What is Nasal Polyps
Nasal polyps are small, sac-like growths made up of inflamed tissue lining
the nose (nasal mucosa).
Causes
Nasal polyps start near the ethmoid sinuses (located at the top of the
inside of the nose) and grow into the open areas. Large polyps may block the
airway.
Having any of the following conditions may make people more likely to get
nasal polyps
Immune deficiency
The most common immune deficiency is IgA deficiency. IgA is the immune
protein that helps to protect the respiratory and gastrointestinal tract from
infections. 1 in 300 people have an immune deficiency but a significantly
higher percentage of chronic sinusitis sufferers have IgA deficiency.
Classically recurring acute sinus infections rather than chronic sinus
infections are indicative of immune deficiency but the distinction between the
two is sometimes blurred. If a patient has recurring sinus and ear infections
as well as a history of pneumonia, then serious consideration should be given
to an immune deficiency evaluation.
Symptoms of Nasal Polyps
- Blocked nose.
- Frequent sinus infections.
- Difficulty breathing.
- Patient breathes through the
mouth.
- Thick nasal discharge.
- Post nasal drainage (drainage
from nose down the throat).
- Pain and tenderness over forehead
and face.
- Heavy snoring at night.
- Loss of sense of smell and
taste.
- Frequent nose bleeds
Diagnosis
Allergy skin testing
Testing and treatment for immediate sensitivity to environmental allergens
is important for all chronic sinus patients. It is not always easy to
distinguish allergic from non allergic patients on clinical grounds alone.
Nasal Endoscopy
Usually a direct look in the nose identifies many things such as anatomic
causes of
sinusitis,
sinus drainage or nasal polyps. However, in some cases the inflammation is
restricted to the sinus cavities themselves which cannot be viewed directly
unless someone has already had nasal surgery to open the passages
Sinus CAT scan
This test is the gold standard for the diagnosis of
sinusitis.
If the CAT scan does not show swelling within the sinus passages then chronic
sinusitis is not the diagnosis. However, this does not rule out a nasal source
of sinus pain.
CBC
The amount of eosinophils in Nasal Polyps is related to eosinophilia of the
peripheral blood, but not to elevated serum IgE.
AUROH Homeopathic Treatment for Nasal Polyps
Homoeopathy is
strongly recommended for management of Nasal Polyps, especially when they are
small in size. Timely administered Homoeopathic medicines offer promising
results and help avoid surgery, as well as its inherent complications.
Homeopathic remedies are unique and effective that will shrink your existing
Polyps, prevent recurrence, treat the bleeding and pain associated with the
Polyps, reduce swelling of the mucous membranes, reduce itching and tickling
within the nostrils, prevent mouth breathing and snoring.
homeopathy believes in
treating the patient and not just the disease.
Homeopathic treatment can remove the underlying cause for the allergic
tendency and eliminate sinus problems completely. Homeopathic drugs are
non-habit forming and have no addictive characteristics.
homeopathy has an
exceptional proven safety record with the FDA with 200 years of clinical
effectiveness. Since it treats in totality, it leads to a permanent
long-lasting cure, rather than a temporary suppression of symptoms.
Dr. Subhranil Saha,
B.H.M.S.Hons. (C.U).
Dr. Saha graduated from Mahesh
Bhattacharyya Homeopathic Medical College & Hospital, Govt. of West Bengal,
India under the University
of Calcutta with honors
in Anatomy & Pathology and highest grades in Anatomy, Pathology, Surgery,
Practice of Medicine, Materia Medica & Repertory. He has been practicing
the last 5 years. In addition to the polychrests, he emphasizes the use of rare
medicines to discover their essences.
He has also received a diploma
or certification in HIV/AIDS, Family Education, Yoga Therapy &
Physiotherapy, Health Care Waste Management, Management & Counseling of
Terminal Illness, Food & Nutrition and Nutrition & Child Care.
References:
- Fundamentals of ENT & Head-Neck Surgery / Dr.
Shyamal Kr. De / 9th Indian edition, 2007 / The New Book Stall,
Kolkata, India
- SYNTHESIS: Repertorium Homeopathicum Syntheticum / Dr.
Frederik Schroyens / edition 8.1 / Jan2005 / B. Jain Publisher’s (P) Ltd,
New Delhi / Copyright ©2001, Homeopathic Book Publishers and Archibel S.
A.
- Pocket Manual of Homoeopathic Materia Medica with
Repertory; 3rd Indian edition from American 9th
edition; Dr. William Boericke; Roy Publishing House, Kolkata
- Keynotes & Characteristics of the Materia Medica,
2002; Dr. H.C.Allen; Medical Book Suppliers, Kolkata
- Essence of Materia Medica / Dr. George Vithoulkas / 2nd
edition (1990); reprint (2008) / Copyright© B. Jain Publishers (P) Ltd.
