Removal of polyps in the nose: laser, endoscopic, radio wave

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

What is polyposis of the nose?

As we know, the entire outer surface of our body is covered with skin. But the cavity inside it as a coating also has some kind of skin - a gentle 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.

Proliferation of cells of glandular tissue is somewhat similar to the situation with cancer. But the rounded outgrowths of various sizes appearing in this case do not have malignant (mutated, malignant) cells, therefore they are considered benign neoplasms.

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

What can cause the appearance of polyps in the nose ? It is clear that the mucous membrane will not behave inadequately from scratch. Proliferation of cells causes a prolonged irritation of the nasal mucosa, which can be caused by:

• bacterial or fungal microflora, causing inflammation of the tissues, especially if the process takes a chronic course,
• frequent colds and rhinitis,
• an allergy accompanied by frequent colds, and sometimes bronchial asthma,
• violation of patency of the nasal passages (for example, in the curvature of the nasal septum) with stagnant phenomena in them.

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

To say that polyposis of the nose is a very frequent disease would be wrong. Such an unenviable fate is only 4% of the population. And women in this plan were luckier, because the polyps in their nose they are almost twice less likely than the stronger sex.

Very often overgrown multiple polyps in the nose are compared to a bunch of grapes by analogy with adenoids. Yes, only from this "grapes" somehow have little pleasure, because the nasal passages are not intended for the cultivation of such vegetation. The diameter of the hole through which the warm, cleaned and moistened air enters the body is a little over 1 cm in size. It is clear that any obstacle inside the nasal passages will make it difficult to pass the air. And the larger the size, the more difficult it is for a person to breathe.

Polyps, although they are painless formations, are a big problem for humans. While the polyp has dimensions described in millimeters, the person with difficulty, but breathes a nose. But the build-up gradually increases in size and grows "neighbors", which, in the end, is fraught with overlapping the passage for air. At the third stage of the pathology, there is nothing left for the person to breathe with the mouth.

Polyps are rather mobile neoplasms, which are rarely attached to the main tissues with a thick base. Usually, these growths are connected to the mucosa by a thin feeding leg 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 be formed? They can be found directly on the nasal mucosa and the trellis labyrinth, as is the case with most adult patients. But in childhood, when the rhinitis becomes a part of the baby's life, and it does not work out normally, it goes to the paranasal sinuses, where later the appearance of benign formations can be expected. In children, polyps are most often formed in the maxillary sinuses, aggravating the process with stagnant phenomena, and as they grow they gradually begin to exit through the mouth into the nasal passages, blocking the movement of air.

Do I need to remove polyps in the nose?

It would seem that the nose is not the only way to get air into the body, so why not breathe with your mouth if you have a nasal breathing disorder associated with the same polyps in the nose? And in parallel, you can treat polyps with medicament and folk remedies.

All would not be so bad if conservative and alternative therapy gave tangible and lasting 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 (some kind of delay). After a time, the growths again begin to increase in size, and removing the polyps in the nose is the only cardinal way to solve the problem.

Is it OK to live with polyps in the nose? You can live, but normally it is unlikely. The fact that the lack of normal nasal breathing has a negative effect on the person's health, and on his performance. Therefore, after suffering for several months, patients still agree that removal of tumors is necessary.

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

Breathing with the mouth has some differences from nasal breathing. Passing through the nasal passages, the air has time to warm up a bit, the ciliated epithelium and hairs inside the nose contribute to the retention of infection and dust coming from the air, and its moistening also occurs in parallel. Thus, air enters the lower respiratory tract, unable to cause irritation or inflammation of their mucosa.

When we inhale the air with the mouth, it in the original state enters the bronchi and lungs. Low ambient temperature (and, accordingly, air) - the basic conditions for reducing immunity and the development of colds. Bacteria, viruses and fungi, penetrating without delay into the bronchi, contribute to inflammatory processes in the respiratory system. And dry air and dust cause irritation of the throat, coughing, allergies.

It turns out that when breathing with 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 represented by polyps in the paranasal sinuses that prevent their natural purification. In the cavities of the paranasal sinuses, mucus and microbes accumulate, causing a chronic purulent-inflammatory process that tends to spread to the brain region. In addition, purulent masses can burst into the blood and cause infection (sepsis) when the blood vessels break.

Another trouble with the polyposis of the nose becomes a deterioration in the perception of odors. A disturbed sense of smell also worsens 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 likely to breathe through his nose, so breathing through the mouth turns out to be inadequate. Lack of oxygen primarily affects the work of the brain. Symptoms of hypoxia of the brain can be considered frequent migraines, sleep disorders, rapid fatigue. As a result, a person's working capacity decreases, and the state leaves much to be desired.

But the polyps themselves are not so harmless growths. They, like other benign tumors, under certain conditions can degenerate into an oncological disease. This happens rarely, but you should not rule out such a possibility.

You can, of course, do nothing, expecting that the polyposis will resolve itself. But statistics show that the probability of such an outcome is extremely small. But the further proliferation of glandular tissue more and more affects the quality of life of patients. They suffer from headaches, shortness of breath, they even have a skull shape due to the constantly open mouth, as in the case with adenoids, irritability arises due to constant lack of sleep, and as a result of oxygen deficiency, the work of various organs is disrupted.

But is it worth it to torment and torment your body if today there are many different methods of removing polyps in the nose. Yes, before the polyps were removed mainly surgically, which was associated with a certain discomfort, pain, bleeding. But to date medicine has reached a new level, and painless removal of polyps in the nose with a minimum of complications has become a reality. It is only necessary to consult a doctor and determine the method of instrumental treatment of polyps.

