Nasal polyps

Question

Our child (9 years old) has nasal polyps in the right side of the nose. According to the opinion of the ENT-doctor, only in the ethmoidal sinus. The left side is free. For about half a year we are taking a cortisone containing nose spray without achieving a change of the polyps. Now an MRI is going to be done, in order to see everything in more detail compared to the ultrasound, however we have already been told, that it will probably come to an operative resection of the polyps.
Are there any alternatives, that we could try before?
Many thanks for your answer.

Answer

Hello,
altogether, about 50% of CF patients show nasal polyps, whereas the rate increases with increasing age. Polyps are glassy appearing benign proliferations of the mucosa, which can - in gerenal grow out of the sinuses - reach the nasal duct and fill this out completely from time to time. Surprisingly, some patients with minimal polyps report about strong complaints, whereas single patients do not report any problems, in spite of the fact that the polyps grow almost out of their nose.
Nasal polyps respond also in CF on topic corticosteroid preparations, even if the effect should be stronger in allergy-caused polyps. In case a polyps is only cut down during an operation, he regrows again in general in CF within a few months.
Important to me is the free nasal breathing, freedom of symptoms and the prevention of infiltration of the lower airways with problematic germs via the nose and its sinuses. Therefore the investigation of a colonization with germs of the upper airways will get more and more important, besides the until now common microbiological investigations of secretions from the lower airways, especially in patients who are not yet permanently colonized with Pseudomonas aeruginosa.
It has until now not been clarified yet, how the above mentioned aims can be achieved the best, and how aggresive the indication for an ENT-operation in CF has to be declared.
I would not derive a necessity to operate from the sole finding of polyps by an ENT-specialist. Drugs, such as cortisone nasal spray can be given with quite great saftey for a longer period of time; Nasal showers help at the removal of secretions and crusts. As vibrating aerosoles, drugs such as DNAse or the cheaper hypertonic sodium chloride (6%) can be inhaled in the sinuses via the Pari Sinus; we are performing multicenter studies on this.
Yours sincerely,
Dr. Jochen Mainz

05.10.2010