Scope of Homeopathy in Nasal Polyp
Broadly defined, Nasal polyps are
abnormal lesions that originate from any portion of the nasal mucosa or
paranasal sinuses. Polyps are an end result of varying disease processes in the
nasal cavities. They are overgrowths of the mucosa that frequently accompany
allergic rhinitis. Generally they are freely movable and nontender.
Nasal polyps are usually classified
into antrochoanal polyps and ethmoidal polyps.
Antrochoanal polyps
They arise from the mucosa of
maxillary antrum near its accessory ostium, and grow in the choana and nasal
cavity. Antrochoanal polyps are usually single and unilateral.
Nasal allergy coupled with sinus
infection is its most important cause. Antrochonchal polypi are seen in
children and young adults.
Unilateral nasal block is the
presenting symptom but it may become bilateral nasal block if polyp grows into
the nasopharynx and starts obustructing the opposite choana. Voice may become
thick and dull due to hyponasality. Mucoid nasal discharge may be seen on one
or both sides.
Ethmoidal Polyps
Ethmoidal polyps arise from the
ethmoidal sinuses. They are multiple and bilateral and are usually found in
adults.
Though the exact cause is unknown
but allergic or vasomotor rhinitis may be an important cause.
Nasal stuffiness leading to total
nasal obstruction may be the presenting symptom associated with total loss of
sense of smell or/ and headache. Associated allergy may cause watery nasal
discharge and sneezing. Mass protruding from the nostril may also present.
The tendency to manifest multiple
polyps is referred to as "polyposis".
Pathophysiology
The pathogenesis of nasal polyposis
is unknown. Polyp development has been linked to chronic inflammation,
autonomic nervous system dysfunction, and genetic predisposition. Most theories
consider polyps to be the ultimate manifestation of chronic inflammation;
therefore, conditions leading to chronic inflammation in the nasal cavity can
lead to nasal polyps. The following conditions are associated with multiple
benign polyps:
- Bronchial asthma - In 20-50%
of patients with polyps
- CF - Polyps in 6-48% of patients
with CF
- Allergic rhinitis
- AFS - Polyps in 85% of
patients with AFS
- Chronic rhinosinusitis
- Primary ciliary dyskinesia
- Aspirin intolerance - In
8-26% of patients with polyps
- Alcohol intolerance - In 50%
of patients with nasal polyps
- Churg-Strauss syndrome -
Nasal polyps in 50% of patients with Churg-Strauss syndrome
- Young syndrome (ie, chronic
sinusitis, nasal polyposis, azoospermia)
- Nonallergic rhinitis with
eosinophilia syndrome (NARES) - Nasal polyps in 20% of patients with NARES
Most studies suggest that polyps are
associated more strongly with nonallergic disease than with allergic disease.
Statistically, nasal polyps are more common in patients with nonallergic asthma
(13%) than with allergic asthma (5%), and only 0.5% of 3000 atopic individuals have
nasal polyps.
Risk Factors
These risk factors increase the
chance of developing nasal polyps.
- Gender: males.
- Age: older than 40.
- Aspirin sensitivity.
- Asthma.
- Churg-Strauss syndrome (a
rare disease that inflames the blood vessels).
- Cystic fibrosis .
- Hay fever or other
respiratory allergies.
- Frequent sinus infections
Signs and Symptoms
The manifestation of nasal polyps
depends on the size of the polyp. Small polyps may not produce symptoms and may
be identified only during routine examination when they are anterior to the
anterior edge of the middle turbinate. Polyps located posterior to the site are
not typically seen during routine anterior rhinoscopy examination performed
with an otoscope and are missed unless the child is symptomatic. Small polyps
in areas where polyps normally arise (ie, the middle meatus) may produce
symptoms and block the outflow tract of the sinuses, causing chronic or
recurrent acute sinusitis symptoms.
Symptom-producing polyps can cause
nasal airway obstruction, postnasal drainage, dull headaches, snoring, and
rhinorrhea. Associated hyposmia or anosmia may be a clue that polyps, rather
than chronic sinusitis alone, are present. Epistaxis that does not arise from
irritation of the anterior nasal septum (ie, Kiesselbach area) usually does not
occur with benign multiple polyps and may suggest other, more serious, nasal
cavity lesions.
Massive polyposis or a single large
polyp (eg, antral-choanal polyp [see the images below] that obstructs the nasal
cavities, nasopharynx, or both) can cause obstructive sleep symptoms and
chronic mouth breathing.