[1], [2]

Indications for the procedure

Whichever method or method is used to treat nasal polyposis, one must understand that this disease, like many others, requires a serious attitude to itself. If in the case of drug treatment we often act as a doctor to ourselves, than often we only inflict harm on our body, then it will not work so with surgical treatment. You can not remove polyps yourself, and the surgeon can not meet the patient only at his request.

Removal of polyps in the nose is a serious operation, and without special need it will not be done. First, the patient should examine the otolaryngologist, diagnose and evaluate the stage of the development of the process, and then you can already talk about the possibilities of treating polyps.

What symptoms should alert a person and become a reason for visiting a therapist and an ENT? Difficult nasal breathing (the larger the size of the polyps, the heavier it becomes to breathe through the nose), the appearance of regular mucous or purulent discharge from the nose, chronic rhinitis, frequent sneezing episodes without apparent cause, deterioration of smell (in neglected cases, a person generally ceases to distinguish smells) often repeated migraines, change of voice (it becomes nasal).

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

Depending on the prevalence of the process, the stage of the disease and the concomitant pathologies, the doctor makes a decision about conservative or surgical treatment. 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 only if conservative treatment does not give a decent result or there is a relapse of the disease.

Most often, surgery for resection of tumors is prescribed for those who have a nose that completely stops breathing because the polyps cover almost the entire space of nasal passages. Other indications for the operation are:

• the growth of polyps against the background of curvature of the nasal septum,
• development of bronchial asthma and atrophic rhinitis, as complications of polyposis of the nose,
• if a person has had bronchial asthma or an allergy diagnosed earlier, the indication for the operation is an increase in the frequency of attacks of the disease,
• The presence of a chronic cold that is not treated medically,
• the appearance of bloody discharge from the nose,
• an unpleasant odor of secretions, which indicates a purulent process,
• the developing inflammatory process in the sinuses of the nose,
• a critical breach of the sense of smell and taste,
• a strong voice change, the appearance of episodes of snoring, frequent migraines.

In any case, the decision to send to the operation remains with the doctor. But what method will be used to remove polyps in the nose, the patient can choose himself. But it should be borne in mind that any operation can have its own contraindications.

[3], [4]

Preparation

So, surgery to remove polyps in the nose is only after a thorough diagnostic examination and the final diagnosis. In most cases, a preliminary diagnosis can be confirmed by a rhinoscope when the physician can visually assess the presence and size of the polyps. But if the dysplastic process occurs deep in the nasal passages or paranasal sinuses, quantitative and qualitative indices are difficult to quantify. And then a computer tomogram, radiography and an endoscopic examination of the nasal passages and sinuses come to the rescue.

If, after examining the patient and examining the dangerous complaints, the doctor comes to the conclusion that the operation is necessary, he immediately reports his decision to the patient, fully describing the situation and the possible consequences of the lack of effective treatment. But any operation requires some preparation, especially in the case of polyposis of the nose, when surgical intervention is not carried out for urgent reasons.

Delivery of tests before removing polyps in the nose is a routine procedure that allows you to assess the state of human health, the work of vital organs, the likelihood of bleeding. And although the direction of the operation is given by an ENT doctor, it will not be carried out without the therapist's permission.

For 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 give the necessary directions for analysis:

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

If a purulent discharge is detected in the nose, it is a bacterial infection that will need to be treated with antibiotics before the operation. For treatment to be more effective, bacussis can be performed to determine the type of pathogen of inflammation. The same is necessary for a person in case of acute infectious diseases in the body.

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

As preparation for surgery, the patient is prescribed anti-inflammatory drugs and decongestants. The doctor specifies whether the patient is taking anticoagulant medications or other drugs that can reduce blood clotting and increase the risk of bleeding during or after surgery. Reception of such medicines should be stopped in advance, so that subsequently there would be no dangerous complications.

Surgery for resection of 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 in the removal of polyps in the nose can be both local and general, depending on the method of operation and the patient's sensitivity to pain. In most cases, limited to local administration of drugs, although in endoscopic surgery in some cases it is also possible to use general anesthesia (intravenous, and preferably endotracheal anesthesia).

Before the operation, the anesthetist must necessarily inquire about the patient's health, check the tolerability of anesthetics, calculate the minimum effective dose of drugs. And also tell about the conditions of food intake on the eve and on the day of the operation: from the evening a light supper is allowed, on the day of the operation 6 hours before it from food and drinks it will be necessary to refuse, especially in case of general anesthesia.

Technique of the polyp removal in the nose

Like any other operation, the removal of polyps in the nose should be strictly according to a certain pattern, which does not exclude the "creativity" of the surgeon in the event of unforeseen situations. But since there are at least 5 methods of polypectomy, it is not necessary to talk about any general scheme. So, it makes sense to consider each method separately.

Removing polyps with a loop

Let's start with the simple surgical operation for removing polyps in the nose, which, in essence, is usually called ordinary polypectomy. This method removed neoplasms in the form of enlarged adenoids in the throat or polyps in the nose earlier, but it is not forgotten to this day as the cheapest of all operations available in a conventional hospital. Its popularity is due to the fact that for the operation it is not required complicated equipment and mainly local anesthesia is used (irrigation of the nasal cavity with anesthetics plus infiltration anesthesia).

