Removal of nasal polyps: laser, endoscopic, radio wave removal

Nasal polyposis is an unpleasant disease that creates problems with nasal breathing and significantly worsens the quality of life of patients. But if with a banal runny nose against the background of a cold or flu you can sit at home on sick leave to thoroughly treat it, then with rhinitis caused by polyps in the nose, you have to live and work without any indulgences. Moreover, the treatment of polyposis with conservative methods does not give any guarantee that the problem will not return after a while. And in such a situation, the removal of polyps in the nose is considered the only reliable way to solve the problem.

What is nasal polyposis?

As we know, the entire outer surface of our body is covered with skin. But the cavities inside it also have a kind of skin as a covering - a delicate mucous membrane consisting of glandular tissue. This tissue, under the influence of some unfavorable factors that cause irritation of the mucous membrane, can grow due to uncontrolled cell growth.

The proliferation of glandular tissue cells is somewhat reminiscent of the situation with cancer. However, the round growths of various sizes that appear do not have malingized (modified, malignant) cells, so they are considered benign neoplasms.

It is these growths on the mucous membrane inside the body that are called polyps. Moreover, they can appear in any place where there is glandular tissue. And it is inside the nasal passages, in the paranasal, maxillary sinuses, ethmoid labyrinth, etc. When polyps form on the mucous membrane of the olfactory organ (and the disease is most often not limited to single neoplasms), they talk about nasal polyposis.

What can cause polyps to appear in the nose? It is clear that the mucous membrane will not behave inappropriately out of nowhere. Cell proliferation is caused by prolonged irritation of the nasal mucosa, which can be caused by:

• bacterial or fungal microflora that causes tissue inflammation, especially if the process becomes chronic,
• frequent colds and rhinitis,
• allergies, accompanied by frequent runny noses, and sometimes bronchial asthma,
• obstruction of the nasal passages (for example, with a deviated nasal septum) with congestion in them.

There is also a possibility that the disease is hereditary and is caused by the peculiarities of the structure of the nasal mucosa. And in some cases, the growth of mucosal tissue is associated with malfunctions of the immune system, which entails the appearance and inevitable removal of polyps in the nose.

It would be wrong to say that nasal polyposis is a very common disease. Such an unenviable fate only affects 4% of the population. And women are luckier in this regard, because they have nasal polyps almost twice as rarely as the stronger sex.

Very often, overgrown multiple polyps in the nose are compared to a bunch of grapes by analogy with adenoids. But there is little pleasure in these "grapes", because the nasal passages are not designed for growing such vegetation. The diameter of the opening through which warm, purified and humidified air enters the body is slightly more than 1 cm. It is clear that any obstacle inside the nasal passages will impede the passage of air. And the larger the size of such an obstacle, the more difficult it is for a person to breathe.

Polyps, although painless formations, are a big problem for a person. While the polyp has dimensions described in millimeters, a person breathes through the nose with difficulty. But the growth gradually increases in size and becomes overgrown with "neighbors", which, in the end, is fraught with blocking the air passage. At the third stage of the pathology, a person has no choice but to breathe through the mouth.

Polyps are fairly mobile neoplasms that are rarely attached to the main tissues by a thick base. Usually, these growths are connected to the mucous membrane by a thin feeding stalk and can move within its length, which allows them to fall out of the paranasal sinuses into the lumen of the nasal passages, move in the nasal passages, causing irritation of the cilia of the epithelium and sneezing.

Where exactly in the nose can polyps form? They can be found directly on the mucous membrane of the nasal passages and the ethmoid labyrinth, as is the case with most adult patients. But in childhood, when a runny nose becomes part of the baby's life, and he cannot blow his nose normally, the inflammatory process moves to the paranasal sinuses, where benign formations can subsequently be expected. In children, polyps most often form in the maxillary sinuses, aggravating the process with congestion, and as they grow, they gradually begin to exit through the mouth into the nasal passages, blocking the movement of air.

Do nasal polyps need to be removed?

It would seem that the nose is not the only way for air to enter the body, so why not breathe through the mouth when nasal breathing is impaired, associated with the same polyps in the nose? And in parallel, you can treat polyps with medications and folk remedies.

Everything would not be so bad if conservative and alternative therapy gave tangible and long-term results. But, firstly, such treatment makes sense only at the very beginning of the dysplastic process. And secondly, most often, treatment without surgery gives only a temporary effect (a certain delay). After a while, the growths begin to increase in size again, and the removal of polyps in the nose turns out to be the only radical way to solve the problem.

Is it possible to live normally with polyps in the nose? It is possible to live, but it is unlikely to live normally. The fact is that the lack of normal nasal breathing has a negative impact on both a person’s well-being and their ability to work. Therefore, after suffering for several months, patients still agree that the removal of neoplasms is necessary.

We are used to breathing first through the nose, and then through the mouth. But when breathing through the mouth, a person feels a certain discomfort, especially when the mucous membranes of the throat begin to dry out. This discomfort is especially noted during sleep, forcing a person to wake up often, cough, moisten the throat with liquid, etc. As a result, a person does not feel rested in the morning, and this despite the fact that there may still be a whole working day ahead.

Mouth breathing has some differences from nasal breathing. Passing through the nasal passages, the air has time to warm up a little, the ciliated epithelium and hairs inside the nose help to retain infection and dust coming with the air, and at the same time it is moistened. Thus, air enters the lower respiratory tract that is unable to cause irritation or inflammation of their mucous membrane.

When we inhale air through our mouth, it initially enters the bronchi and lungs. Low ambient temperature (and, accordingly, air temperature) is the main condition for a decrease in immunity and the development of colds. Bacteria, viruses and fungi that penetrate the bronchi without delay contribute to inflammatory processes in the respiratory organs. And dry air and dust cause throat irritation, coughing, and allergies.

It turns out that when breathing through the mouth, a person condemns himself to frequent colds (tonsillitis, bronchitis, pneumonia, etc.) and allergic diseases, the most unpleasant of which is bronchial asthma. And yet, the greatest danger is posed by polyps in the paranasal sinuses, which prevent their natural cleansing. Mucus and microbes accumulate in the cavities of the paranasal sinuses, causing a chronic purulent-inflammatory process that has a tendency to spread to the brain. In addition, purulent masses can enter the blood when blood vessels rupture and cause its infection (sepsis).

