Nasal polypectomy. Removal of polyps in the nose

Nasal polyps are benign neoplasms,
which look like small rounded formations and are formed as a result of prolonged irritation of the nasal mucosa and paranasal sinuses.

The presence of polyps in the nose leads to the development of a number of undesirable symptoms, which can only be eliminated with the help of surgical intervention.

Removal of polyps in the sinuses. Indications for surgery

Before implementing surgical intervention in connection with polyposis neoplasms of the nasal cavity, it should be determined whether there are indications for their removal. There are absolute and relative indications for surgical removal of polyps in the nose.

If you don't want to go under the surgeon's knife, then read about modern treatment nasal polyps.

Absolute indications for surgery to remove nasal polyps:

Complete absence of nasal breathing.
Increase in asthma attacks.
Anosmia (complete absence of the sense of smell).
Attachment of symptoms of inflammation paranasal sinuses nose.
Frequent occurrence of discharge from the nose with an unpleasant odor and an admixture of blood.
Development of deformity of the nasal septum.
Chronic course of purulent-inflammatory processes of the nose and paranasal sinuses.

Relative indications for surgery:

The appearance of snoring.
Voice change (hoarseness).
Hyposmia.
Periodic headache and dizziness.
Sensation of a foreign body in the nose.

Contraindications to surgery

The presence of polyposis neoplasms in the nose is not in all cases an indication for their removal during surgery. There are local and systemic contraindications to the removal of polyps.

Systemic contraindications for surgery to remove polyposis neoplasms:

Attack of bronchial asthma.
Blood diseases such as hemophilia, acute leukemia, thrombocytopenic purpura.
Decompensated states from the side of cardio- vascular system(myocardial infarction, ischemic disease hearts, hypertensive crisis, collapse, etc.).

Local contraindications for surgery:

Acute diseases of the nose and paranasal sinuses ( acute rhinitis, acute sinusitis).
allergic rhinitis.

If you have a history of oncological pathology of the nasal cavity, you should consult with an oncologist before the operation.

Distinguish a large number of different methods surgical removal of polyps. To date, the operation to remove polyps in the nose is performed under general anesthesia. The essence of surgical intervention is to excise pathological neoplasms. Polypotomy (surgical intervention to remove polyps) is performed in a sitting position of the patient.

Technique for the operation to remove polyps in the nose:

First of all, anterior and posterior rhinoscopy should be performed using nasal mirrors.
Sanitize the nasal cavity and paranasal sinuses with a hypertonic solution or pharmacological agent Humer.
drain nasal cavity using a cotton swab.
Consistently lubricate the nasal mucosa twice with 10% dicaine solution to reduce its sensitivity during surgical excision of neoplasms.
Find out the location of the legs of polyps, their number and size.
Insert the snare into the nose under visual control.
Conduct an audit of the nasal cavity with the help of a loop outlet.
Put a loop on a polyp or a group of polyps (if they are small).
Move the loop up to the head of the polyp.
After feeling the solid consistency of the head of the polyp, tighten the loop.
Remove the loop with polypous masses from the nasal cavity and put in a special tray.

Especially important!

An important criterion that prevents recurrence is the removal of the polyp along with the stem. Therefore, you should carefully tighten the loop so as not to cut off the head of the polyp, but to pull the polyp along with the leg from the nasal cavity.

Modern methods of surgery to remove polyps help to avoid the formation of scars and adhesions in the nasal cavity. In addition to the usual polypotomy, there are such methods for eliminating polyposis:

Endoscopic surgery. Endoscopic removal is one of the most accurate removal methods. The operation is performed using a special medical endoscope with a camera. This allows you to achieve complete removal of even the smallest formations and at the same time not damage the surrounding structures of the nasal cavity.
Removal with a shaver (microdebrider). The essence of this technique is the grinding of neoplasms and their absorption. The operation is less traumatic and is performed under the control of a screen monitor.
Laser removal of polyps. Under the influence of laser beams, the neoplasm disappears. advantage this method is an additional coagulation of blood vessels and an obstacle to the spread of infection to surrounding structures.
Crochet Lange removal. With the help of the Lange hook, it is possible to remove not only nasal polyps, but also polyps with localization in the choanal area.

With all this, there are methods for removing polyps without surgery!

Ways to remove polyps in the nose:

In the vast majority of cases, the postoperative period proceeds without significant complications.

In particular cases, postoperative symptoms are presented:

The development of minor bleeding. This symptom develops as a result of damage to the vessels of the nasal cavity.
The formation of adhesions and adhesions after surgery in the nasal passages. This symptom develops 2-3 months after surgery. Patients again complain of aggravated nasal breathing. This symptomatology requires surgical dissection of newly formed adhesions.
Disease recurrence. The development of relapses is possible if there was an incomplete removal of polyps or the doctor removed only the head of the polyp.
Accession of infectious complications. Infectious complications are added in the case of an operation in the acute period of diseases of the nose or paranasal sinuses. Infectious agents can spread through the hematogenous or lymphogenous route and lead to systemic manifestations of an infectious disease.
Headaches. Headaches are a transient symptom that disappears after 3-5 days. The temperature after removal of polyps in the nose is kept at around 37.
Difficulty nasal breathing and lost the sense of smell as a result of the development of edema. This symptom is a physiological response to surgery. Normally, the restoration of the respiratory and olfactory function of the nose occurs 3-5 days after the operation.

More modern methods operational influence prevent the development of postoperative symptoms.

Proper patient management postoperative period help to avoid the occurrence of recurrence of the disease and the development of many dangerous complications(recurrence of the disease, bleeding, etc.).

In the first days after surgery to remove polyps, you should take antibacterial medicines(Ceftriaxone, Suprax). Data pharmacological preparations help to avoid the development of complications of an inflammatory nature. Antibiotics should be taken for 3-5 days of the postoperative period.
Also, after the operation, otolaryngologists recommend instilling oil-based drops (Pinosol, sea buckthorn oil) into the nasal cavity, because they contribute to faster healing of the postoperative wound and prevent the formation of adhesions and adhesions in the nasal passage.
The next step after the operation is the regular sanitation of the nasal cavity with saline or Humer's pharmacological agent. Sanitation should be carried out from 5 to 14 days after surgery.
In the first days of the postoperative period, steroids are recommended for local application(Nasonex). These medicines do not cause side effects from other organs and systems and at the same time prevent the development of relapses of the disease.

In the treatment after removal of polyps in the nose, it is recommended to use 30% propolis ointment. Swabs are wetted and placed in the nose. The duration of the procedure is 2 weeks

Propolis ointment after removal of polyps in the nose

Rehabilitation after removal of polyps in the nose does not require long-term measures. In order to avoid complications after the operation, the following doctor's instructions should be followed for five days:

Follow a gentle regimen.
Avoid hot food and drinks. Hot drinks and food lead to vasodilation and provoke the development of bleeding.
Don't lift weights. Increasing systemic blood pressure is also a risk factor for bleeding.
Avoid prolonged sun exposure.
Not located in a dusty environment.
Do wet cleaning in the house twice a day
Carry out timely ventilation in the apartment.
Do not come into contact with infectious patients

An increase in the overall resistance of the body and a positive psychological attitude of patients will also help to avoid complications in the postoperative period.

Removal of polyps in the nose video:

Polyps are outgrowths of the mucous membrane due to excessive proliferation of its glandular tissue. Polyps can form anywhere in the body where there is a mucous membrane. The nasal cavity is no exception. It is believed that about 4% of the population has nasal polyps.

The causes of polyps are different, mainly:

Violation of the aerodynamics of the nasal cavity.
Chronic inflammatory process in the paranasal sinuses.
Allergy, in this case, polyposis is usually combined with bronchial asthma.

Polyps can form both from the mucosa of the nasal cavity itself, and (more often) from the mucosa of the paranasal sinuses. At the same time, polyps that have arisen in the sinuses “fall out” through the anastomoses into the nasal cavity and continue to increase in size and block the nasal passages. In children, antrochoanal polyps (derived from the maxillary sinus) are more common, in adults - ethmoid polyps (growing from cells of the ethmoid labyrinth).

Polyps in the sinuses are usually multiple, outwardly they resemble a bunch of grapes. With excessive growth, they come out of the fistulas of the sinuses and are located in the nasal cavity.

Why polyps need to be removed

In the initial stage, polyps are tried to be treated conservatively, but usually these measures do not work. Sooner or later, they still have to be removed surgically.

Removal of polyps is one of those operations that many patients themselves ask doctors for. Mainly because the violation of nasal breathing greatly disrupts normal life. A person cannot breathe through his nose, he does not feel very well from this, it prevents him from working, and no one frees him from work.