Removal of polyps in the nose is made by a special steel loop (or use the Lange hook), which must be inserted into the nostril, thrown over the growth, lowered to the base of the stem and tightened. Now the surgeon needs to show all his skill to not just cut the polyp in any place, and pull it out with the leg. Alas, this is not always possible, and then relapses of the disease can not be avoided.

Such an operation is prescribed when it is necessary to simultaneously remove several polyps in the nasal passages. But in the event that polyps are formed in the paranasal sinuses and only hang in the nasal passage, the probability of removing them "with the root" is extremely small.

During the operation, the patient sits in a chair. To his chin, put a special container, where the blood will drain after the polyp is removed. It is almost impossible to avoid bleeding during normal polypectomy.

Stop bleeding after removal of polyps is done with the help of tampons (turund), which are protected from sticking with petroleum jelly. A bandage is superimposed on top, which fixes turundas inside the nasal passages.

Usually, the operation takes no more than an hour. But it all depends on the amount of work. If the removal of single polyps is carried out, 20-30 minutes will suffice.

The doctor observes the course of the operation visually with the help of dilators and a flashlight, which is attached to the surgeon's head. In these conditions, and even with bleeding it is very difficult to assess the quality of polyp removal.

This operation is considered not particularly effective. First, not all polyps will be visible with anterior rhinoscopy, so some of the growths can remain and continue to grow, disrupting nasal breathing. Remove the remaining polyps can be a couple of weeks later, but this is an additional trauma to the olfactory organ.

Lack of an opportunity to assess the quality of the operation leads to the fact that later the various shortcomings are found: the polyp is not cut off completely, not all growths in the nasal passages, etc. Have been removed. The probability of recurrence of polyposis with simple removal of the loop is quite high, and reaches 60-70%. And this suggests that after 1-2 years the operation will have to be repeated with the same or another method.

The disadvantages of a simple polypotomy are also:

• high risk of heavy bleeding,
• pain during and after surgery,
• a long duration of the recovery period due to the fact that together with the polyp a small area of a healthy mucosa can break out, which is fraught with relatively large damages of the tissues and the development of the inflammatory process in them, nevertheless on the mucous wounds heal longer than on the skin,
• the lack of the ability to qualitatively remove polyps in the paranasal sinuses.

Polypotomy has several positive aspects, thanks to which a not very effective procedure is being carried out to this day in many hospitals:

• a great experience with old surgeons in removing polyps in the nose with a loop, after all the method has been around for a long time,
• The availability of surgery in many health facilities,
• low price for the operation in medical centers (other methods will be much more expensive, in addition in many ENT departments you can enroll for free polyp removal in the nose by polypotomy).

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

Laser removal

The laser in recent years has been increasingly used in medicine and cosmetology. And this is not surprising, because the removal of various neoplasms by the laser provides for a deeper penetration into the tissue, while the risk of bleeding in this case is quite small.

With the help of the laser, polyps can also be removed in the nose, and this method of polypectomy is considered to be the least traumatic and safest, which makes it possible to use it for the treatment of children and patients suffering from asthma attacks. This technique is still relatively new, but it already shows good results.

Removal of polyps in the nose by a laser specialist can perform even in a procedure room equipped with special instruments (laser equipment and an endoscope attached to the monitor). To do this, do not necessarily go to the hospital. 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 incisions in the tissues, the laser knife is brought directly to the polyp, after which the apparatus is turned on, and the high frequency beam almost burns the polyp. The temperature of heating the tissues of the neoplasm approaches 100 degrees, and the polyp completely dries. His remains can be easily reached with tweezers.

The laser burns out the build-up completely, along with the leg, which significantly reduces the likelihood of relapse. Simultaneously with the removal of the polyp, the laser beam seals the ruptured blood vessels and disinfects the wound, thus avoiding bleeding and developing the infectious process. The absence of severe bleeding allows avoiding the plugging of the nose and a person can normally breathe right after the operation.

Even if the operation is performed in a hospital, it is not necessary for the patient to remain in the hospital. If everything went without complications, the person goes home the same day and goes only for a preventive check-up to the otolaryngologist.

Laser treatment provides for mandatory visual control of the operation, which excludes damage to nearby tissues. This is not a rhinoscopy, but a tracking of the process of removing polyps in the nose with the help of endoscopic equipment, the tube (probe) which is also inserted into the nasal cavity and transfers the image from the microscopic chamber to the computer monitor. Thus, the doctor can 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 frequency of radiation as necessary.

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

Endoscopic removal of polyps

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

What is not available to the loop or laser is quite possible for special surgical instruments that are brought to the site of operation with the help of an endoscope tube, which makes it possible to penetrate deeply into the nose without opening the tissues and perform a full-scale surgical operation there. For example, in violation of patency of the maxillary sinuses and polyposis inside of them before the removal of polyps, expansion of the anus of sinuses and nasal passages is carried out. If there is a curvature of the nasal septum, an operation to restore its shape is carried out in parallel, which serves as a preventive measure for relapses and complications.

Endoscopic surgery, depending on the volume and nature of the work, can be carried out with the help of local or with the assistance of general anesthesia. If we are talking only about the removal of polyps in the nasal passages, then a local injection of anesthetics is sufficient. But when it is required to clean up the labyrinth and paranasal sinuses, and also operation on the nasal septum without general anesthesia it will be difficult to do.

If a polyp is removed in the nose in a child under 7 years of age, preference is given to general anesthesia using the endotracheal system. This will allow the patient to remain immobile and calm during the operation, because the child can twitch, spin, cry, which will negatively affect the result of the intervention.

