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nasal polyps

What about nose polyps and CF?? My 8 year old son has nasal polyps. He had surgery 3 times but these polyps grow back every time
Dear parent, your question concerning nasal polyps is of great relevance for patients with cystic fibrosis. Disease in the upper airways, nose and sinuses is indeed nearly always present in patients with CF.

The lining of the nasal passages is in continuity with the sinuses, the cavities just next to the nose. From early life on, patients with CF will form thick secretions in the nose, just as they have sticky secretions in the lungs. These secretions can block the openings between the nose and the sinus . Secretions build up in the sinus, infection with bacteria complicates the matter, chronic infection starts . Many patients will then form ‘nasal polyps’,. These are really only protrusions of thickened mucosa (the lining) into the nasal passages. The doctor can see nasal polyps when he looks into the nose of the patient and the extent of these polyps can also be evaluated on a CT scan. Nasal polyps are most common between the age of 5 and 20 years. They may be detected in up to 20% of the patients.

A CT scan of the sinusses will nearly always demonstrate sinusitis in patients with CF. Still only about half of them may complain about one of the following: blocked nose, mouth breathing, headache, bad breath, cough, disturbance of sleep , loss of sense of smell. The treatment of the nose and sinuses aims at better draining the secretions from the nose by rinsing the nasal passage with a good amount of salt water. Infection can be treated with antibiotics, by mouth or via nose drops. Often a cortisone spray will be used to diminuish inflammation and at times a small cortisone dose by mouth can be prescribed. Stil some patients will get worse and form large nasal polyps. Then surgery is a valuable option. About 3-4% of patients have such surgery done in any one year. During general anesthesia, the nasal polyps are removed and usually the opening between nose and sinuses is also enlarged to further improve drainage of secretions. This will nearly always improve the complaints allthough the problem will at times not be solved definitively

Often infection will start again, inflammation will start again and new polyps can be formed. If chronic rinsing of the nose and medication again provides insufficient improvement, repeated surgery may be needed. More extensive surgery with not only removal of the polyps but drastic widening of the sinus opening may limit the need for further surgery. Local treatment with antibiotics following surgery can also decrease the chance that the problem starts all over again.

As you can read, there is no easy solution for the treatment of nasal polyps. Depending on the severity of the complaints and the scan images of the sinuses, possibilities for further improvement with surgery should be evaluated. This can best be done with your CF-doctor and an ear- nose- throat specialist who is experienced in treating patients with cystic fibrosis.
Dr. F. Vermeulen