The main problem that polyps cause is difficulty in nasal breathing. That is, when they grow, they mechanically block the nasal passages, the air cannot freely pass into the nasopharynx. Vasoconstrictor drops in this case will be ineffective. The patient breathes through his mouth, which is not physiological and unpleasant.
The second problem that often accompanies patients with polyps is a violation of the sense of smell. Polyps overlap the mucous membrane of the olfactory zone. Lack of sensitivity to smells greatly reduces the quality of life.
Blocking the natural communications of the paranasal sinuses with the nasal cavity, polyps lead to a violation of the cleansing of the sinuses from mucus and microbes, which causes a chronic inflammatory process in the sinuses. And that's enough serious complication. So, purulent sinusitis can lead to serious consequences up to meningoencephalitis and sepsis.
If a person breathes not through his nose, but through his mouth, then the air is not warmed up, not cleaned and humidified properly. All this increases the risk of developing pharyngitis, tonsillitis, laryngitis, bronchitis, pneumonia and bronchial asthma.
Inadequate nasal breathing leads to some hypoxia of the brain, as a result of which a person experiences frequent headaches, bad dream, rapid fatigue, impaired performance.

Who is shown the removal of polyps

Intervention is indicated for the following groups of patients:

Patients with complete nasal congestion.
The combination of polyposis with a curvature of the nasal septum.
The combination of polyps with chronic rhinitis, chronic sinusitis, not amenable to conservative treatment.

Preparing for the operation

At the first examination, the ENT doctor performs a rhinoscopy at the reception. Polyps with rhinoscopy are usually clearly visible.

However, to clarify their number, size, degree of damage to the nasal mucosa and sinuses, clarifying examinations are usually prescribed:

X-ray of the paranasal sinuses.
Computed tomography of the sinuses.
Videoendoscopic examination of the nasal cavity and sinuses.

When the indications and scope of the operation are determined, it is necessary to choose the right time and prepare for it. So, with purulent rhinitis or rhinosinusitis, it is necessary to undergo a course of antibiotic therapy based on the results of bakposev purulent discharge.

Operation is not assigned:

During the flowering season, when the course of allergic rhinitis and asthma worsens.
For acute infectious diseases
Decompensated course chronic diseases heart, liver, kidneys.
Violation of blood clotting.
During pregnancy.

2 weeks before the operation, you must undergo:

General blood and urine tests.
Coagulogram.
Biochemical analysis.
Electrocardiography.
Chest x-ray.
Blood on markers viral hepatitis, syphilis, HIV.
Therapist's review.

A few days before the operation, drugs that prevent blood clotting (aspirin, warfarin) are canceled. Decongestants and anti-inflammatory drugs (ketotifen, dexamethasone) are prescribed.

Types of operations to remove nasal polyps

To date, the following types of interventions are carried out:

The usual polypotomy. The oldest, most traumatic, but also the cheapest operation.
Endoscopic removal of polyps.
Removal of polyps with a laser.
Radio wave polypotomy.

It must be said that nasal polypotomy is very often combined with other operations:

With drainage of the paranasal sinus in chronic sinusitis, ethmoiditis, sphenoiditis.
Correction of deviated nasal septum.
With resection of the nasal concha (conchotomy).

Conventional polypotomy

Removal of polyps is carried out with a special polyp loop: the loop is thrown over the polyp and gradually tightened at its base, pulled out and torn off. The art of the surgeon should not be to cut the polyp with a loop, but to pull it out with a leg (“with a root”). The risk of recurrence with such a correct removal is much less.

The operation is usually performed under local infiltration anesthesia with novocaine, lidocaine or ultracaine. Additionally, the anesthetic is applied to the nasal mucosa (together with vasoconstrictor drugs).

The position of the patient is sitting, a tray for flowing blood is placed under the chin. The duration of the operation is 40-60 minutes.

Usually, all polyps visible during anterior rhinoscopy are removed. Those polyps that were not noticed during the first operation are removed after 1-2 weeks.

After the removal of one or more polyps, the nasal cavity is tamponed with turundas lubricated with petroleum jelly and a sling-like bandage is applied.

The next day, the turundas are removed, the nasal cavity is washed with antiseptics and salt solutions. After 3-5 days, with a favorable course, the patient is discharged from the hospital.

Disadvantages of the method:

The operation is the most traumatic, always accompanied by bleeding of one degree or another.
The longest recovery period.
This method can remove polyps that only grow in the nasal cavity. That is, if a polyp grows from the sinus, it is impossible to remove it completely to the base.
This method is most often accompanied by relapses (up to 70%). That is, the polyps grow back within a year.

The advantages of the method include its availability and low cost, since in this case expensive equipment is not required.

Endoscopic surgery

Endoscopic surgery of the nasal cavity and paranasal sinuses is increasingly gaining a niche surgical treatment this area. With the help of a microendoscope, almost all operations in the nose, including the removal of polyps, can be performed.

The endoscope displays a magnified image on the monitor screen. This allows the surgeon to perform manipulations both in the nasal cavity and in the cavities of the paranasal sinuses with maximum accuracy.

Endoscopic removal of polyps can be performed under local or general anesthesia. The choice of anesthesia depends both on the volume and expected duration of the operation, age (children under 7 years old are general anesthesia), and on the preferences of the patient himself.

Endoscopic removal of polyps can be performed in three ways:

Polypotomy with microinstruments without shaver.
Removal of polyps with a shaver (microderiber).
Shaver removal with navigation.

removal of polyps with a shaver

Removal of polyps with a shaver is the most convenient way of this type of operation. A shaver is a special tool that has a tip with a set of various cutting nozzles and suction. The use of a shaver allows you to very accurately, within healthy tissues, with minimal trauma, remove all polyps both in the nose and in the sinuses.

The shaver is brought to the polyp, cuts it off together with the leg, crushes and sucks.

The use of video navigation makes it possible to revise the paranasal sinuses and remove all polyps in them (mainly in the cells of the ethmoid labyrinth).

The whole procedure lasts 50-60 minutes. After the operation, the nasal cavity is plugged for a day. Terms of inpatient treatment - 2-3 days. Sometimes the patient can be sent home immediately.

Video: endoscopic shaver removal of nasal polyps

After polypotomy

The patient usually stays in the hospital for observation for several days. A day later, the turunda is removed, the nasal cavity is washed with antiseptics and lubricated with synthomycin ointment or petroleum jelly to soften the crusts. For the same purpose, irrigation of the nasal cavity with saline solutions or the use of oil drops (Pinosol, sea buckthorn oil) is used.

Antibiotics are prescribed to prevent infectious complications. A week after the removal of polyps, the use of anti-inflammatory and antiallergic drugs (Nasonex spray) is recommended.

In the postoperative period, you can not:

Pick crusts in the nose.
Blow your nose hard.
Take hot food.
Take a hot bath or shower.
Lift weights.
Take alcohol.

According to patients, nasal breathing is restored after a few days, and the sense of smell resumes within a month.

Complications that may occur after a polypectomy:

Bleeding.
Inflammation - rhinitis, rhinosinusitis.
The formation of adhesions.
Re-formation of polyps (unfortunately, recurrence of polyps is the main problem even endoscopic surgery, the recurrence rate is about 50%).

Removal of polyps with a laser

Laser removal of polyps is perhaps the most safe method polypectomy. Removal of polyps with a laser can be performed on an outpatient basis, under local anesthesia.

It is often used to remove polyps in children, as well as those with chronic diseases.

The essence of the operation is that the polyp tissue is simply “evaporated” under the influence of high-precision laser energy. The operation is performed under the control of the endoscope. The procedure is quick and takes no more than 15-20 minutes. Bleeding is not observed, as the laser seals the vessels. The risk of infection is also minimal. Nose packing is not required.

However, the use of laser polypotomy is limited: only single polyps can be removed by this method, and only those located in the nasal cavity. With multiple polyps and polyposis of the paranasal sinuses, laser treatment will not solve the problem.

Radio wave polypotomy

It is carried out by the Surgitron apparatus using a radio wave loop. The operation is also almost bloodless and can be performed on an outpatient basis. It is used to remove only large and medium polyps.

Main conclusions

Let's summarize:

Surgical treatment of polyps is a thankless task. None of the operations to remove polyps from the nose guarantees their re-growth.
The smallest percentage of relapses gives complete endoscopic removal of polyps in the nasal cavity and in the paranasal sinuses. When removed in this way, the time until the re-formation of polyps is stretched to 5-6 years.
If the patient has the opportunity to choose, then you need to choose a clinic with modern video endoscopic equipment, with sufficient experience in performing such operations. Of all the methods, the most effective is the shaver removal of polyps with navigation.
It is advisable to simultaneously eliminate all defects that can contribute to the re-formation of polyps (correct the crooked nasal septum, resect the hypertrophied nasal concha).
After the removal of polyps, it is necessary to follow all the recommendations, as well as use agents that inhibit the growth of polypous tissue (mainly hormonal preparations local action), to be examined and treated by an allergist.