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

• microsurgical instruments that allow for deep resection of polyps and cleansing of space,
• shaver or microderibe, which operate on the principle of a pump, i.e. Cut off the polyp together with the foot under the root, grind it, suck it inside and out of the nose.

In principle, both methods of removing polyps with the help of endoscopic equipment are highly efficient, but using the shaver is considered the most convenient, therefore such operations are conducted most often.

Endoscopic removal of polyps in the nose by the shiver will be even more effective if it is carried out using video navigation. This will make it possible to assess the state of the paranasal sinuses and labyrinth cells in order to exclude poor-quality removal of polyps.

The operation under the control of the endoscope lasts about an hour. In this case, it is possible to remove both single and multiple neoplasms, carry out correction of defects, penetrate into the most inaccessible places. This is the reason for the great popularity of endoscopic operations in comparison with other methods.

The advantages of endoscopic treatment are:

• the ability to accurately assess the condition of the mucosa and the size of the neoplasms present on it,
• permanent visual comprehensive control of the operation allows you to avoid injuring healthy tissues,
• absence of severe bleeding,
• removal of polyps together with roots (this is especially important for the shaver, which with great accuracy removes anything that touches the build-up without touching the nearby mucous membrane, which gives almost a hundred percent guarantee that the polyps will not form again)
• the removal of polyps is more accurate compared to the usual polypotomy, so the wounds on the mucosa heal faster, and the recovery period after surgery is reduced,
• possibility to perform the procedure under local anesthesia,
• after the removal of polyps, as in the case of laser surgery, scarring is almost non-existent and spikes are rarely formed.

The disadvantages of endoscopic removal of polyps in the nose include:

• the need for a tamponade of the nose within 24 hours after surgery,
• the impossibility of carrying out an operation in the laboratory, nevertheless, various instruments are required for its operation and sterile conditions,

To say that this method of combating polyposis completely excluded the possibility of polyps in the future is impossible. Still, this is a method of struggle not with the cause of the disease, but with the consequence of its development. Something, of course, can be corrected (for example, to normalize the outflow of a secret from the maxillary sinuses or to straighten the nasal septum), but frequent colds and inflammations that are not treated promptly can lead to the fact that a few years later the mucous nasal will again begin to expand. I'm glad that this is possible much later than with other methods of removing polyps in the nose.

[5], [6]

Radio waves from polyps

Surprisingly, radio waves of a certain frequency are also capable of acting as a knife, cutting off polyps under the very ground. In doing so, they are somewhat reminiscent of the action of the laser, since they are capable of sealed vessels, which prevents severe bleeding. But their effect on the polyps still approaches the work of the loop with the usual polypotomy, although it can be carried out under the control of the endoscope.

Radio wave removal of polyps in the nose, like other similar techniques, has its advantages and disadvantages. The main advantage of the method is:

• the possibility of holding in an outpatient setting,
• minimal risk of bleeding and infection of the wound,
• no need to walk with tampons in the nose and undergo a lengthy rehabilitation.

But the method has significant drawbacks:

• insufficient deep removal of polyps, which increases the risk of relapse,
• the impossibility of removing small outgrowths in this way.

Cryotherapy

Removing the polyp in the nose with liquid nitrogen is not one of the popular procedures, although it has many advantages:

• there are no strong bleeding,
• insignificant soreness, which makes it possible to dispense with local anesthesia,
• small risk of infection,
• short postoperative period,
• there is no need to conduct a procedure in the operating room.

Still, 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 apparatus acts on the same principle as the laser. The polyp is not excised, but is susceptible to critical temperatures. But if the laser heats up and drains the pathological growth, then during cryotherapy it freezes and disappears.

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

[7], [8]

What can influence the choice of the method of operation?

As you can see, there are a lot of methods for conducting an operation to remove polyps in the nose. All of them have their pros and cons. The operations differ in their cost. The most budgetary operation is considered polypotomy, and very costly methods can include an endoscopic procedure, which is not surprising, given its effectiveness and a small risk of relapse.

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

But after all, each method of treatment has its own contraindications to the procedure, with which we now get acquainted.

Conventional polypotomy with Lange loop:

• an acute period of any disease, especially an infectious plan,
• diseases of the cardiovascular system,
• hemopoiesis, low blood coagulability
• bronchial asthma because of the high probability of developing asthmatic status.

Laser removal of polyps:

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

Endoscopic removal of polyps in the nose:

• exacerbation of allergic rhinitis,
• chronic bronchitis of an allergic nature in the acute stage,
• bronchial asthma,
• severe cardiovascular pathology (heart failure, cardiac ischemia, post-infarction),
• liver, kidney, respiratory system (especially when using general anesthesia),
• acute infectious diseases
• a mild contraindication can be menstruation.

For the radio wave method, in addition to the above contra-indications, there is another point. Radio waves can adversely affect the operation of electrical appliances, so they are undesirable to use in the treatment of people with metal implants (for example, pacemakers).

Common contraindications for all methods of removal of polyps in the nose are: any malaise, fever or blood pressure jumps, acute infectious processes in the body, intolerance to anesthetics. In principle, the absolute contraindications for the operation is not so much. Usually the procedure is simply transferred to another time, i.e. It is carried out after the achievement of persistent remission of chronic diseases, after childbirth, with the disappearance of symptoms of acute pathologies.