Another unpleasant thing about nasal polyposis is the deterioration of the perception of smells. And the impaired sense of smell also deteriorates the perception of taste, which is very, very unpleasant, and also affects appetite, sexual desire and some other functions.

In any case, a person is more accustomed to breathing through the nose, so breathing through the mouth is incomplete. Lack of oxygen primarily affects the functioning of the brain. Symptoms of brain hypoxia include frequent migraines, sleep disorders, and rapid fatigue. As a result, a person's performance decreases, and his condition leaves much to be desired.

But polyps themselves are not such harmless growths. They, like other benign tumors, under certain conditions can degenerate into an oncological disease. This happens rarely, but it is still not worth excluding this possibility.

Of course, you can do nothing, expecting the polyposis to resolve on its own. But statistics show that the probability of such an outcome is extremely low. However, further growth of glandular tissue increasingly affects the quality of life of patients. They suffer from headaches, shortness of breath, even the shape of their skull changes due to the constantly open mouth, as in the case of adenoids, irritability appears due to constant lack of sleep, and as a result of oxygen deficiency, the functioning of various organs is disrupted.

But is it worth it to suffer and torment your body if today there are many different methods for removing polyps in the nose. Yes, previously polyps were removed mainly surgically, which was associated with a certain discomfort, pain, bleeding. But today medicine has reached a new level, and painless removal of polyps in the nose with a minimum of complications has become a reality. You just need to consult a doctor and decide on the method of instrumental treatment of polyps.

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Indications for the procedure

Whatever the method or method of treating nasal polyposis, it is important to understand that this disease, like many others, requires a serious attitude. If in the case of drug treatment we often act as "our own doctor", which often only harms our body, then this will not work with surgical treatment. You cannot remove polyps yourself, and the surgeon cannot meet the patient halfway only at his request.

Removal of nasal polyps is a serious operation, and it will not be done without special need. First, the patient should be examined by an otolaryngologist, diagnosed and the stage of development of the process assessed, and then we can talk about the possibilities of treating polyps.

What symptoms should alert a person and become a reason to visit a therapist and ENT specialist? Difficulty breathing through the nose (the larger the polyps, the harder it is to breathe through the nose), the appearance of regular mucous or purulent discharge from the nose, chronic rhinitis, frequent episodes of sneezing without apparent reason, deterioration of the sense of smell (in advanced cases, a person stops distinguishing smells altogether), frequently recurring migraines, changes in voice (it becomes nasal).

It is clear that it is very difficult to make an accurate diagnosis based on such symptoms. It is not always possible to detect polyps in the nose with the naked eye. Sometimes it is necessary to resort to an endoscopic examination of the nose and nasopharynx, as well as to a computer tomography of the paranasal sinuses.

Depending on the prevalence of the process, the stage of the disease and concomitant pathologies, the doctor makes a decision on conservative or surgical treatment. At the same time, at the beginning of the development of the pathological process, preference is still given to drug treatment, and the removal of polyps in the nose is carried out only if conservative treatment has not given a decent result or there is a relapse of the disease.

Most often, the operation to resect neoplasms is prescribed to those whose nose completely stops breathing due to the fact that polyps block almost the entire space of the nasal passages. Other indications for the operation are:

• growth of polyps against the background of a deviated nasal septum,
• development of bronchial asthma and atrophic rhinitis as complications of nasal polyposis,
• if a person has previously been diagnosed with bronchial asthma or allergies, an indication for surgery is an increase in the frequency of attacks of the disease,
• the presence of chronic rhinitis that is not treated with medication,
• the appearance of bloody discharge from the nose,
• an unpleasant smell of discharge, which indicates a purulent process,
• developing inflammatory process in the sinuses,
• critical impairment of smell and taste perception,
• a strong change in voice, the appearance of snoring episodes, frequent migraines.

In any case, the decision to refer for surgery remains with the doctor. But the patient can choose the method of removing nasal polyps himself. But it is worth considering that any operation may have its own contraindications.

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Preparation

So, the operation to remove polyps in the nose is carried out only after a thorough diagnostic examination and a final diagnosis. In most cases, rhinoscopy allows confirming the preliminary diagnosis, when the doctor can visually assess the presence and size of polyps. But if the dysplastic process occurs deep in the nasal passages or paranasal sinuses, it becomes difficult to determine its quantitative and qualitative indicators. And then a CT scan, X-ray and endoscopic examination of the nasal passages and sinuses come to the rescue.

If, after examining the patient and studying dangerous complaints, the doctor comes to the conclusion that surgery is necessary, he immediately informs the patient of his decision, fully describing the situation and the possible consequences of the lack of effective treatment. But any operation requires certain preparation, especially in the case of nasal polyposis, when surgical intervention is not performed for urgent indications.

Taking tests before removing nasal polyps is a routine procedure that allows you to assess a person's health, the functioning of vital organs, and the likelihood of bleeding. And although the referral for surgery is issued by an ENT doctor, it will not be performed without permission from a therapist.

1.5-2 weeks before the scheduled event, the patient should visit a therapist who will conduct a physical examination, listen to breathing, measure blood pressure and heart rate. He will also give the necessary directions for tests:

• clinical and biochemical blood analysis,
• coagulogram (blood clotting test),
• blood test for hepatitis, syphilis, human immunodeficiency virus,
• general urine analysis (helps to assess the condition of the excretory organs, which is important due to the fact that the operation is performed under anesthesia).

If purulent discharge is found in the nose, it is a bacterial infection that will need to be treated with antibiotics before the operation. To make the treatment more effective, bacterial culture can be performed to determine the type of pathogen causing the inflammation. The same thing will be done in the case of acute infectious diseases in the body.

Additionally, instrumental examination of the heart and respiratory organs is prescribed. Usually, this is an electrocardiogram and chest X-ray.

In preparation for the surgery, the patient is prescribed anti-inflammatory drugs and decongestants. The doctor clarifies whether the patient is taking anticoagulant drugs or other drugs that can reduce blood clotting and increase the risk of bleeding during or after surgery. Such drugs should be stopped early to avoid dangerous complications later.