The cost of polyp removal surgery

Most a budget option is a polypotomy in the usual way using a polyp loop. It can be carried out free of charge in any ENT department. In paid clinics, it costs from 2000 rubles (on the one hand).

Endoscopic removal of polyps will cost from 15 to 35 thousand rubles (depending on the volume of the operation, the rank of the clinic, the duration of inpatient treatment). The operation under general anesthesia will cost up to 70 thousand rubles.

Laser removal of a polyp will cost about 8-10 thousand rubles.

Video: removal of polyps in the nose in the Health program

Nasal polyps are an overgrowth of the epithelial tissue of the mucous membrane of the labyrinth or maxillary sinus. Some ENT specialists refer to them as benign tumors. Others prefer to consider polyps separately because their structure is more consistent with unaltered, normal tissues.

The average prevalence of the disease in the world is 1-4%. It does not belong to the category of dangerous, but is recurrent: in 70% of cases, polyps reappear after removal.

Reasons for the formation of polyps

Nasal polyps (the official medical name for the disease is polyposis rhinosinusitis) can have completely different etiologies. However, such a remark can be made in relation to most tumors and growths similar to them. Among the most common causes are the following:

Allergy and accompanying symptoms (runny nose, sneezing, cough).
Chronic infectious diseases associated with the nose or paranasal sinuses (sinusitis, rhinitis).
Some physiological conditions accompanied by hormonal changes (pregnancy).
Deviated septum, nasal trauma.
One of the latest theories expressed in the domestic literature is a violation of the metabolism of arachidonic acid. Note. This compound is involved in the formation of substances that transmit signals between nerve cells. Products of arachidonic acid - prostaglandins, are responsible in particular for the regulation of the inflammatory process.
Cysts in the nasal cavity and sinuses. They are small, fluid-filled formations.
Hereditary diseases that lead to disruption of the normal functioning of the mucosa (for example, cystic fibrosis).
Taking drugs or products with aspirin if you are intolerant to it.

Development of the disease

Despite the heterogeneity of the causes that cause polyps, the disease develops according to the same pattern. The mucous membrane of the paranasal sinuses or the ethmoid labyrinth has to function long time under conditions of increased activity. This is necessary to cope with allergies, inflammation or other adverse factors. At first, it performs this task, but gradually the reserves run out, and the effect of the factor does not stop.

Then the body tries to compensate for the insufficient efficiency of the mucosa by increasing its area. The tissue begins to grow, a polyp forms. At first, it is localized in the organ in which it was formed, but gradually, with an increase in its size, it begins to hang down into the nasal cavity. There he interferes with breathing, over time seriously complicating it.

The formed polyp looks like this: it is a mushroom-shaped formation on a stalk that hangs down into the nasal cavity with its wide part. The color of a polyp can vary from pearlescent to red, depending on how well the blood supply is developed in it. It is characterized by moderate growth, spherical or cylindrical shape.

The polyp does not affect other tissues, except for the mucous membrane and does not pose a serious danger to the body.

Symptoms of polyposis rhinosinusitis

The main symptom of the disease is nasal congestion. It does not go away after taking vasoconstrictor drugs, worsens over time. Patients may also complain of:

Sinusitis. Inflammation of the paranasal sinuses is often the cause or concomitant disease of polypous rhinosinusitis.
Rhinitis. Runny nose (allergic or otherwise) often provokes hypertrophic development of the mucosa.
Decrease or loss of smell. Due to changes in the size of the mucosa, sensitive areas cease to function properly, they become smaller relative to the total surface of the nasal cavity.
Headache. Violation of nasal breathing often results in problems with the regular supply of oxygen to the brain. Periodic hypoxia can cause migraines.
Voice disturbance. Due to the constant congestion of the nasal passages, the patient is forced to nasalize when talking.

Diagnostics

As a rule, polyps are easily detected during rhinoscopy. An important task of a specialist is differential diagnosis from benign malignant tumors and other diseases. To do this, research:

Computed tomography of the nasal sinuses. It is carried out, as a rule, before the operation, in order to accurately identify the localization of the polyp.
Biopsy. A piece of tissue that makes up a polyp is subjected to a comprehensive study, its structure, size and shape of cells are studied under a microscope.
Serological study. It allows, in the absence of certain antibodies in the blood, to exclude scleroma, tuberculosis, syphilis, leprosy. These diseases sometimes produce similar tissue indurations (granulomas) that can be mistaken for polyps.

Diagnosis can be somewhat difficult in children, especially at a younger age, when they can't talk about their problems on their own. Parents should take their child to the doctor if:

He suffers from a prolonged runny nose, which then subsides, then resumes again.
The child's nose is stuffed up, he breathes mainly through his mouth.
The kid periodically rubs his nose, shows obvious discomfort.
Along with the above symptoms, the child's appetite has changed, he has become capricious and irritable.

Treatment of polyps and prevention of recurrence

In the treatment of the disease, the doctor should set the following goals:

Elimination of the cause of the disease when it is detected.
Restoration of normal nasal breathing.
Polyp removal.
Prevention of the emergence of a new formation.

Important! The combined measures of medical treatment of polyps (conservative therapy) and surgery are recognized as the most effective at the moment. Exclusively surgical intervention does not make it possible to achieve a stable remission (recovery).

Conservative treatment

The basis of the drugs taken are steroids. Along with them, antibiotics and antiseptic drugs, general stimulants and immunomodulators can be prescribed. In therapeutic practice, intranasal topical steroid sprays are usually used:

Beclomethasone. The drug acts as an anti-inflammatory and antiallergic agent. It inhibits the work of certain parts of the immune system, therefore, with prolonged use, infection of the nasal cavity is possible (most often with fungi of the genus Candida). In this case, the reception is not stopped, but beclomethasone is combined with antimicrobials. Also, the drug can affect the adrenal glands, slowing down the growth of the body in childhood. For this reason, it is contraindicated for use under 12 years of age.
Mometasone. The drug reduces inflammation, relieves swelling, itching, fluid accumulation in the nasal cavity. Mometasone reduces the production of arachidonic acid, which can presumably be involved in the formation of polyps. With prolonged use, control of adrenal function is necessary.
Fluticasone. The drug belongs to synthetic corticosteroids. Its use in the form of an intranasal spray is allowed from the age of 4. One of the frequent side effects from the use of the drug include: nosebleeds; sensation of dryness, unpleasant smell or taste; headache.

The impact of immunomodulatory drugs is currently being studied, but the work of recent decades shows their unequivocal effectiveness. They make it possible to treat diseases by influencing the mechanism of its development.

However, the results are highly dependent on the route of administration of drugs (preferably local). Often they are used along with surgery. Candidate of Medical Sciences Samolazova S.G. describes the results of the use of these drugs for polyps (2003): “Local immunocorrection with cycloferon and subsequent surgery lead to an improvement in immunogram scores… and an increase in the rate of mucociliary transport.”

The positive effect of recombinant human interferon 2a. This drug affects cells at the genetic level, preventing their proliferation (excessive growth and reproduction). Researches show ( Miroshnenko A.P., 2004) that “recombinant a2 interferon should be used in addition to traditional treatment polypous rhinosinusitis.

Surgical removal of polyps

It is worth noting that getting rid of a polyp without surgery is quite difficult, usually on conservative treatment stop only if there are serious contraindications to surgical intervention (asthma during an exacerbation, bleeding disorders, etc.).

There are three main operational methods:

Laser removal.
Endoscopic polypectomy.
Removal with Lange's loop.

The laser is considered the least traumatic, but it is used only for single polyps. The operation lasts 15-20 minutes and is usually performed under local anesthesia. During the procedure, a device that emits laser beams is inserted into the nasal cavity. They cause coagulation of polyp cell proteins. As a result, they die. As such, no wound is formed in the process, which minimizes the risk of infection and subsequent complications. Scarring at the site of the former polyp also does not occur.

Due to the limitations of the method, endoscopic polypectomy is performed much more frequently. It allows you to remove any growth, even in hard-to-reach places in the body. The operation is performed under general anesthesia and is associated with a small risk of bleeding. A big plus of polypectomy is the low risk of recurrence. New polyps usually appear no earlier than 5-6 years after surgery.

The doctor observes the entire space in an enlarged view on the monitor screen, which allows him to act with great accuracy. The actual removal is performed using a special device - a rhinoscopic shaver. It resembles a pistol in appearance, but instead of a muzzle, it contains a hollow tube with cutting nozzles of various sizes. Depending on the volume of the polyp, the doctor chooses one or another knife. During the operation, the cutting nozzles rotate, and at the same time, excess tissue is captured. Removal with shaver is an excellent alternative to conventional surgery, because. the device acts pointwise, leaving healthy mucosa intact.

