nose and the polyps may be clamped and then removed with a wire loop or forceps. An instrument called a microdebrider may be used to cut and remove the polyp or a small mechanical suction device may be used.
Bleeding may be controlled by electro-cauterization or packing and pressure. Petroleum jelly and gauze applied to the surgical area may help to prevent bleeding. The dressing is usually removed 3 to 4 days after surgery.
Endoscopic sinus surgery
Functional endoscopic sinus surgery (FESS) is a minimally invasive technique where accurate polyp removal can be done along with clearing of the sinus, thus restoring sinus ventilation and normal function. This procedure may be performed under local anesthesia with sedation, or general anesthesia.
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An endoscope (a narrow tube with a tiny camera at the end) is introduced into the sinus cavities through the nostrils. With the help of the endoscope, a better view may be possible when the polyps are situated in the roof of the nose or sinuses. Tiny instruments are used to remove the polyps and other obstructions within the sinuses.
Complications of Polyp Surgery
Apart from the complications of any surgery such as bleeding, infection and adverse anesthetic reactions, the potentially dangerous neurological and orbital complications should be kept in mind. Of these, CSF leakage is a common major complication. Complications of a nasal polyp surgery is uncommon given modern surgical methods.
Some of the possible complications include :
- Intracranial hemorrhage.
- Brain abscess.
- Brain herniation.
- Optic nerve injury.
- Orbital hematoma.
- Eye muscle injury leading to diplopia (double vision).
- Nasolacrimal duct injury leading to epiphora (overflow of tears).
It must be stressed that the surgical removal of a nasal polyp at the hands of a skilled otolaryngologist is quite a safe procedure with minimal or no complications in most cases, unless there are other predisposing factors.
Outcome after Surgery
After surgery, nasal congestion caused by polyps ease significantly and sinus infections are better controlled. Other symptoms associated with a nasal polyp may resolve completely. Proper patient selection for surgery is crucial for the best long-term results.
Patients who qualify for surgery should be made aware of the following :
- Recurrence of polyp at a later stage is possible even after surgical removal.
- Recovery of the sense of smell cannot be guaranteed.
- Continued medical treatment for allergy, asthma and other medical conditions is important even after surgery.
- Chronic treatment of allergic rhinitis and other nasal conditions following surgery is necessary for the prevention of polyp recurrence.