Consequences after the procedure

In our minds, a surgical operation is associated with an operating theater, a scalpel, an artificial ventilation device, a bright light from the ceiling, etc. The procedure for removing polyps does not fit this framework, and in this connection it may not seem so serious. In fact, this is not so. It is not important what method is used to perform the operation, but it is still the same interference in the body's functioning, metabolic processes in its tissues, the work of respiratory organs.

Removal of polyps in the nose is a serious operation, even if it is done in a somewhat unusual way. It is clear that after the operation for a while a person may feel uncomfortable. By the way, many patients speak of the operation as unhelpful but terribly unpleasant, although they agree that life with polyps in the nose is even more terrible.

The expected consequences after the procedure of polypectomy come not immediately. It will take at least 1 or 2 days before the nose starts to breathe normally even after laser removal with a minimal recovery period. The cause of nasal congestion in the first days after surgery is edema of tissues that have undergone mechanical or thermal traumatization. It is clear that after a usual polypotomy swelling and inflammation of the tissues will be the most powerful, which means that breathing will recover at the best after 3-5 days.

Sometimes patients complain that after removing polyps in the nose, the head hurts. This is not surprising, considering that the operation was carried out in the head region, while the nerve endings in the nose were strongly irritated, which subsequently turned into a transistor neurological disorder.

To be afraid of headaches it is not necessary. After all, if with polyposis they only increased with each passing day, now the symptom will gradually weaken, while the mucosa will return to normal. It is clear that headaches can be facilitated by a slight inflammation of the tissues after surgery and the anesthesia used, especially when it comes to general anesthesia.

After a general anesthesia, nausea, single attacks of vomiting, headaches and dizziness are a common condition that usually passes within a day or a little more.

The temperature after removal of polyps in the nose may slightly rise. But usually it fluctuates between 37-37.2, which indicates an inflammatory process due to tissue trauma, and not serious complications. How long this temperature will last depends on the method of operation and the amount of intervention.

If after the removal of polyps, the sense of smell suddenly disappeared, it is also not worth worrying about. So the body reacts to interference in his work. Plus, the mucosal edema does not contribute to the normal functioning of sensitive receptors, which also worsens the perception of odors, and sometimes of taste. Usually after 3-5 days the swelling subsides, and the sense of smell is gradually restored. True, sometimes it takes about one month.

[9], [10]

Complications after the procedure

But what you should really worry about is the appearance of possible complications after the operation to remove the polyps in the nose, although they occur rarely. Some complications are not dangerous and are quickly stopped with improvised drugs and medications, others require more serious treatment.

What kind of troubles can you expect immediately after the procedure or in the distant future? Consider the most common undesirable consequences:

• Even after a successful operation, there may be a certain risk of bleeding from the nose. Especially if the patient has problems with blood coagulability or he takes drugs that reduce the viscosity of this biological fluid (anticoagulants, NSAIDs, some cardiac drugs). As for non-steroidal anti-inflammatory drugs, they are not used in the postoperative period, giving way to corticosteroids.
• In some patients, against the background of the general anesthesia used, short-term disturbances in the functioning of the cardiovascular and respiratory systems can be observed.
• At the site of the inflammatory process, after surgery, a couple of months later, spikes and scar tissue can form, which obstruct nasal breathing and require repeated surgery to excise them. To prevent this complication, intensive anti-inflammatory therapy can.
• If the removal of polyps is poor (some part of the build-up in the area of the leg remained in place), it is more likely that a few weeks later a new, and possibly not a single one, forms on the site of the old polyp. Those. There is always the likelihood of recurrence of the disease, since not one of the methods of removing polyps in the nose does not give a hundred percent guarantee of curing the disease forever, just the risk of re-growth of benign neoplasms is not the same for normal polypotomy or cryotherapy and laser, radio wave or endoscopic surgery.
• The most unpleasant complication, with which it is difficult to fight, is getting the infection into the area of an unhealed wound in the nose. This is possible if you do not comply with the requirements for care of the nasal cavity in the postoperative period or try palpation to feel how the wound healing process is going. It must always be remembered that even on the washed hands can remain conditionally pathogenic microorganisms, which will immediately cause inflammation, they only need to get into suitable conditions, which is the fresh wound.

But wound infection can occur at the time of surgery. It is not necessary to think that the blame for everything will unequivocally be the non-observance of hygiene and disinfection requirements by medical staff. It is likely that the operation was carried out in the acute period of infectious pathology, resulting in the generalization (spread) of the infection through the body through the blood and lymphatic ways, and the weakness was the area of recent surgery.

Than it is dangerous? 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.

[11], [12], [13]

Care after the procedure

In principle, whether there will be complications of removing polyps in the nose, depends not only on the doctor, but also on the patient himself. It is not necessary to think that all treatment is limited to an operation alone, and one can immediately begin to live an ordinary life, especially without caring about its own sense of smell. Even if the patient's state of health is good, this does not mean that you should forget about all the requirements of the rehabilitation period.

The way recovery and rehabilitation takes place quickly after removal of polyps in the nose depends on the ongoing medical and caring procedures in the postoperative period.

For example, after the usual removal of polyps, the Lange loop performs disinfection of the nasal cavity and inserts tampons into the nostrils that must prevent bleeding. They are removed only after a day, after which the mucosa is treated with a synthomycin emulsion.

After the operation, the patient can stay in the hospital for another week, fulfilling all the requirements of doctors for nasal care. After discharge, it may be prescribed to wash the nose with antiseptic solutions. Caution will need to be observed for 2 or even 3 weeks, which are given for the recovery of the nasal mucosa after surgery. Controlling the regeneration process should be the attending physician at the place of residence.