Video: removal of polyps in the nose, endoscopic surgery

The last method - polypotomy with a loop, is the oldest, "classic" way to get rid of growths in the nasal cavity. The operation is performed under general anesthesia and can take up to 1 hour. Important! Its main disadvantage is the high recurrence rate. After a few months, the polyps reappear. This is due to the fact that the surgeon removes only the visible part of the neoplasm, while the growth of the polyp from the sinuses or the mucosa of the ethmoid labyrinth begins. The advantages of the operation are its accessibility, the possibility of carrying it out without a highly qualified doctor or special expensive equipment.

Treatment of polyps with traditional medicine

At the moment, there is no encouraging data on the possibility of getting rid of the disease on their own. Although homeopathy and alternative medicine offer a wide range of methods, home treatment is unlikely to bring the desired recovery. However, folk remedies for dealing with polyps in the nose can be considered as maintenance therapy, which will alleviate the patient's condition before a medical examination or surgery.

For such purposes, you can use:

Celandine juice diluted with water 1:2. It is recommended to bury it in the nose for 10 days. First you need to make sure that you do not have an allergic reaction to the plant. Also, the solution can be laid in the nasal passages by moistening a cotton swab with it.
Hypericum juice mixed with sea buckthorn juice. This tool is used for long-term use. Homeopaths advise using it for instillation for at least 1 year. The main thing is to monitor the freshness of the solution. It must be stored in the refrigerator, but not more than 10-14 days.
Tui oil. It can be used in finished form or used as part of the same name. homeopathic remedy. The oil is sold in specialized pharmacies or can be ordered from non-traditional practitioners.

Video: treatment of polyps in the nose with folk methods

Nasal hygiene

During illness and as part of its prevention, it is necessary to perform certain hygiene procedures:

Frequent moistening of the nasal cavity.
Washing the nose with sea water or iodine-salt solution.
Inhalations with decoctions of herbs with anti-inflammatory properties: chamomile, calendula, sage, etc.
Wetting the nasal mucosa with vaseline, almond, peach oil.

It is also desirable to protect the patient from the action of additional damaging factors:

Smoke from a fire or tobacco smoke;
Inhalation of poisons, including insecticides for private use;
dust;
Aroma and pollen of flowering plants.

A big plus will be the rejection of food allergens that can aggravate the situation: coffee, chocolate, citrus, spicy, salty or smoked foods.

Important! It is not possible to cure polyps with surgery or by taking steroid drugs. These methods are purely symptomatic. They are necessary because there is no other way to get rid of polyps. However, to prevent recurrence, it is important to identify the causes of neoplasms and eliminate them.

Nasal polyps are benign neoplasms
which look like small rounded formations and are formed as a result of prolonged irritation of the nasal mucosa and paranasal sinuses.

The presence leads to the development of a number of undesirable symptoms, which can only be eliminated with the help of surgical intervention.

Removal of polyps in the sinuses. Indications for surgery

Before performing surgery in connection with polyposis neoplasms of the nasal cavity, it should be determined whether there are indications for their removal. There are absolute and relative indications for surgical removal of polyps in the nose.

Absolute indications for surgery to remove nasal polyps:

Relative indications for surgery:

The appearance of snoring.
Voice change (hoarseness).
Hyposmia.
Periodic headache and dizziness.
Sensation of a foreign body in the nose.

Contraindications to surgery

The presence of polyposis neoplasms in the nose is not in all cases an indication for their removal during surgery. There are local and systemic contraindications to the removal of polyps.

Systemic contraindications for surgery to remove polyposis neoplasms:

Attack of bronchial asthma.
Blood diseases such as hemophilia, acute leukemia, thrombocytopenic purpura.
Decompensated conditions of the cardiovascular system (myocardial infarction, coronary heart disease, hypertensive crisis, collapse, etc.).

Local contraindications for surgery:

Acute diseases of the nose and paranasal sinuses (, acute sinusitis).

If you have a history of the nasal cavity, you should consult with an oncologist before the operation.

Nasal polyps operation. Description of the method

There are a large number of different methods of surgical removal of polyps. To date, the operation to remove polyps in the nose is performed under general anesthesia. The essence of surgical intervention is to excise pathological neoplasms. Polypotomy (surgical intervention to remove polyps) is performed in a sitting position of the patient.

Technique for the operation to remove polyps in the nose:

First of all, anterior and posterior rhinoscopy should be performed using nasal mirrors.
Sanitize the nasal cavity and paranasal sinuses with a hypertonic solution or Humer pharmacological agent.
Dry the nasal cavity with a cotton swab.
Consistently lubricate the nasal mucosa twice with 10% dicaine solution to reduce its sensitivity during surgical excision of neoplasms.
Find out the location of the legs of polyps, their number and size.
Insert the snare into the nose under visual control.
Conduct an audit of the nasal cavity with the help of a loop outlet.
Put a loop on a polyp or a group of polyps (if they are small).
Move the loop up to the head of the polyp.
After feeling the solid consistency of the head of the polyp, tighten the loop.
Remove the loop with polypous masses from the nasal cavity and put in a special tray.

Especially important!

An important criterion that prevents recurrence is the removal of the polyp along with the stem. Therefore, you should carefully tighten the loop so as not to cut off the head of the polyp, but to pull the polyp along with the leg from the nasal cavity.

Methods for removing polyps in the nose

. Endoscopic removal is one of the most accurate removal methods. The operation is performed using a special medical endoscope with a camera. This allows you to achieve complete removal of even the smallest formations and at the same time not damage the surrounding structures of the nasal cavity.
Removal with a shaver (microdebrider). The essence of this technique is the grinding of neoplasms and their absorption. The operation is less traumatic and is performed under the control of a screen monitor.
. Under the influence of laser beams, the neoplasm disappears. The advantage of this method is the additional coagulation of the vessels and the prevention of the spread of infection to the surrounding structures.
. With the help of the Lange hook, it is possible to remove not only nasal polyps, but also polyps with localization in the choanal area.

Ways to remove polyps in the nose:

Symptoms after removal of polyps

In the vast majority of cases, the postoperative period proceeds without significant complications.

In particular cases, postoperative symptoms are presented:

The development of minor bleeding. This symptom develops as a result of damage to the vessels of the nasal cavity.
The formation of adhesions and adhesions after surgery in the nasal passages. This symptom develops 2-3 months after surgery. Patients again complain of aggravated nasal breathing. This symptomatology requires prompt dissection of newly formed adhesions.
Disease recurrence. The development of relapses is possible if there was an incomplete removal of polyps or the doctor removed only the head of the polyp.
Accession of infectious complications. Infectious complications are added in the case of an operation in the acute period of diseases of the nose or paranasal sinuses. Infectious agents can spread through the hematogenous or lymphogenous route and lead to systemic manifestations of an infectious disease.
Headaches. Headaches are a transient symptom that disappears after 3-5 days. The temperature after removal of polyps in the nose is kept at around 37.
Difficulty in nasal breathing and loss of smell as a result of the development of edema. This symptom is a physiological response to surgery. Normally, the restoration of the respiratory and olfactory function of the nose occurs 3-5 days after the operation.

More modern methods of operational influence prevent the development of postoperative symptoms.

The correct tactics of the patient in the postoperative period will help to avoid the recurrence of the disease and the development of many dangerous complications (recurrence of the disease, bleeding, etc.).

In the first days after surgery to remove polyps, antibacterial drugs (Ceftriaxone, Suprax) should be taken. These pharmacological preparations will help to avoid the development of complications of an inflammatory nature. Antibiotics should be taken for 3-5 days of the postoperative period.
Also, after the operation, otolaryngologists recommend instilling oil-based drops (Pinosol, sea buckthorn oil) into the nasal cavity, because they contribute to faster healing of the postoperative wound and prevent the formation of adhesions and adhesions in the nasal passage.
The next step after the operation is the regular sanitation of the nasal cavity with saline or Humer's pharmacological agent. Sanitation should be carried out from 5 to 14 days after surgery.
In the first days of the postoperative period, topical steroids (Nasonex) are recommended. These medicines do not cause side effects from other organs and systems and at the same time prevent the development of relapses of the disease.

In the treatment after removal of polyps in the nose, it is recommended to use 30% propolis ointment. Swabs are wetted and placed in the nose. The duration of the procedure is 2 weeks

Propolis ointment after removal of polyps in the nose

Recovery after removal of polyps in the nose

Follow a gentle regimen.
Avoid hot food and drinks. Hot drinks and food lead to vasodilation and provoke the development of bleeding.
Don't lift weights. An increase in systemic arterial pressure is also a risk factor for bleeding.
Avoid prolonged sun exposure.
Not located in a dusty environment.
Do wet cleaning in the house twice a day
Carry out timely ventilation in the apartment.
Do not come into contact with infectious patients

An increase in the overall resistance of the body and a positive psychological attitude of patients will also help to avoid complications in the postoperative period.