The operation to resect neoplasms in the nasal cavity and paranasal sinuses is associated with certain pain sensations and discomfort, so it is preferable to perform it with anesthesia. Anesthesia for the removal of nasal polyps can be either local or general, depending on the method of the operation and the patient's sensitivity to pain. In most cases, local administration of drugs is limited, although in endoscopic surgery in some cases the use of general anesthesia (intravenous, or better endotracheal anesthesia) is also allowed.

Before the operation, the anesthesiologist must inquire about the patient's health, check the patient's tolerance to anesthetics, calculate the minimum effective dose of drugs. And also tell about the conditions for eating the day before and on the day of the operation: a light dinner is allowed in the evening, on the day of the operation, you will have to refrain from eating and drinking for 6 hours before it, especially in the case of general anesthesia.

Technique to remove nasal polyps

Like any other operation, removal of nasal polyps should be carried out strictly according to a certain scheme, which does not exclude the "creativity" of the surgeon in case of unforeseen situations. But since there are at least 5 methods of polypectomy, there is no need to talk about any general scheme. This means that it makes sense to consider each method separately.

Loop polyp removal

Let's start with a simple surgical operation known for many decades to remove polyps in the nose, which is essentially what is commonly called a regular polypectomy. This method was used to remove neoplasms in the form of overgrown adenoids in the throat or polyps in the nose, but it has not been forgotten to this day as the cheapest of all operations available in a regular hospital. Its popularity is due to the fact that the operation does not require complex equipment and mainly uses local anesthesia (irrigation of the nasal cavity with anesthetics plus infiltration anesthesia).

Nasal polyps are removed with a special steel loop (or a Lange hook is used), which must be inserted into the nostril, thrown over the growth, lowered to the base of the stalk and tightened. Now the surgeon must show all his skill, not just to cut off the polyp in any place, but to pull it out together with the stalk. Alas, this is not always possible, and then relapses of the disease cannot be avoided.

This type of surgery is prescribed when several polyps in the nasal passages need to be removed at the same time. However, if the polyps have formed in the paranasal sinuses and are only hanging down into the nasal passage, the probability of removing them "with the root" is extremely low.

During the operation, the patient sits in a chair. A special container is placed under his chin, where the blood will flow after the polyp is removed. It is almost impossible to avoid bleeding during a regular polypectomy.

Stopping bleeding after polyp removal is done with tampons (turundas), which are protected from sticking with Vaseline. A bandage is applied on top, which fixes the turundas inside the nasal passages.

Usually the operation takes no more than an hour. But everything depends on the volume of work. If single polyps are removed, 20-30 minutes will be enough.

The doctor monitors the progress of the operation visually using expanders and a flashlight, which is attached to the surgeon's head. Under these conditions, and especially with bleeding, it is very difficult to assess the quality of polyp removal.

This operation is not considered particularly effective. Firstly, not all polyps will be visible during anterior rhinoscopy, so some growths may remain and continue to grow, disrupting nasal breathing. The remaining polyps can be removed after a couple of weeks, but this is additional trauma to the olfactory organ.

The inability to assess the quality of the operation leads to the fact that various shortcomings are subsequently discovered: the polyp was not completely cut off, not all growths in the nasal passages were removed, etc. The probability of recurrence of polyposis with simple loop removal is quite high and reaches 60-70%. This means that after 1-2 years the operation will have to be repeated using the same or another method.

The disadvantages of simple polypotomy also include:

• high risk of heavy bleeding,
• pain during and after surgery,
• a longer recovery period due to the fact that a small area of healthy mucous membrane may be torn out along with the polyp, which is fraught with relatively large tissue damage and the development of an inflammatory process in them; after all, wounds on mucous membranes take longer to heal than on the skin,
• the inability to efficiently remove polyps in the paranasal sinuses.

Polypotomy also has several positive aspects, which is why the not very effective procedure is still performed in many hospitals today:

• old surgeons have a lot of experience in removing nasal polyps with a loop, after all, the method has existed for quite a long time,
• availability of surgery in many medical institutions,
• low price for surgery in medical centers (other methods will be much more expensive, in addition, in many ENT departments you can sign up for free removal of nasal polyps using the polypotomy method).

Today, there are several more effective, but not at all budgetary methods of removing polyps in the nose, which are less traumatic and painful. But in the absence of financial opportunities to carry out high-quality treatment of polyposis, polypotomy will be a good opportunity to prevent the development of dangerous complications associated with hypoxia and malignancy of the process, and this is also worth something.

Laser removal

In recent years, laser has become increasingly widespread in medicine and cosmetology. And this is not surprising, because the removal of various neoplasms with a laser involves deeper penetration into tissues, while the risk of bleeding in this case is quite small.

Laser can be used to remove polyps in the nose, and this method of polypectomy is considered the least traumatic and safest, which makes it possible to use it to treat children and patients suffering from asthma attacks. This method is still relatively new, but already shows good results.

A specialist doctor can perform laser removal of nasal polyps even in a treatment room equipped with special devices (laser equipment and an endoscope connected to a monitor). It is not necessary to go to a hospital for this. The operation is performed using local anesthesia and does not involve the use of surgical instruments.

During the procedure, there is no need to make cuts in the tissues, the laser knife is brought directly to the polyp, after which the device is turned on, and the high-frequency beam practically burns out the polyp. The heating temperature of the neoplasm tissues approaches 100 degrees, and the polyp dries out completely. Its remains can be easily removed with tweezers.

The laser burns out the growth completely, together with the stalk, which significantly reduces the likelihood of relapse. Simultaneously with the removal of the polyp, the laser beam seals the torn blood vessels and disinfects the wound, which helps to avoid bleeding and the development of an infectious process. The absence of severe bleeding allows you to avoid tamponade of the nose and a person can breathe normally immediately after the operation.

Even if the operation is performed in a hospital setting, the patient does not have to stay in the hospital. If everything went without complications, the person goes home the same day and only goes to a preventive examination with an otolaryngologist.