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

The endoscopic removal of polyps and the radio wave method are slightly inferior to the polypathy in terms of the degree of trauma, however, the patient can feel discomfort in the nose and an unpleasant feeling for a few more hours. If there is no bleeding from the nose, the patient can be discharged after 1-3 days, as soon as the turuncas are removed from the nasal passages. But you need to understand that it will take another 2 weeks, until the mucosa completely recovers.

If the operation was performed by the shiver, the length of stay in the hospital can be increased up to 5 days, during which it will be necessary to do the lavage of the nasal passages and use anti-inflammatory drops.

What other measures to prevent relapse are advised to follow doctors in the postoperative period?

• Adhere to a sparing regimen: sports and heavy physical labor are excluded, the patient should rest more and eat fully.
• Try to avoid eating hot food and drinks.
• It is necessary to control blood pressure and take all measures so that it does not rise.
• Long stay in the open sun and in the heat is forbidden. Excluded hikes in the sauna, sauna, solarium, work in a stuffy room.
• You should try not to blow your nose at least for the first 5 days.

All this will avoid such trouble as nosebleeds. But how much care will be needed, the doctor will say in each case.

Warn the infection of the wound from the outside and ease the nasal breathing will help such measures:

• It is necessary to avoid walking along roads and near industrial enterprises and staying in a room with a strong dust content of air.
• Twice a day in the apartment must be done wet cleaning.
• It is necessary to regularly ventilate the room where the patient is after the operation.
• It is recommended to avoid a large number of people and visit patients with infectious diseases.
• Do not put your fingers in the nose, if the treatment procedure does not require it.
• It is necessary to observe the hygiene of the face, nose and hands, especially before the treatment.

But the most important thing is that it will help to cope faster with the disease, avoiding complications, this is discipline and patience. The doctor prescribes medication - you need to drink pills. He says regularly to wash his nose - you need to do this. For its own sake.

Treatment after removal of polyps

What can doctors offer as an anti-relapse therapy after removal of polyps in the nose? In each case, the treatment scheme will differ, because the amount of work during the operation and the degree of tissue damage during it will have a significant impact on the rate of tissue repair. And the ability to regenerate the mucous in each person is individual. Therefore, we are only talking about the possible, and not mandatory, appointments of an otolaryngologist.

So, what types of drugs can be prescribed after removal of polyps from the introduction:

• Anti-inflammatory drugs from the group of glucocorticosteroids. Yes, hormonal drugs are not a gift, not in vain many patients try so hard to avoid their admission. But in this case, hormones are used mainly in the form of nasal sprays and drops: "Fluticasone" with the same active ingredient, and also an analog of the drug called "Avamis", "Forinex" and "Nazonex" based on mometasone, Budesonide, its import analogue "Pulmicort", "Naphthyzin", etc. When topical application of hormones do not enter the blood and do not cause systemic effects, therefore they are considered safe even with a long course of treatment.

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

• Antibiotics can be prescribed both for the prevention of secondary infection, and for its treatment in case of complications. For the treatment can be used systemic drugs of a wide range of action in the form of tablets and injections, which are prescribed individually. But for the prevention of infections within a few days after the operation, it is more appropriate to use anti-inflammatory sprays with antibiotics:

• complex preparation "Polidex" (dexamethasone - anti-inflammatory component, phenylephrine provides vasoconstrictive action, neomycin and polymexin antibiotics),
• "Isofra" (the active substance of Framichetin is an antibiotic-aminoglycoside),
• "Bioparox" (the active substance is the antibiotic fusafungin).

• Antihistamines. The use of drugs for allergies can improve nasal breathing by removing the edema of the mucosa and reducing its sensitivity to irritating factors. Quite often doctors prescribe such systemic preparations: "Loratadin", "Erius", "Suprastin", etc.

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

• Oil droplets with a regenerating effect. They help the wound to tighten more quickly, which is the prevention of adhesions. In this capacity, both specialized preparations, for example "Pinosol", and vegetable oils, in particular sea buckthorn oil, can be used.
• Preparations for washing (sanitation) of nasal passages. Can be used as saline solution, and special sprays or drops based on sea salt: "Humer", "Salin", "Aqua Maris", "Physiomer", etc. They help to clean the surface of mucous from dust, allergens, microbes, inflammatory exudate, mucus. The saline solution of home preparation in the first days after the operation is not recommended.
• Vitamins and drugs-immunomodulators on a plant basis, helping the body to restore its protective functions.

Which types and names of drugs will be included in the treatment regimen is decided by the attending physician, based on the patient's condition after the operation.

Is there an alternative to the operation?

It must be said that doctors are not always in a hurry to send a patient to an operation, realizing that such a treatment alone can not fight the cause of glandular tissue proliferation. Removal of polyps in the nose is a fight against the symptoms of the disease, but not with its origins. This is one of the reasons for prescribing medication after surgery.

But if the operation does not completely solve the problem, perhaps there are other, less traumatic methods for treating polyps? And they are. True, not as effective as polypectomy, but for patients who do not agree or can not go to surgery, and those who have the disease for the time being in embryonic stage, this is a very real solution.

Since the proliferation of the mucous membrane with the formation of polyps is associated with the inflammatory process, the drugs of choice in the treatment of polyposis are corticosteroids. 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 tissue of the tumor, and therefore can not significantly reduce it.

It is possible to fight with polyps medically only by injecting hormones into the interior of the polyp. To do this, use corticosteroids in the form of solutions, for example, "Diprospan". And in order for such treatment to be effective (practically drained polyp), the doses of drugs should be high.