Removal of polyps in the nose video:

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

The causes of polyps are different, mainly:

Violation of the aerodynamics of the nasal cavity.
Chronic inflammatory process in the paranasal sinuses.
Allergy, in this case, polyposis is usually combined with bronchial asthma.

Polyps in the sinuses are usually multiple, outwardly they resemble a bunch of grapes. With excessive growth, they come out of the fistulas of the sinuses and are located in the nasal cavity.

Why polyps need to be removed

In the initial stage, polyps are tried to be treated conservatively, but usually these measures do not work. Sooner or later, they still have to be removed surgically.

Who is shown the removal of polyps

Intervention is indicated for the following groups of patients:

Patients with complete nasal congestion.
The combination of polyposis with a curvature of the nasal septum.
The combination of polyps with chronic rhinitis, chronic sinusitis, not amenable to conservative treatment.

Preparing for the operation

At the first examination, the ENT doctor performs a rhinoscopy at the reception. Polyps with rhinoscopy are usually clearly visible.

However, to clarify their number, size, degree of damage to the nasal mucosa and sinuses, clarifying examinations are usually prescribed:

X-ray of the paranasal sinuses.
Computed tomography of the sinuses.
Videoendoscopic examination of the nasal cavity and sinuses.

No operation scheduled:

During the flowering season, when the course of allergic rhinitis and asthma worsens.
For acute infectious diseases
Decompensated course of chronic diseases of the heart, liver, kidneys.
Violation of blood clotting.
During pregnancy.

2 weeks before the operation, you must undergo:

General blood and urine tests.
Coagulogram.
Biochemical analysis.
Electrocardiography.
Chest x-ray.
Blood for markers of viral hepatitis, syphilis, HIV.
Therapist's review.

A few days before the operation, drugs that prevent blood clotting (aspirin, warfarin) are canceled. Decongestants and anti-inflammatory drugs (ketotifen, dexamethasone) are prescribed.

Types of operations to remove nasal polyps

To date, the following types of interventions are carried out:

The usual polypotomy. The oldest, most traumatic, but also the cheapest operation.
Endoscopic removal of polyps.
Removal of polyps with a laser.
Radio wave polypotomy.

It must be said that nasal polypotomy is very often combined with other operations:

With drainage of the paranasal sinus in chronic sinusitis, ethmoiditis, sphenoiditis.
Correction of deviated nasal septum.
With resection of the nasal concha (conchotomy).

Conventional polypotomy

The position of the patient is sitting, a tray for flowing blood is placed under the chin. The duration of the operation is 40-60 minutes.

Usually, all polyps visible during anterior rhinoscopy are removed. Those polyps that were not noticed during the first operation are removed after 1-2 weeks.

After the removal of one or more polyps, the nasal cavity is tamponed with turundas lubricated with petroleum jelly and a sling-like bandage is applied.

The next day, the turundas are removed, the nasal cavity is washed with antiseptics and saline solutions. After 3-5 days, with a favorable course, the patient is discharged from the hospital.

Disadvantages of the method:

The operation is the most traumatic, always accompanied by bleeding of one degree or another.
The longest recovery period.
This method can remove polyps that only grow in the nasal cavity. That is, if a polyp grows from the sinus, it is impossible to remove it completely to the base.
This method is most often accompanied by relapses (up to 70%). That is, the polyps grow back within a year.

To benefits The method can be attributed to its availability and low cost, since in this case expensive equipment is not required.

Endoscopic surgery

Endoscopic surgery of the nasal cavity and paranasal sinuses is increasingly gaining a niche in the surgical treatment of this area. With the help of a microendoscope, almost all operations in the nose, including the removal of polyps, can be performed.

Endoscopic removal of polyps can be performed under local or general anesthesia. The choice of anesthesia depends both on the volume and expected duration of the operation, age (general anesthesia is used for children under 7 years of age), and on the preferences of the patient himself.

Endoscopic removal of polyps can be performed in three ways:

Polypotomy with microinstruments without shaver.
Removal of polyps with a shaver (microderiber).
Shaver removal with navigation.

removal of polyps with a shaver

The shaver is brought to the polyp, cuts it off together with the leg, crushes and sucks.

The use of video navigation makes it possible to revise the paranasal sinuses and remove all polyps in them (mainly in the cells of the ethmoid labyrinth).

The whole procedure lasts 50-60 minutes. After the operation, the nasal cavity is plugged for a day. Terms of inpatient treatment - 2-3 days. Sometimes the patient can be sent home immediately.

Video: endoscopic shaver removal of nasal polyps

After polypotomy

Antibiotics are prescribed to prevent infectious complications. A week after the removal of polyps, the use of anti-inflammatory and antiallergic drugs (Nasonex spray) is recommended.

In the postoperative period, you can not:

Pick crusts in the nose.
Blow your nose hard.
Take hot food.
Take a hot bath or shower.
Lift weights.
Take alcohol.

According to patients, nasal breathing is restored after a few days, and the sense of smell resumes within a month.

Complications that may occur after a polypectomy:

Bleeding.
Inflammation - rhinitis, rhinosinusitis.
The formation of adhesions.
Re-formation of polyps (unfortunately, recurrence of polyps is a major problem even in endoscopic surgery, the recurrence rate is about 50%).

Removal of polyps with a laser

Laser removal of polyps is perhaps the safest method of polypectomy. Removal of polyps with a laser can be performed on an outpatient basis, under local anesthesia.

It is often used to remove polyps in children, as well as those with chronic diseases.

Radio wave polypotomy

Main conclusions

Let's summarize:

Surgical treatment of polyps is a thankless task. None of the operations to remove polyps from the nose guarantees their re-growth.
The smallest percentage of relapses gives complete endoscopic removal of polyps in the nasal cavity and in the paranasal sinuses. When removed in this way, the time until the re-formation of polyps is stretched to 5-6 years.
If the patient has the opportunity to choose, then you need to choose a clinic with modern video endoscopic equipment, with sufficient experience in performing such operations. Of all the methods, the most effective is the shaver removal of polyps with navigation.
It is advisable to simultaneously eliminate all defects that can contribute to the re-formation of polyps (correct the crooked nasal septum, resect the hypertrophied nasal concha).
After the removal of polyps, it is necessary to follow all the recommendations, as well as use agents that inhibit the growth of polyposis tissue (mainly local hormonal preparations), undergo an examination and treatment by an allergist.

The cost of polyp removal surgery

The most budgetary option is polypotomy in the usual way using a polyp loop. It can be carried out free of charge in any ENT department. In paid clinics, it costs from 2000 rubles (on the one hand).

Laser removal of a polyp will cost about 8-10 thousand rubles.

Video: removal of polyps in the nose in the Health program

Polypotomy is a manipulation that allows you to get rid of polyps, restore normal nasal breathing, and also get rid of the accompanying unpleasant symptoms (loss of smell, hearing, sleep, etc.)

Contraindications:

bronchial asthma;
poor blood clotting;
cardiovascular diseases.

Used equipment:

polyp loops for the nasal cavity;
radio wave loop for removal of polyps of the nasal cavity;
rhinoshaver (microdebrider).

Polyps are formations that occur in the paranasal sinuses and descend into the nasal cavity, interfering with normal air circulation and full breathing. Outwardly, they look like small bunches of grapes. When they grow, they not only make it difficult to breathe, but can cause unpleasant symptoms that cause discomfort and interfere with normal life: loss of smell, hearing, sleep. People turn to the clinic for the removal of polyps in the nose already when such signs of the disease appear as:

it is difficult to breathe through the nose; vasoconstrictor drops do not make life easier, and you have to breathe through your mouth;
due to poor air circulation in the nasal cavity, pathogenic microflora develops, causing frequent viral diseases, accumulation of mucus and pus;
the patient does not leave the feeling that there is foreign body;
frequent headaches.

How to delete?

There are three methods of getting rid of polyposis: laser removal of polyps in the nose, removal under the control of an endoscope and a loop. The operation itself is called polypotomy.

Laser removal is the most delicate and safe method. It is performed under local anesthesia and lasts about 20 minutes. Suitable for those patients who cannot be treated general anesthesia, and children. The only disadvantage of the procedure is that only single polyps can be removed in this way; it is not possible to remove them inside the sinuses. The price for laser removal of nasal polyps in Moscow clinics depends directly on the degree of polyposis growth and the pricing policy of the clinic.
With the help of an endoscope, you can see polyps in the most inaccessible corners, including in the sinuses. Moreover, the risk of recurrence of polyposis is sharply reduced. The image from the endoscope camera is displayed on the monitor, and it becomes possible to see the number of polyps and their size. The operation is performed both under local anesthesia and under general anesthesia.
If the formations are large, they need to be removed with a loop. The loop can be tearing and cutting. The first is used when endoscopic polypotomy is performed for the first time, the second - during a second operation. You can use the loop of the Surgitron apparatus - this is a more gentle way. First, local anesthesia is performed with a solution of lidocaine, then an injection with an anesthetic. The whole procedure takes about an hour. With this method, you can get rid of multiple neoplasms, but only those that are in the nasal cavity. The method is contraindicated in patients with bronchial asthma, poor blood clotting and cardiovascular diseases. An unpleasant consequence of the operation is the possibility of re-formation of polyps within a year.