Laser treatment requires mandatory visual control of the operation, which eliminates damage to nearby tissues. In this case, we are not talking about rhinoscopy, but about monitoring the process of removing polyps in the nose using endoscopic equipment, the tube (probe) of which is also inserted into the nasal cavity and transmits an image from a microscopic camera to a computer monitor. Thus, the doctor gets the opportunity to assess the condition of the nasal mucosa, as well as the location and number of polyps, monitor all movements and the result of the laser equipment, adjusting the radiation frequency if necessary.

Despite all the advantages of laser polyp removal, it is considered relevant in the case of single growths. Removing "grape clusters" with a laser is quite problematic. In addition, it is almost impossible to bring laser equipment close to polyps located inside the paranasal sinuses, so the removal may be incomplete, which can subsequently lead to relapses of the disease.

Endoscopic removal of polyps

Like laser surgery, endoscopic surgeries are considered a relatively young but very promising direction in medicine. The presence of an endoscope allows for high-quality diagnostics of the disease with an assessment of the degree of development of the pathology and the location of polyps, as well as the removal of polyps that are located in hard-to-reach places.

What is inaccessible to a loop or laser is quite possible with special surgical instruments that are brought to the site of the operation using an endoscope tube, which makes it possible to penetrate deep into the nose and perform a full-fledged surgical operation there without opening the tissue. For example, if the patency of the maxillary sinuses is impaired and there is polyposis inside them, the sinus ostium and nasal passages are widened before removing the polyps. If there is a curvature of the nasal septum, an operation to restore its shape is performed in parallel, which serves as a preventive measure for relapses and complications.

Depending on the volume and nature of the work, endoscopic surgery can be performed using either local or general anesthesia. If we are talking only about removing polyps in the nasal passages, then local administration of anesthetics is sufficient. But when it is necessary to clean the labyrinth and paranasal sinuses, as well as surgery on the nasal septum, it will be difficult to do without general anesthesia.

If a nasal polyp is removed from a child under 7 years of age, preference is given to general anesthesia using an endotracheal system. This will ensure the patient remains still and calm during the operation, since the child may twitch, twist, cry, which will negatively affect the outcome of the intervention.

Endoscopic surgery can be performed in various ways, but in any case it is carried out under the control of endoscopic video equipment. To remove polyps, they use:

• microsurgical instruments that allow for deep resection of polyps and space cleaning,
• shaver or microderiber, which operate on the principle of a pump, i.e. they cut off the polyp along with the stalk right at the root, crush it, suck it in and remove it outside the nose.

In principle, both methods of removing polyps using endoscopic equipment are highly effective, but using a shaver is considered the most convenient, so such operations are performed most often.

Endoscopic removal of nasal polyps with a shaver will be even more effective if it is carried out using video navigation. This will allow you to assess the condition of the paranasal sinuses and labyrinthine cells to exclude poor-quality removal of polyps.

An operation under endoscope control lasts about an hour. It is possible to remove both single and multiple neoplasms, correct defects, and penetrate into the most inaccessible places. This is the reason for the great popularity of endoscopic operations compared to other methods.

The advantages of endoscopic treatment are:

• the ability to assess the condition of the mucous membrane and the size of any neoplasms present on it as accurately as possible,
• constant visual comprehensive control of the operation allows avoiding injury to healthy tissues,
• absence of severe bleeding,
• removal of polyps together with the roots (this is especially important for a shaver, which removes everything that touches the growth with great precision, without touching the nearby mucous membrane, which gives an almost 100% guarantee that polyps will not form again),
• polyps are removed more carefully compared to conventional polypotomy, so wounds on the mucous membrane heal faster and the recovery period after surgery is reduced,
• the ability to perform the procedure under local anesthesia,
• After removal of polyps, as in the case of laser surgery, there are practically no scars and adhesions rarely form.

The disadvantages of endoscopic removal of nasal polyps include:

• the need for nasal tamponade for 24 hours after surgery,
• the impossibility of performing the operation in laboratory conditions, after all, various instruments are required to perform it and sterile conditions,

It cannot be said that this method of combating polyposis completely excludes the possibility of polyps appearing in the future. After all, this is a method of combating not the cause of the disease, but the consequence of its development. Of course, some things can be corrected (for example, normalizing the outflow of secretion from the maxillary sinuses or straightening the nasal septum), but frequent colds and inflammations that are not treated promptly can lead to the fact that after several years the nasal mucosa will begin to grow again. The good news is that this is possible much later than with other methods of removing polyps in the nose.

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Radio waves from polyps

Surprisingly, radio waves of a certain frequency can also act as a knife, cutting polyps to the very base. In this case, they are somewhat reminiscent of the action of a laser, as they can seal vessels, which prevents severe bleeding. But their effect on polyps is still close to the work of a loop during a conventional polypotomy, although it can be carried out under the control of an endoscope.

Radio wave removal of nasal polyps, like other similar methods, has its advantages and disadvantages. The main advantages of the method are:

• possibility of carrying out in outpatient conditions,
• minimal risk of bleeding and wound infection,
• no need to wear tampons in your nose and undergo long-term rehabilitation.

But the method also has significant disadvantages:

• insufficiently deep removal of polyps, which increases the risk of recurrence,
• the impossibility of removing small growths in this way.

Cryotherapy

Removal of nasal polyps with liquid nitrogen is not a popular procedure, although it has many advantages:

• no heavy bleeding,
• minor pain, which allows for local anesthesia,
• low risk of infection,
• short postoperative period,
• there is no need to carry out the procedure in a hospital operating room.

However, the operation requires special expensive equipment, which affects its cost. But the result of treatment with liquid nitrogen leaves much to be desired.

The cryotherapy device operates on the same principle as the laser. The polyp is not excised, but is exposed to critical temperatures. But if the laser strongly heats and dries out the pathological growth, then with cryotherapy it freezes and falls off.

Everything would be fine if the device could freeze tissues to a greater depth, but this does not happen. And where the root remains, there is always a risk of new polyps appearing. It is clear that an expensive but ineffective operation will not be in great demand.

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What can influence the choice of surgical method?

As we can see, there are many methods of performing surgery to remove polyps in the nose. They all have their pros and cons. The operations also differ in cost. The most budgetary operation is considered to be polypotomy, and the endoscopic procedure can be considered a very expensive method, which is not surprising, given its effectiveness and low risk of relapse.