Imaging Studies
- The criterion standard to
evaluate nasal lesions, especially nasal polyposis or sinusitis, is a
thin-cut (1-3 mm) CT scan of the maxillofacial area, the sinuses axially, and
the coronal plane. Perform a compatible CT scan if an intraoperative
image-guided system is used. Plain film radiography has no significant
value after polyps are diagnosed.
- Also perform MRI in patients
with possible intracranial involvement or extension of benign nasal
polyps.
- CT scan findings and MRI
findings can help diagnose the polyp or polyps; define the extent of the
lesion in the nasal cavities, sinuses, and beyond; and narrow the
differential diagnosis of an unusual polyp or clinical presentation.
Conservative Medical treatment
Oral and topical nasal steroid
administration is the primary medical therapy for nasal polyposis.
Antihistamines, decongestants, and cromolyn sodium provide little benefit.
Immunotherapy may be useful to treat allergic rhinitis but, when used alone,
does not usually resolve existing polyps. Administer antibiotics for bacterial
superinfections.
Topical corticosteroid
administration generally causes fewer adverse effects than systemic
corticosteroid use because of the former's limited bioavailability. Long-term
use, especially at high dosages or in combination with inhaled corticosteroids,
presents a risk of hypothalamic-pituitary-adrenal axis suppression, cataract
formation, growth retardation, nasal bleeding, and, in rare cases, nasal septal
perforation.
Surgical Care
Surgical intervention is required
for children with multiple benign nasal polyposis or chronic rhinosinusitis who
fail maximum medical therapy. Simple polypectomy is effective initially to
relieve nasal symptoms, especially for isolated polyps or small numbers of
polyps. In benign multiple nasal polyposis, polypectomy is fraught with a high
recurrence rate.
Closely monitor children with benign
multiple nasal polyps, whatever the cause, because recurrence is likely,
whether medically or surgically treated. Postoperative follow-up should occur
3-4 times the first month to monitor healing of the sinus cavities; frequency
depends on the patient's own geographic location and symptoms.
Complications
Massive polyposis or a single large
polyp (eg, an antral-choanal polyp) that obstructs the nasal cavities and/or
nasopharynx can cause obstructive sleep symptoms and chronic mouth breathing.
Rarely, massive polyposis, can alter the craniofacial structure resulting in
proptosis, hypertelorism, and diplopia.
Prognosis
Polyposis recurrence is common
following treatment with medical or surgical therapy if multiple benign polyps
are present (see Surgical Care). Single large polyps (eg, antral-choanal
polyps) are less likely to recur.
Patient Education
Educating patients about the
chronicity of the disease is important to make them aware of the recurrent
nature of the problem.
Homeopathic Understanding of Nasal Polyps
Homeopathy medicines have been found
to be very effective in cases of Nasal polyp. Not only they save the patient
from surgeon’s scalpel but they also help in reducing the associated
complaints. The biggest complication of Nasal polyp is its tendency to recur
here also homeopathy offers a helping hand and prevents the patient from
repeated doctor visitations.
Homeopathy is a holistic science
which believes that a person’s disease is due to his increased susceptibility.
This superadded with the miasmatic soil present in his body helps the disease
to grow. So if this increased susceptibility is normalized then the person
fares fairly well against constant environmental and telluric atrocities. As a
result no recurrent allergic cold, coryza, no swollen turbinates, no
inflammation in nasal mucosa. Now correcting this increased susceptibility is
not a child’s play that you add 2 + 2 and get 4, here you have to use all the
permutations and combinations to extract the special tailored medicine best
suited to your patient i.e similimum to the case. This similimum alone can cure
the patient and restore health. Regarding the choice of line of treatment in
such cases we opt for:
- Conservative treatment for
present complaints: This can range from Allium cepa, Arsenic-alb,
Sanguinaria can, Lemna according to the present complaint.
- Intercurrents when case stops
progressing: These are the remedies that provide a boost to your line of
treatment. It can be Calcarea carb, Phosphorus, Psorinum, Thuja, Nitric
acid and even Sulphur.
- Constitutional medicines for
holistic treatment: When you get no breakthrough in a case and the patient
comes with only general complaints or disease symptoms then a detailed
mental and physical case history is considered for prescribing. It is the
interrogation to search for the uncommon among the common. In cases where
the polyps are due to deep seated chronic disorders like asthma or
allergies this constitutional treatment surely helps the patient.
- Antimiasmatic medicine in
slow responding cases and in preventing re-occurrences: antimiasmatic
prescribing such as Sulphur, Thuja, Medorrhinum, Nitric acid and even
Tuberculinum help to relieve the patient permanently from his complaints.