Our doctors

Forecast

After the intervention, great attention must be paid to the hygiene of the nasal cavity. You can not sharply blow your nose. Nose crusts must be removed very carefully. Do not eat very hot food. Breathing normalizes within a few days after endoscopic polypotomy, the sense of smell returns within 30 days. At home, you need to rinse your nose with products like Aquamaris, Aqualor, etc. and take allergy medications. And of course, observation by an otorhinolaryngologist is necessary.

Endoscopic polypotomy with us

The cost of nasal polyp surgery depends on several factors. First of all, on the degree of growth of formations. The more advanced the disease, the longer, harder and more expensive this operation will cost. The cost in Moscow of this operation also depends on the chosen removal method. So the cost of laser polypotomy of the nose in Moscow will cost more than conventional polypotomy.

The cost of removing nasal polyps with a laser, loop or endoscope in our clinic has remained unchanged for 3 years now.

To find out the exact cost of manipulations, you need to contact the specialists of our clinic for primary diagnosis. ENT doctors will conduct a comprehensive examination, the results of which will determine the degree of the disease, the number of formations, their size, and suggest one of the methods of surgery. After examination, the ENT will announce the exact cost of nasal polypotomy with a laser, loop or endoscope.

You can find out how much the procedure in the clinic costs on the website or at the appointment with the ENT

ENT doctor's consultation

* - the cost of admission is included in the cost of the operation

ENT diagnostics

ENT manipulation

Possible ENT manipulations in the postoperative period

medical service	price, rub.
Removal of tampons from the nasal cavity with treatment of the nasal cavity	500
Sanitation of the nasal cavity	500
Nasal toilet	500
Laser session photodynamic therapy nasal cavity and nasopharynx	1000
laying medicinal ointment into the nasal cavity	500
Session of ultrasonic medicinal irrigation (device "TONZILOR-M")	1000
Session of infrared laser therapy of the nasal cavity and nasopharynx	200
Session of ultraviolet irradiation of the nasal cavity and nasopharynx	200
Session of vibroacoustic therapy in the projection of the maxillary sinuses	200
Session of magnetotherapy with the device "POLYUS - 2D"	200
Percutaneous infrared laser treatment with RVB device (Italy)	200

** - discount is provided for complex treatment diseases

nasal polyps- These are rounded benign, painless to the touch formations that are the result of an overgrowth of the nasal mucosa. Outwardly, they look like a pea, a mushroom or a bunch of grapes.

According to statistics, nasal polyps are one of the most common complications. chronic rhinitis. Nasal polyposis affects 1-4% of the population. Men are 3-4 times more susceptible to it than women. Anthrochoanal polyps are more common in children, while ethmoid polyps are more common in adults.

The disease is manifested by nasal congestion and mucous secretions. Unlike the common cold, after application vasoconstrictor drops breathing does not improve. The person is forced to breathe through the mouth. And as a result, dry air enters the lungs, insufficiently purified from dust and allergens. It causes frequent illnesses respiratory tract and asthma. As a result, polyposis reduces the life expectancy of a person by 6 years.

nose anatomy

The human nose is a rather complex structure. The part we see is called the external nose. It includes: the frontal process of the maxilla, the lateral cartilage and the greater pterygoid cartilage of the nose. Lateral surfaces - the wings of the nose consist of cartilage and connective tissue, from below they open with nostrils. All this is covered on top with muscles and skin rich in sebaceous glands.

The internal structure of the nasal passages is more complex. The nasal cavity is formed by the nasal septum, which consists of a vertical plate of the ethmoid bone, vomer and cartilage. For many people, this septum is curved. Minor changes are considered a variant of the norm.

The nasal cavity has four walls:

lateral
internal
top
lower

The most complex structure has a side wall, on which the upper, middle and lower nasal conchas are located. It is formed by the nasal bones, upper jaw, lacrimal bone, ethmoid bone, pterygoid process of the sphenoid bone, lower turbinate(independent bone) and the vertical plate of the palatine bone.

Between the nasal septum and the nasal conchas is a space called the common nasal passage. In the lateral sections of the nose there are three nasal passages, each of which corresponds to the nasal concha. The opening of the nasolacrimal canal opens in the lower nasal passage.

Also, the lumens of the paranasal sinuses open into the nasal cavity. These are small "pockets" in the bones of the skull that contain air.

The maxillary sinus is located in the upper jaw
The frontal sinus is located in the frontal bone
Ethmoid labyrinth in the ethmoid bone
Sphenoid sinus in the main (sphenoid) bone

This whole complex system performs a number of vital functions.

Prevents hypothermia. Warms cold air before it enters the lungs.
Humidifies and filters the air from dust, allergens and microorganisms. Detains these particles on the hairs and mucous membranes, neutralizes and prevents them from entering the respiratory tract.
Participates in the formation of voice, playing the role of a resonator.
Provides odor discrimination.

But all these functions of the nose would not be possible without a special mucous membrane that lines the nasal cavity. From above, it is covered with pseudostratified epithelium. Below is a loose connective tissue, under it is a layer of glands and perichondria (the top layer of cartilage).

On the surface there are goblet and ciliated cells with numerous cilia, as well as short and long intercalated epitheliocytes, which are responsible for renewing mucosal cells.

The protective function of the inner lining of the nose is provided by ciliated cells of the ciliated epithelium. Each of them has 250-300 cilia a few microns long. Cilia retain the smallest particles of substances that are contained in the air. With oscillatory movements, the cilia sends these substances to the nasopharynx.

The protective factor is mucus, which is produced in the nose by mucous glands and goblet cells. It prevents the nasal cavity from drying out, and foreign particles also stick to it. Then this contaminated mucus is pushed out by the movement of the cilia and a natural cleansing of the respiratory tract occurs.

Causes of nasal polyps

During infectious diseases, microorganisms multiply on the mucosa. This process leads to the exfoliation of the upper layer of mucosal cells. At this time, we feel a burning sensation in the nose, congestion, voice changes. Mucus flows from the nose, which is the result of increased work of the mucous glands and exudate, a liquid that forms during inflammation. At proper treatment and normal immunity after 7-10 days recovery occurs. The mucosa is restored and again able to perform its functions.

If the disease is not treated, then it can drag on and go into chronic form. A prolonged inflammatory process undermines local immunity and the strength of the mucous membrane. But she tries to fulfill her functions by increasing the area. As a result, it begins to grow intensively and thicken due to the growth of connective tissue. It often occurs in the paranasal sinuses. At a certain point, the hyperplastic (overgrown) mucosa exits the sinus opening into the nasal cavity - this is commonly called a polyp.

The cause of the appearance of polyps can be:

frequent colds and infectious diseases, accompanied by a runny nose
chronic sinusitis(inflammation of the paranasal sinuses - sinusitis, frontal sinusitis, ethmoiditis)
allergic rhinitis caused by inhalation of household and library dust, plant pollen, fungal spores, animal hair, particles of household chemicals, chromium compounds
a severe curvature of the nasal septum, causing respiratory failure and mucosal overgrowth
hereditary tendency to form polyps
pathological reaction immune system

A number of diseases can affect the occurrence of polyps: asthma, cystic fibrosis, aspirin intolerance, nasal mastocytosis, Young's syndrome.

According to the place of origin, polyps are divided into:

Anthrochoanal - often arise from the mucosa of the maxillary sinus. Settled on one side. More common in children.
Ethmoidal- develop from the mucosa lining the ethmoid labyrinth. Occur on both sides of the nasal septum. Affect adults.

From the size of the polyp and the changes it causes, there are three stages of polyps:

First stage - polyps cover only a small part of the nasal space
The second stage - the connective tissue grows so much that it covers a significant part of the lumen of the nasal cavity.
The third stage - polyps completely block the respiratory passage.

Symptoms of nasal polyps

A nasal polyp is a rounded formation from a few millimeters to 3-4 centimeters. It is painless, insensitive to touch, and moves easily.

With nasal polyposis, the following symptoms occur:

Prolonged difficulty in nasal breathing, feeling of nasal congestion. This is due to the fact that the overgrown mucosa partially or completely blocks the lumen of the nasal passage.

Runny nose, mucous or mucopurulent discharge. These are signs of secondary infection and intense work of the mucous glands.

sneezing with polyps in the nose, it occurs due to the fact that the outgrowth of the mucous membrane touches the cilia, and they perceive it as a foreign object. And sneezing is a defensive reaction that allows you to get rid of it.