For the treatment of polyps, hormones are administered once. If necessary, repeat the injection a week later. In theory, after such treatment, the polyp must atrophy and fall off, which often happens. But even such treatment is not able to prevent the appearance of other polyps, unless steroid sprays ("Nazonex", "Fliksonase", "Nasobek", "Fluticasone", etc.) are used as prophylaxis. Both new and well-known preparations of hormonal sprays are perfectly suitable for preventing the growth of benign neoplasms instead of and after the operation to remove polyps in the nose.

Injection therapy with hormonal drugs in large doses can scare ignorant patients. But you should not be afraid. The polyp is connected to the main tissue with a thin pedicle, so that the penetration of hormones outside the neoplasm into the total blood flow is virtually impossible.

For greater effectiveness of drug treatment of polyps it is additionally recommended to use homeopathic and natural remedies. Well-established drug on a plant-based basis "Loromax" (Altaic propolis, green tea, juniper, thuja, Kalanchoe, Ledum). It helps cleanse the sinuses of the nose, relieves swelling, disinfects, fights pathogens.

Of homeopathic remedies, preference should be given to the drug Teukrim, in indications for the use of which there is an indication of treatment for polyps. The drug is diluted 1 to 5 and the nasal passages are rinsed. You can also use it in undiluted form, adding glycerin to the medicine, and lubricate this mixture with available polyps.

When polyposis of the nose, the homeopathic doctor can also prescribe the following medicines: Silicea, Calcium carbonum, Sulfur, Kalium bichromicum. These drugs help reduce tissue swelling and inflammation, so they can be used for both prevention and treatment of polyps in order to reduce them in size. With the permission of the doctor, homeopathic remedies can also be used in the postoperative period. Still, they have virtually no side effects and a low probability of developing allergic reactions.

The otolaryngologist, in the absence of suppurative processes and infections in the nose, may recommend an additional physiotherapeutic effect: magnetotherapy, warming up procedures that help reduce inflammation and inhibit proliferative processes in the tissues of the nasal mucosa.

It must be said that the removal of polyps in the nose without surgery makes sense to try at the beginning of the disease, when the growths are still relatively small, and the process is limited to one or two neoplasms. "Bunches of grapes" in this way will be very problematic, and unpromising. And there's nothing to say about build-ups in the paranasal sinuses. There is usually no operation without surgery because of the complexity of the penetration of drugs to the location of the polyp.

Removal of polyps in the nose folk remedies

It would seem that even if the operation on polyps does not give a 100% result of getting rid of the polyposis of the nose forever, then where is there already the folk remedies to cope with the disease. Nevertheless, it is possible to find sets of recipes by which people try, if not to get rid of polyps, then at least to stop their growth or slightly reduce these unusual neoplasms. Consider some of these tools, perhaps someone they will help to treat polyps without surgery.

The leader in the therapy of polyposis folk remedies is celandine. The plant is rich in alkaloids, flavonoids, organic acids, saponins, essential oils, thanks to which its effectiveness in fighting polyps is ensured. But applying plant juice in its pure form is fraught with burns, so the preference is given to the plant.

For the medicine you can use both fresh grass and flowers of celandine, and dry raw materials. Half a cup of a glass of boiling water is taken 1/3 tbsp. Dry whether fresh grass, and insist for at least 20 minutes. The filtered solution is used to impregnate cotton or gauze tampons, which need to be inserted into the nostrils alternately for a quarter of an hour. Before use, tampons need to be squeezed slightly so that liquid does not flow over the face.

The procedure is recommended to be performed every day for 7-10 days, after which it is necessary to make a weekly break. We alternate treatment courses and breaks for a couple of months. Then a month of rest and repeat all over again. The general course of treatment can take from 6 to 12 months depending on the stage of the process.

Do not think that increasing the number of procedures per day will help to get rid of polyps faster. Purity is an unsafe plant. Its high toxicity can adversely affect the work of the body, and even the nasal mucosa from such treatment can suffer significantly.

On the prescription of a doctor, the juice of celandine or horsetail can be used to cauterize recently appeared small tumors. But you need to do this with great care, so that there is no burn of healthy tissue.

But before carrying out moxibustion of polyps, the nasal passages should be thoroughly cleaned with a solution of table salt or sea salt, taking 2 glasses of warm water to a glass of warm water. Salt, which will help remove from the nose not only dust and allergens, but also infectious pathogens. Plus, you need to conduct effective anti-inflammatory therapy using herbs.

Remove the inflammatory process on the eve of treatment celandine or horsetail can be with the help of broths or infusions of herbs such as chamomile, calendula, string, nettle. Infusions are prepared by taking 1 spoon of shredded vegetable raw material (you can use individual herbs or a mixture of them) for a glass of boiling water. Insist the composition from 20 to 40 minutes, after which it is filtered and used for wetting tampons. Tampons are left 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 secretion of the glands of the nose, which contributes to moisturizing and natural cleansing of the nasal mucosa, therefore it is also recommended to include it in the therapeutic plant collection.

Treatment of polyps in the nose  can be carried out with the use of essential oils. Most often, Ledum oil, thuja and sea-buckthorn are used. They drip into each nasal passage of 1-2 drops, carrying out the procedure twice a day.

There is a good prescription for the treatment of polyposis in the nose on the basis of sea buckthorn oil and fresh St. John's wort. Grass and flowers of medicinal plants are crushed, squashed with a rolling pin, adding a little water until a thick slurry is obtained, which is then filtered using a folded four bandage or a not very dense fabric.