But the price in choosing a surgical method does not always play a decisive role, unlike contraindications. Based on the volume and nature of the work, doctors try to offer an operation that will be most useful with minimal harm to health in each specific case.

But each treatment method has its own contraindications for the procedure, which we will now get to know.

Conventional polypotomy using Lange's loop:

• acute period of any disease, especially infectious,
• cardiovascular diseases,
• hematopoiesis disorder, low blood clotting
• bronchial asthma due to the high probability of developing asthmatic status.

Laser removal of polyps:

• nasal polyposis with multiple neoplasms,
• obstructive bronchitis in the acute stage,
• acute infections,
• exacerbation of bronchial asthma and allergies, which is typical for the spring-summer period,
• pregnancy.

Endoscopic removal of nasal polyps:

• exacerbation of allergic rhinitis,
• chronic bronchitis of allergic origin in the acute stage,
• bronchial asthma,
• severe pathologies of the cardiovascular system (CHF, cardiac ischemia, post-infarction state),
• diseases of the liver, kidneys, respiratory system (especially when using general anesthesia),
• acute infectious diseases
• For women, menstruation may be a contraindication.

In addition to the above contraindications, there is one more point for the radio wave method. Radio waves can negatively affect the operation of electrical appliances, so it is undesirable to use them in the treatment of people with metal implants (for example, pacemakers).

General contraindications for all methods of removing nasal polyps are: any malaise, fever or blood pressure surges, acute infectious processes in the body, intolerance to anesthetics. In principle, there are not so many absolute contraindications to surgery. Usually, the procedure is simply postponed to another time, i.e. it is carried out after achieving stable remission of chronic diseases, after childbirth, when the symptoms of acute pathologies disappear.

Consequences after the procedure

In our minds, a surgical operation is associated with an operating room, a scalpel, a ventilator, bright light from the ceiling, etc. The procedure for removing polyps does not quite fit into this framework, and therefore may not seem so serious. In fact, this is not so. It does not matter what method is used to perform the operation, but it is still an intervention in the functioning of the body, metabolic processes in its tissues, and the functioning of the respiratory system.

Removing nasal polyps is a serious operation, even if it is performed in a somewhat unusual way. It is clear that after the operation a person may feel uncomfortable for some time. By the way, many patients describe the operation as painless, but terribly unpleasant, although they agree that life with nasal polyps is even more terrible.

The expected consequences after the polypectomy procedure do not occur immediately. It will take at least 1 or 2 days before the nose begins to breathe normally even after laser removal with a minimal recovery period. The cause of nasal congestion in the first days after surgery is swelling of tissues that have been subjected to mechanical or thermal trauma. It is clear that after a regular polypotomy, swelling and inflammation of the tissues will be the strongest, which means that breathing will be restored in the best case after 3-5 days.

Sometimes patients complain that after removing nasal polyps, their head hurts. This is not surprising, considering that the operation was performed in the head area, and the nerve endings in the nose experienced severe irritation, which subsequently resulted in such a transient neurological disorder.

There is no need to be afraid of headaches. After all, if with polyposis they only intensified with each passing day, now the symptom will gradually weaken until the mucous membrane returns to normal. It is clear that headaches can be facilitated by slight inflammation of tissues after surgery and the anesthesia used, especially if we are talking about general anesthesia.

After general anesthesia, nausea, occasional bouts of vomiting, headaches and dizziness are common and usually pass within a day or a little more.

The temperature after removal of nasal polyps may rise slightly. But usually it fluctuates within 37-37.2, which indicates an inflammatory process due to tissue trauma, and not serious complications. How long this temperature lasts depends on the method of surgery and the scope of the intervention.

If after the removal of polyps in the nose the sense of smell suddenly disappears, there is also no need to worry too much. This is how the body reacts to interference in its work. Plus, swelling of the mucous membrane does not contribute to the normal functioning of sensitive receptors, which worsens the perception of smells, and sometimes taste. Usually after 3-5 days the swelling subsides, and the sense of smell is gradually restored. However, sometimes this takes about a month.

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Complications after the procedure

What you really need to worry about is the possible complications after nasal polyp removal surgery, although they are quite rare. Some complications are harmless and can be quickly treated with improvised means and medications, while others require more serious treatment.

What troubles can be expected immediately after the procedure or in the distant future? Let's consider the most common undesirable consequences:

• Even after a successful operation, there may still be a certain risk of nosebleeds. Especially if the patient has problems with blood clotting or takes medications that reduce the viscosity of this biological fluid (anticoagulants, NSAIDs, some heart medications). As for non-steroidal anti-inflammatory drugs, they are not used in the postoperative period, giving way to corticosteroids.
• Some patients may experience short-term disturbances in the functioning of the cardiovascular and respiratory systems as a result of general anesthesia.
• At the site of the inflammatory process after the operation, after a couple of months, adhesions and scar tissue may form, which make nasal breathing difficult and require a repeat operation to excise them. Intensive anti-inflammatory therapy can prevent such a complication.
• If the polyp removal is performed poorly (some part of the growth in the area of the stalk remains in place), most likely, after a few weeks, a new polyp will form in place of the old one, and perhaps more than one. That is, there is always a possibility of a relapse of the disease, since none of the methods of removing polyps in the nose gives a 100% guarantee of curing the disease forever, it is just that the risk of recurrent growth of benign neoplasms is not the same for conventional polypotomy or cryotherapy and laser, radio wave or endoscopic surgery.
• The most unpleasant complication, which is difficult to fight, is the infection getting into the area of an unhealed wound in the nose. This is possible if you do not follow the requirements for caring for the nasal cavity in the postoperative period or try to palpate how the wound is healing. You must always remember that even on washed hands there may be opportunistic microorganisms that will instantly cause inflammation as soon as they get into suitable conditions, which is a fresh wound.

But the wound can also become infected during the operation. You should not think that the cause is definitely the failure to comply with hygiene and disinfection requirements by medical personnel. It is quite possible that the operation was performed during the acute period of infectious pathology, as a result of which the infection generalized (spread) throughout the body through the blood and lymphatic pathways, and the weak point was the area of the recent surgical intervention.

