What to Expect With Surgery for Nasal Polyps

Nasal Surgery
Nasal Surgery.

 

Dana Neely

Nasal polypectomy is the surgical procedure for the removal of nasal polyps, which are abnormal non-cancerous (benign) masses that can form in either your nasal passages or your sinus cavities. When visualized, polyps are a semi-translucent (or glistening) gray color that are formed from inflammatory materials. Most commonly polyps are found either in the ethmoidal sinus or the middle turbinates.

While not all polyps need to be surgically removed, in some cases you and your doctor may decide that surgery is the best option to relieve symptoms related to nasal polyps. A nasal polypectomy is not a cure to nasal polyps, as they can grow back if underlying causes of polyps are not treated.

Prevalence and Causes of Nasal Polyps

While nasal polyps are most commonly found in adults, children with cystic fibrosis (CF) are also prone to the development of nasal polyps. Approximately 50 percent of children with CF will develop nasal polyps, while the development of nasal polyps in children without CF will rarely develop them. Only about 1 to 4 out of 100 adults will develop nasal polyps.

Chronic inflammatory conditions can lead to the development of nasal polyps, which is why polyps are made up of inflammatory tissues. Common chronic inflammatory conditions that can lead to the development of nasal polyps include:

Non-Surgical Therapies to Try Before Surgery

Surgical removal of nasal polyps is not a first-line therapy. Typically a nasal polypectomy is only recommended after failure of other therapies has occurred, or severe obstructions have occurred with uncontrollable symptoms. Therapies that may be used prior to surgery include:

  • Glucocorticoid nasal sprays—Flonase (fluticasone), Rhinocort (budesonide), or Nasonex (mometasone)
  • Oral glucocorticoids—used only after failing nasal sprays or for severe obstruction; prednisone
  • Dupixent (dupilumab)—300 mg; monoclonal antibody administered only by injection every other week
  • Antileukotriene medications—used to treat allergies; Singulair (montelukast)
  • Daily sinus lavage with saline
  • Aspirin desensitization therapy—if the underlying cause of nasal polyps is AERD

Use of decongestants, while providing symptomatic relief, does not provide shrinkage of nasal polyps. Nasal and oral glucocorticoids may provide some shrinkage of nasal polyps.

Dupixent is the first FDA-approved medication that can be used to treat nasal polyps that are uncontrolled with glucocorticoid medications and a possible way to minimize the need for surgery.

When Is Surgery Considered for Nasal Polyps?

If you have nasal polyps with symptoms that have not responded to other therapies, a nasal polypectomy should be considered to remove the polyps. A CT scan of your head is typically performed to see to determine the extent and locations of polyps in your nasal passages and sinus cavities.

A nasal polypectomy should not be performed if you do not exhibit symptoms or if medications can control your symptoms. Other reasons that may prevent this type of surgery include:

  • Cardiac disease
  • Respiratory disease
  • Poorly controlled diabetes
  • Poorly controlled asthma
  • Bleeding disorders

Possible Complications Related to Nasal Polypectomy

Because your nasal passages and sinus cavities are located close to many different anatomical structures, there are several complications that can occur. However many of these complications are uncommon because of the available use of endoscopic viewing during surgery and use of CT scan before, and in some cases during, surgery.

More common but typically less severe complications include:

  • Bleeding
  • Local infection
  • Mucocele (mucus cyst)

Bleeding may occur at home and typically resolves. Bleeding that cannot be controlled is a medical emergency and you should seek emergency care. Your doctor may request that you contact their office during daytime business hours if bleeding occurs, but do not delay getting emergency care for uncontrolled bleeding.

Severe complications that may occur include eye, nasofrontal duct stenosis, and orbital problems.

Any severe headaches or vision problems should be immediately reported. Severe headaches are a sign of a cerebrospinal fluid leak. Vision problems are also possible because the nasal passages and sinus cavities are in close proximity to eye structures.

What to Expect Before Surgery

A nasal polypectomy is an outpatient procedure. This means that you will go home after you have sufficiently awakened from the anesthesia. Typically your doctor's office will instruct you to call, or you will receive a call the business day before your surgery.

When you are talking to the surgical center, you will likely be instructed on the following things:

  1. Do not eat or drink anything after midnight the night before surgery
  2. Stop any medications as instructed by your doctor—you may be asked to stop taking any blood thinners
  3. Arrive early to the surgical center—varies by center but may be around an hour to an hour and a half

Typically, younger children are the first cases in the morning and adults are scheduled afterward. If you have any questions regarding the procedure, you should reach out to the doctor's office rather than the surgical center.

What to Expect During the Surgery

Nasal polypectomy is performed by endoscopy, meaning a fiber-optic tube with a camera is inserted into your nasal passages for visualization. General anesthesia is commonly used, meaning you will be anesthetized with a mask that has you breathe anesthesia gas before the anesthesiologist inserts a breathing tube (referred to as intubation). Topical anesthesia can be used, however, general anesthesia is the more common approach.

While using the endoscope to visualize your polyps, your surgeon will use either forceps, a cutting instrument, or a microdebrider to remove the polyps. The CT scan performed before surgery will let your surgeon know whether your polyps are isolated to only the nasal passages, or if you have polyps in any of your sinus cavities. Expert opinion recommends cleaning out the sinus cavities if polyps are removed from a sinus, however, this is left to the assessment of physician for individualized patient needs and healing.

Cauterization is rarely needed to stop the bleeding, and only used if nasal packing, vasoconstricting medications (constricts blood vessels), or hemostatic (stop bleeding) products are inadequate to stop the bleeding.

What to Expect After the Surgery

Following surgery, you will have nasal packing that is left in place. Prior to being discharged (or cleared) to go home, the nurse that helped you recover will provide directions related to when you can remove nasal packing. This typically is to keep the nasal packing in place for about 24 hours.

If you swallowed any blood during the surgery, which commonly can occur, you may be nauseous and vomit following surgery. This is not a medical emergency and usually resolves after vomiting one time.

Your doctor will arrange for you to be seen following surgery to ensure proper healing and resolution of symptoms related to the nasal polyps. In some cases, your doctor may want to use an endoscope to visualize the areas that had polyps removed.

Follow-Up

Following surgery, you should notice an improvement from any symptoms related to nasal polyps. The surgery will not fix chronic rhinosinusitis or other underlying causes of your nasal polyps. It is important that you follow your doctor's instructions in continuing any therapies for your underlying causes. Without continued use, polyps can return within a few months to years.

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Article Sources

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