Miasmatic predominance: As Polypus
are mucosal overgrowths so they are chiefly Sycotic but they flareup on the
Psoric ground. If we give a look to the pathogenesis of polyp we can know the
predominant miasm.
Onset age- Since
it is common to young and adults so it has predominant Sycotic miasm.
Risk factors:
Hypersensitivity to allergens leads to allergic rhinitis and then polypus- this
shows its psoric predominance in early developing phase.
Pathology:
Appearance like a tumour shows its Sycotic predominance.
So we can conclude that Nasal Polyps
are predominantly Sycotic in nature.
Therapeutics:
Allium cepa
Sneezing, especially when entering a
warm room. Copious, watery and extremely acrid discharge. Feeling of a lump at
root of nose. Fluent coryza with headache, cough, and hoarseness. Polypus.
Alumen
Lupus, cancer, polypi of nose,
sanious discharge, especially when ulceration is present.
Calcarea carb
Swelling of nose and upper lip in
children, with acrid discharge
- purulent, thick, or
yellow-red discharge, making lip sore
- red itching pustules on upper
lip and cheeks
- nose swollen inside and
outside
- impaired smell
- epistaxis frequent and
profuse, almost to fainting
- loud breathing through nose.
Cadmium sulph
It is very useful in ozena. Polypus,
caries of the nasal bones, boils on the nose, ulcerated nostrils, etc. are
cured.
Conium mac
fibrous polypi, hard and elastic,
pricking and itching after touching or handling, excessively acute smell, with
purulent discharge.
Kali bichrom
Great dryness of nose, with feeling
of pressure in nasal bones; also extending along frontal sinuses with soreness
and burning.
Tickling, like a hair moving
or curling itself in top of left nostril.
- Sneezing (in morning).
- Violent shooting pains from
root of nose along left orbital arch.
- Pinching pain in bridge,
better by hard pressure.
- Pressure at root of nose.
- Nose stuffed up.
- Nasal speech.
- The sensation of a hard
substance compels one to blow the nose, but there is no discharge from the
dry nose.
- When blowing nose violent
stitches in right side of nose, and sensation as if two loose bones rubbed
against each other.
- Expired air feels hot in
nose.
- Scab on septum.
- Septum ulcerates.
- Round ulcer in septum.
- Small ulcers on edge of
(right) nostril, violent, burning when touched.
- Discharge of large masses of
thick, clean mucus from nose; if that ceases he has violent headache; pain
from occiput to forehead.
- Watery secretion with great
soreness and tenderness of nose.
- Discharge of tough green
masses from nose.
- Discharge of hard, elastic
plugs (clinkers) from nose.
Lemna minor
Foul smell in nose, or loss of
smell.
- Smell of strong-scented
flowers before intolerable can now be borne.
- Feeling of cold in nose
better, sense of obstruction nearly gone.
- Nose blocked with polypi
became almost cleared with Lemna after Calc. 200, followed by Merc. 3
(given for faceache); - previously Lemna had been given without effect.
- Nasal polypi in man, 60;
markedly worse in wet weather; after taking Lemna 3x gtt. v. three times a
day for a month said, "That is the best tonic I have ever
taken"; and he could breathe quite comfortably.
- Polypi which swell in wet
weather.
- Nostrils plugged by swollen
turbinates.
- Ozaena since childhood in
girl of sixteen; odour most offensive; bad taste; takes cold easily in
night air or damp; bowels and catamenia irregular, greatly relieved by
Lemna.
- Post-nasal ulceration high
up, dry feeling at top of throat with flatulence, much catarrhal
pharyngitis; two weeks after dose of Lemna nose less blocked and better in
every respect; colic and diarrhoea followed.
- Stuffiness of nose relieved;
simultaneously an attack of diarrhoea.
- Turbinate bones swollen.
- Crusts form in right
nostril, pain like a string extends from right nostril to ear, which is
deaf (greatly relieved).
Sangunaria can
Often useful in polypus accompanied
with sick headache.
Teucrium m v
Sensation of obstruction in nose.
- Tingling in nose.
- Frequent sneezing, with
tingling in nose; with crawling in nose without coryza.
- Stinging, lancinating pain
in upper part of the nasal cavity.
- Violent crawling in right
nostril, with lachrymation of right eye.
- Sensation as if nostrils
were stopped; blowing nose or sneezing does not remove the obstruction;
nasal polypus.
- Obstruction of nose.
- Polypus, with stoppage of
the nose on the side he lies on; large red pimple under right nostril,
near septum, sore and smarting to touch.
- Fluent coryza in open air.
MD.JAKIR HOSSAIN
BHMS UNIVERSITY OF DHAKA(1st class 1st in 1st prof BHMS in Dhaka university