What is dangerous about this? The development of the same inflammatory pathologies of the nose and throat (sinusitis, sinusitis, tonsillitis, etc.) with a high risk of transition to a chronic stage.

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Care after the procedure

In principle, whether complications of nasal polyp removal will arise depends not only on the doctor, but also on the patient. There is no need to think that all treatment is limited to just one operation, and you can immediately begin to live a normal life, especially without worrying about your olfactory organ. Even if the patient feels well, this does not mean that you need to forget about all the requirements of the rehabilitation period.

How quickly recovery and rehabilitation occurs after removal of nasal polyps depends on the treatment and care procedures carried out in the postoperative period.

For example, after the usual removal of polyps with a Lange loop, the nasal cavity is disinfected and tampons are inserted into the nostrils to prevent bleeding. They are removed only after 24 hours, after which the mucous membrane is treated with synthomycin emulsion.

After the operation, the patient can stay in the hospital for another week, following all the doctors' requirements for nasal care. After discharge, he may be prescribed nasal rinsing with antiseptic solutions. Caution will need to be observed for 2 and even 3 weeks, which are given for the restoration of the nasal mucosa after the operation. The regeneration process should be monitored by the attending physician at the place of residence.

After laser removal of polyps and cryotherapy, special care of the nasal cavity is not required. The patient is treated at home, regularly visiting the doctor at the clinic. Most often, no procedures are required, but in case of complications and inflammation of the mucous membrane, special treatment may be prescribed, including treatment of the mucous membrane with antiseptic solutions, anti-inflammatory and, if necessary, antibacterial therapy.

Endoscopic removal of polyps and the radio wave method are slightly inferior to polypotomy in terms of trauma, however, the patient may still feel discomfort in the nose and an unpleasant feeling for several hours. In the absence of nosebleeds, the patient can be discharged in 1-3 days, as soon as the turundas are removed from the nasal passages. But you need to understand that it will take about 2 more weeks until the mucous membrane is completely restored.

If the operation was performed with a shaver, the length of hospital stay may increase to 5 days, during which it will be necessary to rinse the nasal passages and use anti-inflammatory drops.

What other relapse prevention measures do doctors recommend in the postoperative period?

• Adhere to a gentle regimen: avoid sports and heavy physical labor, the patient should rest more and eat well.
• Try to avoid consuming hot foods and drinks.
• It is necessary to monitor blood pressure and take all measures to ensure that it does not rise.
• Prolonged exposure to the sun and heat is prohibited. Visits to the bathhouse, sauna, solarium, and work in a stuffy room are excluded.
• You should try not to blow your nose for at least the first 5 days.

All this will help to avoid such trouble as nosebleeds. But how much caution will need to be observed, the doctor will say in each specific case.

The following measures will help prevent external infection of the wound and facilitate nasal breathing:

• You should avoid walking along roads and near industrial plants and being in rooms with very dusty air.
• The apartment should be wet cleaned twice a day.
• It is necessary to regularly ventilate the room where the patient is located after surgery.
• It is recommended to avoid large crowds and visiting patients with infectious diseases.
• Never put your fingers in your nose unless required for a medical procedure.
• It is necessary to maintain hygiene of the face, nose and hands, especially before carrying out medical procedures.

But the most important thing that will help you cope with the disease faster, avoiding complications, is discipline and patience. The doctor prescribes medication - you need to take pills. He says to regularly rinse your nose - you need to do this. For your own benefit.

Treatment after removal of polyps in the nose

What can doctors offer as anti-relapse therapy after removal of nasal polyps? In each individual case, the treatment plan will be different, because the amount of work during the operation and the degree of tissue damage during it will significantly affect the speed of tissue recovery. And the ability to regenerate the mucous membrane is individual for each person. Therefore, we are talking only about possible, and not mandatory appointments of the otolaryngologist.

So, what types of drugs can be prescribed after removal of polyps in the nose:

• Anti-inflammatory drugs from the group of glucocorticosteroids. Yes, hormonal drugs are no gift, it is not for nothing that many patients try so hard to avoid taking them. But in this case, hormones are used mainly in the form of nasal sprays and drops: Fluticasone with the active substance of the same name, as well as an analogue of the drug called Avamis, Forinex and Nasonex based on mometasone, Budesonide, its imported analogue Pulmicort, Naphthyzinum, etc. When applied locally, hormonal drugs do not enter the blood and do not cause systemic effects, so they are considered safe even with a long course of treatment.

If steroids are prescribed orally in severe cases, the course of treatment will be minimal.

• Antibiotics can be prescribed both to prevent secondary infection and to treat it in case of complications. For treatment, broad-spectrum systemic drugs can be used in the form of tablets and injections, which are prescribed individually. But for the prevention of infections for several days after surgery, it is more appropriate to use anti-inflammatory sprays with an antibiotic:

• the complex drug "Polydexa" (dexamethasone is an anti-inflammatory component, phenylephrine provides a vasoconstrictive effect, neomycin and polymyxin are antibiotics),
• "Isofra" (the active substance framycetin is an aminoglycoside antibiotic),
• "Bioparox" (active ingredient - antibiotic fusafungine).

• Antihistamines. The use of allergy medications improves nasal breathing by reducing mucosal swelling and reducing its sensitivity to irritants. Quite often, doctors prescribe systemic drugs such as Loratadine, Erius, Suprastin, etc.

Antiallergic drugs reduce tissue swelling by blocking the production of histamine, which is considered an inflammatory mediator. Thus, allergy medications only enhance the effect of anti-inflammatory drugs with or without an antibiotic.

• Oil drops with a regenerating effect. They help the wound heal faster, which is a preventative measure against adhesions. Both specialized preparations, such as Pinosol, and vegetable oils, in particular sea buckthorn oil, can be used in this capacity.
• Preparations for washing (sanitizing) the nasal passages. Both saline and special sprays or drops based on sea salt can be used: Humer, Saline, Aqua Maris, Physiomer, etc. They help cleanse the mucous surface from dust, allergens, microbes, inflammatory exudate, mucus. It is not recommended to use a home-made saline solution in the first days after surgery.
• Vitamins and herbal immunomodulatory preparations that help the body restore its protective functions.

The attending physician decides which specific types and names of drugs will be included in the treatment regimen, based on the patient’s condition after surgery.