Olfactory disorders, up to total loss sensitivity to odors. With the growth of connective tissue, the work of receptor cells that perceive odors is disrupted in the polyp.

Headache is a consequence of compression of the overgrown tissue of nerve endings. The lack of oxygen caused by polyps causes oxygen starvation brain. Often pain associated with inflammation of the paranasal sinuses.

Voice disturbances, nasality. The nose is the organ that takes part in the formation of the voice. With polyposis, the passage of air is disturbed and this causes the person to speak “into the nose”.

Treatment of nasal polyps

Treatment of polyps depends on the stage of the disease and the cause that caused the growth of the nasal mucosa. In the event that the size of the polyps is insignificant, the doctor prescribes drug treatment.

With allergic rhinitis, which is one of the causes of the disease, a number of allergy tests are performed. This is necessary in order to determine what exactly causes allergies. After that, it is necessary to avoid contact with this substance and undergo a course of treatment with antiallergic drugs (Loratadine, Cetirizine).

If the reason is chronic inflammation sinuses, then these diseases are treated with antibiotics (Macropen, Ceftriaxone).

In the event that polyps are caused by aspirin intolerance, it is necessary to exclude from the menu all foods rich in salicylates (strawberries, gooseberries, cherries, currants), some nutritional supplements and dyes. Also stop taking all non-steroidal anti-inflammatory drugs that contain acetylsalicylic acid.

Treatment with topical steroids (Beclomethasone, Mometasone, Fluticasone) helps to reduce the size of nasal polyps, relieve inflammation and swelling of the mucosa. They give good therapeutic effect, but have a significant drawback. Treatment requires long-term use of large doses of steroids, and this can cause serious side effects.
Membrane stabilizers are used for treatment mast cells- cromoglycates (Ketotifen, Cromoglycate sodium), which can stop the release of histamine in the body. This substance causes manifestations of allergies, swelling of the mucous membranes and increased activity of the respiratory tract.

AT last years immunotherapy has become widespread. To restore the functions of the immune system, immunocorrective preparations of bacterial origin are used (Ribomunil, Polycomponent vaccine VP-4). They contain bacterial antigens and nonspecific immunomodulators in the form of lipopolysaccharides. These funds cause the production of special antibodies in the body, which increase immunity.

In the case when the patient turned to the doctor at a late stage or when drug treatment did not work, an operation to remove polyps may be prescribed.

Indications for surgical removal of polyps are:

frequent asthma attacks
complete nasal congestion
bloody or foul-smelling discharge from the nose
severe deviated nasal septum
inflammation of the paranasal sinuses
smell and taste disorders

Preparing for the operation must start with complete examination patient. This is necessary in order to determine the state of health and identify possible contraindications. You need to tell your doctor:

What medications the person is taking (such as anti-inflammatory birth control)
About the presence of chronic diseases
About problems with cardiovascular system
About cases of allergy to medications and other substances

To determine the structural features of the nose, diagnose inflammation in the sinuses, detect a curvature of the nasal septum, X-rays or computed tomography are performed.

Be sure to do blood tests: general, biochemical, clotting.

Medical preparation for surgery:

Ketotifen is prescribed 10 days before the procedure to eliminate allergies.
3 days before surgery, a daily administration of Dexamethasone solution is prescribed to prevent inflammation, allergic reactions and edema
On the eve of the operation, sleeping pills and a cleansing enema are usually prescribed.
A few hours before the operation, a 2% solution of Clemastine (an anti-allergic and sedative drug) is administered.
An hour before the procedure, an injection of diphenhydramine (intramuscularly 3-5 ml of a 1% solution) and atropine sulfate (subcutaneously 1 ml of a 0.1% solution) is given, they have an analgesic and sedative effect.

How to remove nasal polyps. Operation types

Conventional polypotomy

Polypotomy is an operation that allows you to get rid of polyps using a cutting loop or a Lange hook. Its advantage is that in one procedure you can get rid of numerous polyps.

On the day of surgery, you must refrain from eating. The procedure is performed under local anesthesia. 2 ml of 1% novocaine solution is injected into the area of the polyp. A loop is inserted through the nostril and the polyp is captured with it. Gradually, the lumen of the loop is narrowed around the stem of the polyp and cut off. The Lange hook is used when it is necessary to remove a polyp that has arisen from the ethmoid labyrinth. The duration of the procedure is from 45 minutes to an hour.

During the operation, the patient sits in a chair and holds a kidney-shaped coxa. His head is covered with a sterile sheet. After the operation, the mucosal surface is disinfected. If necessary, the nose is plugged. Turundas soaked in vaseline are inserted into the nose and secured with a sling-like bandage. This procedure leaves no scars and bleeding is usually very minor.

After the operation, the patient remains in the hospital for several days. Tampons are removed the next day and smeared with synthomycin ointment. As prescribed by the doctor, the patient goes to wash the nose. After 5-7 days, the doctor discharges the patient home. The full recovery period takes 10 to 20 days.

Contraindications to this procedure are: an acute period of colds, blood clotting disorders, heart problems. In bronchial asthma, a simple polypotomy can cause status asthmaticus. Therefore, it is advisable for such patients to choose another method for removing polyps.

A significant disadvantage such an intervention is that the polyp re-grows in 70% of cases. And the patient may need a second operation after 6-12 months.

Endoscopic surgery

The procedure is performed under local anesthesia. An endoscope with a camera is inserted through the nostril into the nasal cavity. The image is displayed on the computer screen. This allows you to accurately determine the size and number of polyps and eliminate them without affecting the important structures of the nose. With the help of endoscopic equipment, all altered tissues are removed and the structures of the nose are corrected. With this method of treatment, there are no traumatic scars and scars.

After the operation, there is a feeling of discomfort, which passes quite quickly. The patient feels a significant relief of breathing. For 2-3 days, bloody or mucous (not purulent) discharge is possible. After a day, the patient is discharged home, and after 3 days he can go to work.

In the postoperative period, Pinosol oil drops are prescribed 3 times a day for a period of 5 days. Then spray Nasonex.

Contraindications: exacerbation of bronchial asthma and chronic bronchitis, flowering period of plants, if they are the cause allergic rhinitis. In women, the operation is planned in such a way that it does not coincide with menstruation.

Removal with a shaver

One of the types endoscopic surgery when the doctor sees everything that happens on the monitor screen and is in complete control of the situation. The procedure is carried out under the general or local anesthesia.

A shaver or microdebrider removes polyps to healthy tissue as accurately as possible. He, as it were, crushes neoplasms and sucks them up. The operation is less traumatic and allows you to preserve the healthy mucosa as much as possible. The risk of bleeding is minimal. If necessary, the doctor can correct all anatomical defects of the nose and remove polyps inside the sinuses. This is the only method after which there are practically no repeated polyps.

After the operation, the patient remains in the hospital for 3-5 days. During this period, rinsing with saline is prescribed to remove residual tissue, antibiotics to prevent secondary infections. Topical steroid preparations are prescribed to prevent the re-growth of connective tissue.

Contraindications to the procedure: acute inflammatory processes, colds, the risk of allergies.

Removal of polyps with a laser

This procedure can be performed on an outpatient basis, that is, it is not necessary to go to the hospital. On this day, it is better not to eat. The patient is injected into the polyp area with an anesthetic drug. An endoscope with a camera and laser equipment are inserted into the nasal cavity. By using laser beam the doctor heats the cells that make up the polyp, and they evaporate. During the operation, the laser seals the vessels, and bleeding does not occur. Also, with this procedure, the possibility of infection is completely excluded. This is the least traumatic procedure, it is suitable for people with asthma and children.

After the operation, the patient should come to see a doctor for several days to control the condition of the mucosa. It is not recommended to drink alcoholic beverages, go to the bathhouse and play sports. This may cause bleeding. Special aerosols are often prescribed to prevent the recurrence of polyps.

The contraindication to the procedure is pregnancy, obstructive bronchitis, flowering period of plants, multiple nasal polyps. A significant disadvantage is that during this operation the sinuses are not opened and the polyposis tissue in them is not removed.

Answers to frequently asked questions

What is the effectiveness of the treatment of polyps with folk remedies?

Polyp treatment folk remedies It has been widely used and has been around for hundreds of years. But official medicine does not recognize the effectiveness of the use of herbs. Doctors warn that the cause of nasal polyposis is often allergic reactions. And many traditional medicine recipes are based on products such as honey, propolis, essential oils various plants. They can increase the manifestations of allergies and worsen the situation.
At the same time, traditional medicine has not yet fully studied the problem of the occurrence of polyps and cannot guarantee that polyps will not reappear after treatment with medicines or surgery.

Treatment of polyps with folk remedies eliminates the very cause of the disease. Natural components act on the body in a complex way. They help restore the normal functioning of the nasal mucosa and reduce the size of polyps.

