My mother has nasal polyps. She does not have surgery. She is now taking Chinese medicine. Sometimes the nasal congestion is too uncomfortable, so she uses tweezers to remove the nasal polyps. There i

My mother has nasal polyps. She does not have surgery. She is now taking Chinese medicine. Sometimes the nasal congestion is too uncomfortable, so she uses tweezers to remove the nasal polyps. There is still a lot of blood.

Nasal polyps (nasalpolypus) are common diseases, mostly seen in adults, and are common in the free edge of the middle turbinate, ethmoid sinus, ethmoid alveolar, ethmoid uncinate process, semilunar hiatus, and maxillary sinus ostium.

The cause of nasal polyps

It is caused by long-term edema of the nasal mucosa. It is the result of the simultaneous action of multiple factors, with allergies and chronic inflammation as the main reasons.

It begins with local mucosal edema, translucent bulging, and sessile, which is called polypoid degeneration. As the lesions continue to develop, due to the gravity of the edematous tissue, they gradually sag and form pedunculated polyps. Nasal polyps can be divided into several types: edematous type (mucus type), vascular type (hemorrhagic type), fibrous type, cystic type, etc. The most common ones are edematous type or mixed.

Symptoms of nasal polyps

The main symptoms are progressive nasal obstruction. As the polyps grow slowly, they gradually become persistent nasal obstruction. Often accompanied by sinusitis, nasal discharge increases. There may be symptoms such as olfactory impairment and headache. It can be single or multiple, unilateral or bilateral, and most are multiple and bilateral. When the polyps grow too large, the external nose may be deformed, and the bridge of the nose may become wider and swollen to form a "frog nose." A single polyp hanging from the choanal opening is called a choanal polyp. Complications are often accompanied by sinusitis, which causes increased nasal discharge.

The treatment principle should be to relieve nasal congestion and prevent recurrence. Depending on the specific situation, the following treatment measures may be taken:

1. Medical therapy can be used because nasal polyps are the result of long-term inflammatory reaction of the nasal respiratory mucosa. Adrenocortical hormone treatment Corticosteroids can not only make polyps smaller or even disappear, but also can be used after surgery to delay or prevent the recurrence of polyps. The application of corticosteroids has two administration routes: systemic and intranasal. If there are no contraindications to corticosteroid application, systemic application is suitable. The following situations: ① It is inconvenient to introduce instruments into the nasal cavity during surgery for large polyps; ② For newly diagnosed patients who are willing to accept medical treatment, the method is to take 30 mg of prednisone orally daily for 7 days and then reduce it by 5 mg daily, and the entire course of treatment should not exceed two weeks. Short-term burst therapy will not cause obvious systemic side effects in clinical practice. Generally, the volume of polyps can be significantly reduced after being treated with the above methods. Some nasal congestion is relieved and the sense of smell is significantly improved after oral administration for a few days. At this time, it can be removed surgically or intranasally. Local application

The advantage of local application of intranasal corticosteroids is that it can avoid the systemic side effects of corticosteroids and maintain the effective local concentration of the drug. Local application is suitable for: ① The polyps are small in size and do not exceed the middle turbinate at the initial diagnosis. Those with lower margin; ② Patients who have a better response after oral prednisone and are willing to continue medical treatment; ③ Those who want to prevent recurrence after surgical removal. The most common dosage form of intranasal adrenocortical hormone is aerosol because it is easy to use and patients do not need to take a certain amount. Posture In addition, patients are required to adopt the correct nasal drip position when using nasal drops. However, the preparation process of the drug is simple and low-cost. The corticosteroids used intranasally are mainly clomethasone dipropionate, flunisolide and budesonide. The characteristics of these corticosteroids are: It is not easily absorbed into the bloodstream by the nasal mucosa, causing systemic side effects. In recent years, Johansen (1993) compared the efficacy of budesonide aerosol and nasal drops in the treatment of nasal polyps. The results showed that the two formulations had the same efficacy. The author et al. (1995) applied 0.1 triamcinolone acetate. The following conditions can significantly affect the efficacy of intranasal medication: ① The nasal polyps are too large and the medicinal solution cannot enter the nose. In this case, surgical treatment should be performed first and then intranasal administration to prevent recurrence ② If there is mixed infection of the nose and sinuses at the same time, antibiotic treatment or sinus cleaning should be performed in this case. ③ The polyps themselves are in the active stage and grow too fast. In this case, sudden systemic application of corticosteroids can be performed

2. Surgical treatment If the nasal cavity is mostly or completely blocked and seriously affects physiological functions, surgical treatment should be performed first. A systemic examination should be performed on the patient before surgery. If the patient suffers from cardiovascular disease and asthma attack, surgery should be performed after the condition is stable. The main surgical methods include simple nasal polypectomy. There are two types of intranasal ethmoidectomy

1. Simple nasal polypectomy is used to remove the pedicle. For those who have no previous history of nasal polypectomy, a nasal polyp snare is used to cover the main pedicle of the polyp under local anesthesia. After tightening the nose, pull it out quickly from the inside of the nose to remove the polyps together with the pedicle. If there is any pedicle remaining, you can clean it with forceps and pull out the polyps. Sometimes the ethmoid sinus can be opened. At this time, if the ethmoid mucosa has become polypoid, Intranasal ethmoid sinus resection should be performed at the same time

2. Intranasal ethmoid sinus resection is mainly suitable for patients whose ethmoid sinus mucosa has been replaced by polyp tissue and who has a history of multiple nasal polyp resections. The ethmoid sinus resection should be fully opened during the operation. Complete removal of polyps in the sinus can significantly reduce the recurrence rate of polyps. Endoscopic sinus surgery carried out in recent years has provided a precise, accurate and effective method for ethmoid sinus resection, which has significantly reduced the recurrence rate of nasal polyps. Reducing literature reports can reduce the recurrence rate to less than 20%

In short, the treatment of nasal polyps should follow the following principles:

1. For newly diagnosed patients, if the polyps are large and seriously affect the nasal function, treatment should be carried out. Surgical treatment should be performed first; those with small polyps and mild symptoms of nasal congestion can be treated with medical treatment for 1 month. Those with poor results can then undergo surgical treatment

2. For those with sinus infection, it is advisable to first fight the infection or undergo nasal polyps surgery. Remove to facilitate sinus drainage

3. Recurrent nasal polyps should be treated with ethmoid sinus resection and intranasal corticosteroids should be used for 1 to 2 years after surgery