Is there an alternative to surgery?

It should be said that doctors are not always in a hurry to send a patient for surgery, realizing that such treatment in itself is not able to combat the cause of the proliferation of glandular tissue. Removal of nasal polyps is a fight against the symptoms of the disease, but not against its origins. This becomes one of the reasons for prescribing drug treatment after surgery.

But if surgery does not completely solve the problem, perhaps there are other, less traumatic methods of treating polyps? And they do exist. True, they are not as effective as polypectomy, but for patients who do not agree or cannot undergo surgery, and for those whose disease is still in its infancy, this is a very real solution.

Since the growth of the mucous membrane with the formation of polyps is associated with an inflammatory process, corticosteroids are considered the drugs of choice in the treatment of polyposis. But even the newest drugs in the form of drops and sprays are not very suitable for removing polyps in the nose, because they do not penetrate deeply into the tissues of the neoplasm, and therefore cannot significantly reduce it.

The only way to combat polyps with medication is to inject hormones into the polyp. For this, corticosteroids are used in the form of solutions, for example, "Diprospan". And for such treatment to be effective (practically dry out the polyp), the doses of the drugs must be high.

To treat polyps, hormones are administered once. If necessary, the injection is repeated after a week. In theory, after such treatment, the polyp should atrophy and fall off, which is what most often happens. But even such treatment is not able to prevent the appearance of other polyps, unless steroid sprays are used as a preventive measure (Nasonex, Flixonase, Nasobek, Fluticasone, etc.). Both new and well-known hormonal sprays are great for preventing the growth of benign neoplasms instead of and after surgery to remove nasal polyps.

Injection therapy with hormonal drugs in large doses can scare uninformed patients. But there is no need to be afraid. The polyp is connected to the main tissue by a thin stalk, so the penetration of hormones beyond the neoplasm into the general bloodstream is practically excluded.

For greater effectiveness of drug treatment of polyps, it is additionally recommended to use homeopathic and natural remedies. The herbal preparation "Loromaks" (Altai propolis, green tea, juniper, thuja, Kalanchoe, wild rosemary) has proven itself well. It helps to cleanse the sinuses, relieves swelling, disinfects, and fights pathogens.

Among homeopathic remedies, preference should be given to the drug Teukrium, the indications for use of which include the treatment of polyps. The drug is diluted 1 to 5 and the nasal passages are washed with it. It can also be used undiluted, adding glycerin to the medicine, and lubricating accessible polyps with this mixture.

In case of nasal polyposis, a homeopathic doctor may also prescribe the following medications: Silicea, Calcium carbonicum, Sulphur, Kalium bichromicum. These medications help reduce tissue swelling and inflammation, so they can be used both for prevention and for treating polyps in order to reduce their size. With the doctor's permission, homeopathic remedies can also be used in the postoperative period. After all, they have virtually no side effects and the likelihood of developing allergic reactions is low.

In the absence of purulent processes in the nose and infections in the body, an otolaryngologist may additionally recommend physiotherapeutic treatment: magnetic therapy, warming procedures that help reduce inflammation and inhibit proliferation processes in the tissues of the nasal mucosa.

It should be said that it makes sense to try removing polyps in the nose without surgery at the beginning of the disease, when the growths are still relatively small, and the process is limited to one or two neoplasms. It will be very problematic to remove “clusters of grapes” in this way, and it is also futile. And there is nothing to even talk about growths in the paranasal sinuses. Here, surgery is usually necessary due to the difficulty of penetration of drugs to the location of the polyp.

Removal of polyps in the nose with folk remedies

It would seem that if even a polyp operation does not give a 100% result of getting rid of nasal polyposis forever, then where are folk remedies to cope with the disease? Nevertheless, you can find many recipes with which people try, if not to get rid of polyps, then at least to stop their growth or slightly reduce these unusual neoplasms. Let's consider some of these remedies, perhaps they will help someone to treat polyps without surgery.

Celandine is considered the leader in the treatment of polyposis with folk remedies. The plant is rich in alkaloids, flavonoids, organic acids, saponins, essential oils, due to which it is effective in the fight against polyps. But using the juice of the plant in its pure form is fraught with burns, so preference is given to the infusion of the plant.

For the medicine, you can use both fresh grass and flowers of celandine, and dry raw materials. For half a glass of boiling water, take 1/3 tbsp. dry or fresh grass, and leave for at least 20 minutes. The strained solution is used to soak cotton or gauze swabs, which should be inserted into the nostrils alternately for a quarter of an hour. Before use, the swabs should be squeezed out a little so that the liquid does not flow down the face.

The procedure is recommended to be performed every day for 7-10 days, after which you need to take a week's break. We alternate courses of treatment and breaks for a couple of months. Then a month of rest and repeat everything from the beginning. The total course of treatment can take from 6 to 12 months depending on the stage of the process.

There is no need to think that increasing the number of procedures per day will help get rid of polyps faster. Celandine is an unsafe plant. Its high toxicity can negatively affect the functioning of the body, and the nasal mucosa can be significantly damaged by such treatment.

If prescribed by a doctor, celandine or horsetail juice can be used to cauterize recently appeared small neoplasms. But this must be done with great caution so as not to burn healthy tissue.

But before cauterizing the polyps, it is recommended to thoroughly clean the nasal passages with a solution of table or sea salt, taking 2 tablespoons of salt per glass of warm water, which will help remove not only dust and allergens from the nose, but also infectious agents. Plus, you need to carry out effective anti-inflammatory therapy using herbs.

To relieve inflammation before treatment with celandine or horsetail, you can use decoctions or infusions of herbs such as chamomile, calendula, string, and nettle. Infusions are prepared by taking 1 spoon of crushed plant material (you can use individual herbs or a mixture of them) per glass of boiling water. Infuse the composition for 20 to 40 minutes, then strain and use to soak tampons. Leave the tampons in the nasal passage for 10-15 minutes. The infusion used should be at room temperature.

Nettle does not have pronounced anti-inflammatory properties, but it stimulates the secretion of the nasal glands, which promotes moisturizing and natural cleansing of the nasal mucosa, so it is also recommended to include it in a medicinal herbal collection.