However, if the connective tissue has grown strongly, and the polyp has reached a large size, then with the help of natural remedies it will not be possible to get rid of it. In this case, the tumor needs to be removed. And after the operation, folk remedies are used to prevent recurrent polyps.

Treatment of nasal polyps with folk remedies

Nasal drops

Recipe from a series
The stem and flowers of fresh succession are crushed. Then pour boiling water at the rate of 1 tbsp. l. strings in 200 ml of water and boil for 10 minutes over medium heat. The resulting broth is cooled and filtered. Using a pipette, 2-3 drops are instilled into each nasal passage, 2 times a day. The course of treatment lasts 20 days.

Anise Drops
It is necessary to take 15-20 g of dry anise and grind it. Pour the grass with 100 ml of alcohol and let it brew for 8 days in the refrigerator. Shake the tincture thoroughly before use. Then dilute with boiled water at room temperature in a ratio of 1:3. The resulting composition must be instilled 3 times a day, 10 drops in each nostril. The course continues for 15 days. If the polyps have not gone away, take a break for 2 days and continue treatment.

Horsetail decoction for the nose
To prepare a decoction, you need to take 2 tbsp. tablespoons of dry chopped horsetail and pour 250 ml of boiling water. Cover and let it brew for half an hour, then strain. The decoction must be alternately drawn in each nostril 10 times a day. A new portion is prepared daily.

Drops from St. John's wort and celandine
Take powder from dry St. John's wort and mix with butter in a ratio of 1:4. Steam the mixture for 7-10 minutes. Add celandine juice to the resulting mass, at the rate of 1 drop of juice per 1 teaspoon of a mixture of St. John's wort and oil. Dip 2 drops 4-5 times a day. The course of treatment is 10-15 days.

Ointments for the nose

Ointment from propolis
To prepare this medicine, you need to take 15 gr. homemade propolis, 10 gr. vaseline and 25 gr. butter. Thoroughly mix the components until a homogeneous consistency is obtained. Then cotton swabs are soaked with this ointment and placed in both nostrils. The procedure must be done overnight. The course of treatment lasts 20-30 days. The ointment must be stored in the refrigerator.

The simplest ointment
Take fresh, but thickened honey. Dip in it cotton swab and anoint problem areas in the nose. Do the procedure 3 times a day for 20-30 days. Usually, before the end of the course, the polyps resolve.

Ointment mix of oils
You can make a mixture of: rosemary oil - 20%, St. John's wort oil - 20%, sea buckthorn oil - 40%, propolis tincture - 15%, honey -5%. Cotton flagella are impregnated with this composition and polyps are lubricated. The procedure must be done 5 times a day. The course lasts 10-15 days.

Nasal inhalations

propolis inhalation
Take a piece of solid propolis and put it in a metal bowl. Heat over medium heat until smoke with a characteristic odor appears. Remove the dishes from the fire and inhale the propolis smoke with your nose. Be careful! The procedure can lead to internal burns of the respiratory tract.

Chamomile and celandine inhalation
You need to take 2 tbsp. spoons of chopped chamomile and celandine. Pour boiling water over and put on a small fire. After the broth boils, remove from heat and carefully inhale the steam. The procedure is preferably done 2 times a day for 10-15 days. Then take a break for 5 days and repeat the treatment for another 10 days.

The use of celandine for the treatment of nasal polyps

Celandine is one of the most popular plants, which is used both in folk and in traditional medicine. Celandine contains alkaloids, flavonoids, saponins, organic acids, vitamins A, C, essential oils. This plant has antifungal, anti-inflammatory and tonic properties, relieves swelling and heals wounds.

Due to its medicinal qualities, celandine is effectively used to combat nasal polyps. For medical purposes, the stem, roots and flowers of celandine are used. it medicinal plant collected during the flowering period. The root is cleaned from the ground and stored in a dark, cool place. The grass is dried and stored in paper bags.

Celandine is a poisonous plant. It is necessary to strictly follow the recipes and dosage when using any medicine from this plant.

Drops from celandine
To prepare drops, you need to take a fresh root and flowers of celandine. Rinse them thoroughly with running water. Then grind in a blender or meat grinder. Squeeze the resulting mass through gauze, decanting the juice into a clean glass container. Then let it brew for 5 days in a dark, cool place. After that, the drops are ready for use. Using a pipette, instill 2-3 drops daily into each nostril, 3 times a day. The duration of the course is 10 days.
Juice from a freshly picked stem is also used as drops. Bury 1-2 drops of pure juice, 2 times a day, for 10-15 days. Then you need to take a break for 10 days. Repeat the course 3-5 times.

Infusion of celandine
Take 1 tsp. chopped dry celandine, place in an enameled container and pour 200 ml. steep boil. Cover with a lid and let it brew for half an hour. Strain the resulting infusion through cheesecloth. Soak cotton swabs with the product and alternately insert into each nasal passage for 15 minutes 2 times a day. The course of treatment is 2 months. Then you need to take a break for 1 month and repeat the course.
An infusion of celandine is also used to wash the sinuses. This method is most effective in the treatment of polyps in the nose. The infusion is poured alternately into each nostril and spit. The procedure must be done 2-3 times a day for 15 days.

How to treat nasal polyps in a child?

Polyposis is considered an adult disease, but can also develop in children. Usually in teenagers over 10 years old. Most often, antrochoanal polyps develop from the mucosa. maxillary sinuses. The main causes of their occurrence in childhood are frequent prolonged runny noses and allergic reactions to dust particles, animal hair or fungal spores. Treatment of polyps in a child is associated with the causes that cause inflammation.

It is necessary to conduct allergy tests to establish what exactly causes irritation of the mucosa. If the patient's contact with this allergen is eliminated, then there is a chance that the polyps will stop growing and begin to decrease.
After it turns out which foods are allergic, you can proceed to the treatment of polyps in a child. folk methods.

The safest procedures for the baby are salt washings. Salt solution can be purchased at a pharmacy or you can make your own. This will require a liter of boiled water and two teaspoons of sea or ordinary salt. Rinse the nose with a warm composition 4-5 times a day using a 5 ml syringe.

Salt and iodine. The composition disinfects, dries and kills the infection in the nose. To prepare it, dissolve an incomplete teaspoon of salt in 300 ml of warm water and add 3 drops of iodine. Inhale the solution alternately, then one, then the other nostrils.

Small polyps in children are treated with medications:

antibiotics (Augmentin, Azimed)
antiallergic drugs (Cetrin)
mast cell membrane stabilizers (ketotifen)
steroid drugs (beclomethasone)

In order to stop the growth of polyps, it is necessary to raise immunity. This can be done by hardening and taking vitamins, immunomodulatory drugs and special bacterial antigens (vaccines).

But if the polyps are already large enough, then surgery is required. Signs that a child needs to have polyps removed are:

nasal congestion for several weeks
smell disorders
headache
copious mucous purulent discharge
hoarseness

A laser is suitable for removing single polyps in a child. This procedure is the least traumatic and does not require a long stay in the hospital.

How are nasal polyps removed?

In the event that there are indications for surgical removal of nasal polyps and the doctor insists on surgery, the patient can choose the method of removal.

Loop removal. In the ENT departments of hospitals, you will be offered a polypectomy (surgery to remove a polyp) with a cutting loop. Most often it is performed under local anesthesia through the nostril.

Endoscopic removal of polyps. An endoscope is a device that allows the surgeon to see what is happening inside the nose on a monitor screen. The device that directly removes polyps is called a shaver. It crushes the polyp tissue and removes it from the nose. Through natural openings, the shaver penetrates into the paranasal sinuses and removes polyps there. Thus, it is possible to completely get rid of the altered tissue and prevent the recurrence of the disease.

Removal of polyps with a laser. The laser beam evaporates moisture from the fabric. Formations "dry" significantly decrease in size and then are easily removed. This is the most bloodless method that does not cause complications.

What to do after removal of polyps?

After removal of polyps, it is necessary to take antibiotics and steroid drugs that prevent inflammation and complications.

Oil drops should be instilled into the nose: Pinosol or sea buckthorn oil. This will speed up the healing. They are used 3-5 days 3-4 times a day.

Salt sprays are used to flush germs and allergens from the mucous membrane. They can be used for a long time, they are prophylactic against SARS.

Assign local funds based on steroids. They do not cause systemic side effects. The drugs are designed to prevent the re-growth of polyps. They have anti-allergic and anti-inflammatory properties. Most effective tool is Nasonex spray.

You need to be attentive to your health. If you do not take action, the polyps can grow large, lead to sinusitis, otitis media, deviated septum, and even cancer. If on examination by a doctor, a diagnosis of "polyps" was made, do not despair. Modern traditional and ethnoscience offer a variety of treatment options for this problem.