eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases

Nasal Polyps, Surgical Treatment: Treatment

Author: Andrew Cheng, MD, Clinical Assistant Professor, Department of Otolaryngology-Head & Neck Surgery, New York Medical College
Contributor Information and Disclosures

Updated: Mar 6, 2008

Treatment

Medical Therapy

The following medical treatments are available (see Nasal Polyps, Nonsurgical Treatment):

  • Topical steroid inhaler
  • Topical antihistamine inhaler
  • Systemic steroids
  • Intranasal cromolyn treatment
  • Treatment and control of allergic rhinitis
  • Treatment of underlying sinusitis

Surgical Therapy

Endoscopic sinus surgery is the procedure of choice. With the advent of endoscopic sinus surgery, surgical treatment for sinus diseases has become safer, and the outcome has improved. With appropriate preoperative evaluation and planning, endoscopic sinus surgery is usually carried out in an ambulatory setting with minimal discomfort to patients.

Sinus surgery can be carried out under local anesthesia with sedation or general anesthesia. Intraoperatively, extreme care must be exercised to avoid orbital and neurologic complications. The preoperative CT scan serves a vital role in proper evaluation of potential anatomic anomalies and changes due to disease process or anatomic variance.

Patients undergoing preoperative consultation must be informed of potential orbital complications, the possibility of postsurgical cerebrospinal fluid leakage, possible bleeding from related sinus arteries, and the possibility of polyp recurrence despite surgical removal. Patients should also be counseled regarding the need for close follow-up care and postoperative medical treatment for allergy, asthma, and other related medical conditions.

Preoperative Details

Careful review of the CT scan results preoperatively and the availability of CT scans during the procedure are important for a successful outcome.

Inform the patient that the recovery of the sense of smell is unpredictable and is not guaranteed, even with proper surgical and medical treatment. Stress the importance of continual postoperative treatment of allergic rhinitis and chronic nasal conditions to ensure long-term success and prevent polyp re-formation.

Intraoperative Details

Proper instrumentation and methodical sinus surgery lead to decreased complications and a positive outcome of the surgical treatment.

Surgical specimens are sent for pathological examination.

Nasal packing material is recommended to minimize postoperative bleeding from the sinuses and nose.

Recent advent of a computerized CT tracking system to better define important surgical anatomical sites during surgery in real time has been useful to avoid potential complications in selected potential complex cases. Complex surgical cases include history of prior/repeat sinus surgery, potential orbital and/or brain involvement of disease process, and other pre-existing anatomical variants.

However, CT guidance surgery is not recommended for all sinus surgery cases. Medical judgment and careful patient selection will enhance the benefit for new technology in sinus surgery.

Proper training and surgical techniques are paramount to ensure patient safety in all sinus surgeries. New technology should always be adjunct to careful surgical planning and implementation of treatment decision making.

Postoperative Details

Stress the importance of close follow-up care and debridement of the sinuses and nasal cavity. Resume medical treatment and control of allergic rhinitis to prevent polyp recurrence.

It is not uncommon that patients may have good immediate postsurgery results in relief of nasal obstruction; however, loss to medical follow-up and lack of medical treatment postsurgery may mean not detecting the recurrence of polyposis.

Patient education regarding the long term treatment plan and goal should be stressed. The need for long term treatment to prevent the recurrence of polyposis should be conveyed to all patients.

Follow-up

Guidelines for follow-up care are as follows:

  • Day 1-2 - Removal of nasal packing and debridement of sinuses and instruction for patient's self-care at home with topical antibiotic ointment
  • Day 4-5 - Inspection and debridement of sinuses to ensure proper healing
  • Day 10 - Inspection and debridement of sinuses and resumption of medical treatment with nasal steroid inhaler
  • 2-3 weeks - Inspection and debridement of sinuses to ensure complete healing of nasal and sinus mucosa
  • 5-6 weeks - Inspection and routine follow-up and medical care
  • 3 months - Inspection and routine follow-up and medical care

After the above protocol, follow-up care in 4- to 6-month intervals should be sufficient.

These guidelines may be individualized according to the clinical progress of the patient and severity of disease prior to surgery.

Complications

Major complications include the following:

  • Central nervous system - Surgery-related cerebrospinal fluid leak, meningitis, intracranial hemorrhage, brain abscess, brain herniation
  • Orbit - Blindness, optic nerve injury, orbital hematoma, eye muscle injury leading to diplopia, nasolacrimal duct injury leading to epiphora
  • Vascular - Vascular injury leading to severe hemorrhage
  • Death

More on Nasal Polyps, Surgical Treatment

Overview: Nasal Polyps, Surgical Treatment
Workup: Nasal Polyps, Surgical Treatment
Treatment: Nasal Polyps, Surgical Treatment
Follow-up: Nasal Polyps, Surgical Treatment
References
[ CLOSE WINDOW ]

References

  1. Deal RT, Kountakis SE. Significance of nasal polyps in chronic rhinosinusitis: symptoms and surgical outcomes. Laryngoscope. Nov 2004;114(11):1932-5. [Medline].

  2. Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl. 2007;(20):1-136. [Medline].

  3. Kingdom TT, Orlandi RR. Image-guided surgery of the sinuses: current technology and applications. Otolaryngol Clin North Am. Apr 2004;37(2):381-400. [Medline].

  4. Bhattacharyya N. Progress in surgical management of chronic rhinosinusitis and nasal polyposis. Curr Allergy Asthma Rep. June 2007;3:216-20. [Medline].

  5. Garrel R, Gardiner Q, Khudjadze M, Demoly P, Vergnes C, Makeieff M. Endoscopic surgical treatment of sinonasal polyposis-medium term outcomes (mean follow-up of 5 years). Rhinology. Jun 2003;41(2):91-6. [Medline].

  6. Gosepath J, Mann WJ. Current concepts in therapy of chronic rhinosinusitis and nasal polyposis. ORL J Otorhinolaryngol Relat Spec. 2005;67(3):125-36. [Medline].

  7. Mostafa BE, Abdel Hay H, Mohammed HE, Yamani M. Role of leukotriene inhibitors in the postoperative management of nasal polyps. ORL J Otorhinolaryngol Relat Spec. 2005;67(3):148-53. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

surgical treatment of nasal polyps, nasal polyps, polyposis, chronic allergic rhinitis, chronic sinusitis, cystic fibrosis, nasal obstruction, persistent nasal discharge, rhinorrhea, sinus infection, anosmia, nasal polyposis, chronic rhinosinusitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Andrew Cheng, MD, Clinical Assistant Professor, Department of Otolaryngology-Head & Neck Surgery, New York Medical College
Andrew Cheng, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Medical Editor

Eric Moore, MD, Residency Director, Assistant Professor, Department of Otorhinolaryngology/Head and Neck Surgery, Mayo Graduate School of Medicine
Eric Moore, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Department of Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.