Treatment of nasal polyps can also be carried out using essential oils. Most often, wild rosemary, thuja and sea buckthorn oils are used. They are dripped into each nasal passage 1-2 drops, carrying out the procedure twice a day.

There is a good recipe for treating nasal polyposis based on sea buckthorn oil and fresh St. John's wort. The grass and flowers of the medicinal plant are crushed, pressed with a rolling pin, adding a little water until a thick gruel is obtained, which is then filtered using a bandage folded in four or a not very dense cloth.

Mix sea buckthorn juice and liquid squeezed from St. John's wort pulp in equal parts and stir well. The medicinal composition should be administered into each nostril using a pipette, 3-4 drops twice a day.

It is clear that removing nasal polyps using only vegetable oils and decoctions is impossible. They are used primarily to reduce inflammation and improve the regenerative properties of the mucous membrane, which somewhat facilitates breathing and reduces such manifestations of the disease as nasal congestion and related sleep disorders, appetite and headaches. Oils are useful both for prevention and for treating polyposis as part of complex therapy. In this case, the treatment will be long and may last for a whole year.

Let's look at a few more effective recipes for homemade nasal drops used to treat polyps.

Recipe 1. Drops based on alcohol tincture of white lily.

The tincture can be purchased at a pharmacy or made at home. To do this, 50 g of freshly crushed plant material is poured into a half-liter bottle of vodka or alcohol and infused in a tightly sealed container for 10 days in a dark room. Subsequently, the tincture is filtered and used to prepare the medicine.

The alcohol solution can be used to treat the mucous membrane only in a diluted form. It is dosed and diluted with water in equal proportions immediately before use.

The resulting medicine can be instilled 1-2 drops into the nostril twice a day. But it is better to use it to soak turundas, which are left in the nose for half an hour.

Recipe 2. Drops based on herbal juices.

To obtain juice, each of the herbs is crushed, crushed with a rolling pin, adding a little water, and then filtered through cheesecloth folded in several layers. The juices are mixed in equal quantities.

Use as nasal drops or to soak cotton swabs, which are left in the nasal passages for 40 minutes. Instead of plant juice, you can take infusions (1 tablespoon of raw material per half a glass of boiling water, leave for 30-40 minutes).

Recipe 3. Drops based on mumiyo and glycerin.

For a teaspoon of glycerin, take 2 tablespoons of water and 10 crushed mumiyo tablets. Mix thoroughly until the preparation in the tablets is completely dissolved.

We drip the medicine 1-2 drops three times a day for 2 weeks. We rest for 2 days and repeat the course of treatment.

Recipe 4. Drops on anise alcohol tincture.

For a 100 liter bottle of alcohol, take 1 teaspoon of crushed dry plant material. Put the tincture in a dark place for 1.5 weeks, but do not forget to shake it regularly. After 10 days, filter the composition and use for nasal instillation.

It is clear that we do not use pure tincture, but its aqueous solution, taking 1 part tincture to 3 parts water. We instill the medicine into the nose for 3 weeks in a row, performing the procedure three times a day.

Recipe 5. Tincture of milk nuts on kerosene.

10 milk-ripe nuts should be ground using a meat grinder and poured with 600 g of kerosene. The tincture is placed in a dark place for two weeks, then exposed to light and waited for another 3 weeks and 5 days. In total, the medicine should be infused for 40 days. After straining, it can be used for polyps for external use.

The most convenient way to use the tincture is to soak cotton swabs, which are placed in the nose for 4-5 hours, insulated from the outside with film and warm cloth and applied with a bandage. It turns out to be something like a compress, after removing which the skin will need to be treated with cream for burns and irritations. To avoid the negative impact of the medicine on the skin around the nose, it is recommended to lubricate it with Vaseline in advance.

Compresses are not done daily, but 2 times a week with an interval of 3-4 days. Usually 5-6 such procedures are enough for the polyps to noticeably decrease in size.

This folk recipe is embodied in a pharmaceutical preparation called "Todikamp", the instructions for which state that it has wound-healing, anti-inflammatory, antibacterial, analgesic and other beneficial effects, which has a good effect in the treatment of many diseases, including nasal polyps.

Traditional medicine can also recommend several recipes for solutions for rinsing the nose in case of polyposis.

Composition 1. Based on salt and iodine.

1 teaspoon of salt and 3 drops of iodine are added to 1.5 glasses of warm water and stirred until the salt is completely dissolved. This solution should be drawn into the nostrils one by one. It is not recommended to swallow the liquid.

The procedure is carried out twice a day, after which the polyps can be lubricated with iodine (it will burn!). This treatment should be carried out for three months.

Composition 2. Based on infusions of chamomile and celandine.

And take half a liter of boiling water, 2 spoons of chamomile and celandine herbs and leave to infuse under the lid until the liquid has completely cooled. Inhale the room temperature infusion through each nostril and spit it out.

We carry out the procedure at least 5 times a day for a course of 1.5 weeks. The infusion can also be used to irrigate the nasal mucosa three times a day.

Composition 3. Infusion of horsetail.

2 tablespoons of crushed dry grass are poured with a glass of boiling water, covered with a lid and left for 20 minutes. After that, strain and use for rinsing the nose.

The procedure should be performed frequently (up to 10 times a day) for 3 weeks. The medicinal composition is prepared daily, the remaining part of the infusion is recommended to be drunk in the evening.

During the treatment of polyps, it is necessary to adhere to the principles of healthy eating. It is better to eat food boiled or steamed. Vegetables or porridges cooked in this way can be used as side dishes. The consumption of dairy products should be limited, as well as coffee, beer and alcoholic beverages.

Preference should be given to herbal infusions, teas, compotes, pure water, which are recommended to be drunk an hour before meals. After meals, drinks can be consumed no earlier than an hour later. All these measures are aimed at reducing the secretion of mucus in the nasal passages, which only prevents the reduction of inflammation.

In order to prevent the growth of polyps in the nose, and therefore their removal by any available means, folk healers also recommend paying attention to your diet. Vegetables, fruits, berries should come to the fore. Gooseberries, currants, peanuts, and various types of legumes will be very useful in this regard. They help strengthen the blood vessels of the nose and prevent the appearance of unpleasant neoplasms in it.