Sea-buckthorn juice and liquid, squeezed out of St. John's wort, mixed in equal parts and mix well. The medical composition should be pipetted into each nostril 3-4 drops twice a day.

It is clear that the removal of polyps in the nose only with the help of vegetable oils and broths is impossible. They are used primarily to reduce inflammation and improve the regenerative properties of the mucosa, which somewhat facilitates breathing and reduces such manifestations of the disease as nasal congestion and associated disorders of sleep, appetite and headaches. Useful oils for both prevention and treatment of polyposis as part of complex therapy. In this case, the treatment is long and can be delayed for a whole year.

Let's consider some more effective recipes of self-made drops in a nose, applied for treatment of polyps.

Recipe 1.  Drops on the basis of alcohol tincture of white lily.

Tincture can be purchased at the pharmacy or done by yourself. To do this, 50 g fresh raw vegetable raw material is poured with a half liter bottle of vodka or alcohol and in a tightly closed container is insisted 10 days in a dark room. Subsequently, the tincture is filtered and used to prepare the medicine.

Alcohol solution can be used to treat mucous only in a diluted form. It is dosed diluted with water in equal proportions immediately before use.

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

Recipe 2. Drops on the basis of vegetable grass juices.

To obtain the juice, each of the herbs are ground, pounded with a rolling pin, adding a little water, and then filtered through gauze, folded into several layers. Juices are mixed in equal amounts.

Use in the form of drops in the nose or to impregnate cotton swabs, which are left in the nasal passages for 40 minutes. Instead of plant juice, you can take infusions (1 tablespoon of raw materials for half a cup of boiling water, insist 30-40 minutes).

Recipe 3. Drops based on mummies and glycerin.

On a teaspoon of glycerin take 2 tablespoons of water and 10 crushed tablets mummy. Thoroughly mix until the drug is completely dissolved in tablets.

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 an alcohol tincture of anise.

For 100 liters of a bottle of alcohol, take 1 teaspoon of crushed dry vegetable raw materials. We put the tincture for 1.5 weeks in a dark place, but do not forget to shake it regularly. After a lapse of 10 days, the composition is filtered and used for instillation into the nose.

It is clear that we use not a pure tincture, but its aqueous solution, taking 3 parts of water for 1 part of the tincture. Bury the medicine in the nose 3 weeks in a row, carrying out the procedure three times a day.

Recipe 5.  Tincture of milk nuts on kerosene.

Nuts of milk ripeness in an amount of 10 pieces should be crushed with a meat grinder and pour 600 g of kerosene. For two weeks, the tincture is put in a dark place, then put into the light and wait another 3 weeks and 5 days. The whole medicine should be infused for 40 days. After straining it can be used for polyps for external use.

It is most convenient to use tincture to impregnate cotton swabs, which are laid in the nose for 4-5 hours, warming from the outside with a film and a warm cloth and applying a bandage. It turns out that something like a compress, after removing which the skin will need to be treated with cream from burns and irritations. To avoid the negative effects of the drug on the skin around the nose, it is recommended to lubricate it with petroleum jelly beforehand.

Do compresses are not daily, but 2 times a week with an interval of 3-4 days. Usually, 5-6 such procedures are sufficient to make the polyps noticeably diminish in size.

This folk prescription is embodied in a drugstore called "Todikamp", in the instruction to which it says that it has wound-healing, anti-inflammatory, antibacterial, analgesic and other beneficial effects, which has a good effect in treating many diseases, including polyps in the nose.

Traditional medicine can also advise several recipes of solutions for washing the nose with polyposis.

Composition 1. Based on salt and iodine.

1 tsp salt and 3 drops of iodine are added to 1.5 glasses of warm water and stir until the salt dissolves completely. This solution must be drawn into the nostrils in turn. Swallow liquid is not recommended.

The procedure is carried out 2 times a day, after which the polyps can be lubricated with iodine (it will burn!). Such treatment should be carried out within three months.

Composition 2. Based on infusions of chamomile and celandine.

A half a liter of boiling water take 2 spoons of chamomile grass and celandine and leave to be infused under the lid until the liquid completely cools. The infusion of room temperature draws in each nostril and spits out.

We perform the procedure at least 5 times a day at a course of 1.5 weeks. Infusion can also be used for irrigation of the nasal mucosa three times a day.

Composition 3. Infusion of horsetail in the field.

Crushed dry grass in an amount of 2 tbsp. Pour a glass of boiling water, cover with a lid and leave for 20 minutes. After that, strain and use to wash the nose.

The procedure should be carried out frequently (up to 10 times a day) for 3 weeks. Therapeutic composition is prepared daily, the remaining part of the evening is recommended to drink.

During the treatment of polyps, one must adhere to the principles of healthy nutrition. It is better to eat food in cooked form or steamed. As side dishes, you can take the vegetables or porridges cooked in this way. The use of dairy products should be limited, as well as coffee, beer and spirits.

Preference should be given to herbal infusions, teas, compotes, clean water, which are recommended to drink an hour before meals. After a meal, drinks can be consumed in less than an hour. All these measures are aimed at reducing the release 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 hence their removal by any available means, folk healers also recommend paying attention to their food. On the foreground should come out vegetables, fruits, berries. Very useful in this regard will be gooseberries, currants, peanuts, various types of legumes. They help strengthen the vessels of the nose and prevent the appearance of unpleasant tumors in it.