How long does surgery take to remove nasal polyps? Endoscopic removal of nasal polyps with a shaver and other methods

These are benign formations from the mucous membrane that gradually grow, making it difficult nasal breathing. They form both in the nasal cavity and in the paranasal sinuses. Upon closer examination, they look like outgrowths in the form of peas or a bunch of grapes of a grayish-pearl color. Can be either single or multiple. Depending on the location, there are choanal polyps, which close the entrance to the nasopharynx from the side of the nasal cavity, and polyps located directly in the nasal cavity and paranasal sinuses. Basically, polyps grow from cells of the ethmoidal labyrinth, which are located in the upper parts of the nasal cavity.

Polypous rhinosinusitis (PRS) is a fairly common disease. According to world literature, its prevalence in the population ranges from 1 to 4%; according to European data (EPOS), it affects from 1 to 6% of the population. In Russia, according to some authors, up to 5 million people suffer from PRS and there is a tendency for the number of detected cases to increase annually.

The main reasons for the formation of polyps

The development of the polyposis process occurs with concomitant diseases:

• Bronchial asthma. This disease has an “aspirin triad of symptoms”:
  • bronchial asthma
  • intolerance to non-steroidal anti-inflammatory drugs.
• Cystic fibrosis and Kartagener's syndrome. As these diseases progress, the movement of cilia located on the apical surface of mucosal cells slows down. This changes the constant flow of mucus in the nose, causing stagnation and chronic inflammation of the mucous membrane, changing its structure and the formation of polyps.
• Chronic, bacterial and fungal rhinosinusitis. According to research, when fungal infection in 85% of cases polyps are formed.
• Disturbed structure of the nasal cavity. With a deviated septum, chronic vasomotor or hypertrophic rhinitis, the patient's nasal breathing is incorrect: that is, something blocks the path of the air flow, and it changes its direction. There is a constant mechanical load on areas of the mucous membrane, chronic inflammation occurs, and polyps form.

Stages of development of the polyposis process

Stage	Stage I	Stage II	Stage III
Size	Covers only the upper part of the nasal septum.	Closes the common nasal passage to the lower border of the middle turbinate.	Covers the entire space.
Complaints and signs	The patient is concerned about a decrease in sense of smell or loss of it. Polyps do not interfere with breathing and are discovered by chance.	Polyps are visible during endoscopy or rhinoscopy. The patient is worried minor violation breathing through the nose, mucous discharge from the nose.	The patient stops breathing normally, vasoconstrictor drops do not help him, and a nasal sound develops.

Symptoms of polyp formation

The most obvious symptoms:

• difficulty in nasal breathing;
• Nasal discharge is mostly mucous and thick. If there is interaction with an infectious agent and we're talking about about purulent polypous rhinosinusitis, then purulent discharge also occurs;
• headache;
• fatigue;
• decreased performance;
• sleep disturbance, snoring;
• sneezing and itchy nose.

Methods for diagnosing nasal polyps

Diagnosis begins with an examination by a doctor, followed by video endoscopy. An endoscope allows you to visualize much more than is possible with a conventional illuminator. There are also X-ray methods Research: computed tomography, magnetic resonance imaging. They help to see polyps in the nasal cavity and paranasal sinuses.

Features of treatment in children

Polyps are more common in adults than in children. But in childhood, as with any chronic pathology, doctors show a minimum of radicalism regarding treatment, surgical treatment stands in the background. And if it is still required surgery, then it will be minimally invasive. If the child is under 15 years of age and polypotomy is indicated for him, it will be gentle - with a laser, radio waves, endoscope or shaver, without opening the paranasal sinuses.

Children are treated conservatively, in addition to the prescription of local and generic drugs includes rinsing the nasal cavity using the moving method. During the rinsing process, allergens and bacteria from the nasal cavity and paranasal sinuses are washed away, and inflammation is reduced.

Conservative treatment of nasal polyposis

First place in conservative treatment occupy hormonal drugs: local - topical steroids, and systemic. Systemic hormonal drugs are used mainly in patients with bronchial asthma moderate and severe course. They reduce the intensity and frequency of asthma symptoms, and also counteract the growth of polyposis tissue. Conservative treatment includes mast cell membrane stabilizers and antihistamines. If the polyposis is of an allergic nature or if we are talking about a purulent polyposis process, then antibacterial medications are used. In the case of a fungal process, antifungal agents are prescribed.

Conservative treatment methods are indicated for patients with initial and second stages of polyposis or if there are contraindications to surgical treatment. In addition, after surgery, in order to prevent relapse, it is necessary to conduct periodic courses of conservative therapy.

When the disease occurs in children, conservative treatment takes precedence over other methods.

Surgical treatment of polyposis

Polypotomy is an operation to remove polyps, which can be supplemented by surgery on the paranasal sinuses, depending on the indications.

The volume of intervention depends on the localization and extent of the process. If polyposis develops only in the nasal cavity, polypotomy is sufficient. But if the localization is also in the paranasal sinuses, then in such cases we are talking about extended surgical intervention - it is necessary to remove polyps from the paranasal sinuses, which increases the volume of the operation. Such a surgical intervention will be called polysinsotomy together with polypotomy. During the operation, the surgeon under endoscope control will be produced:

• removal of polyps;
• expansion of the anastomosis of the paranasal sinuses;
• deleting content;
• opening the cells of the ethmoidal labyrinth.

Contraindications to polyp removal

• pregnancy;
• severe general somatic condition of the patient;
• bleeding risks leading to excessive blood loss (coagulopathy).

Polyp removal methods

Removal of a polyp with a loop

The operation is performed under local anesthesia. The main tool is a metal Lange loop, adjustable in width. First it's done local anesthesia, then the loop is put on the polyp and cuts it off at the base of the stalk.

A significant drawback of the operation is that the polyp is not completely removed, which causes high probability relapse. Also, during this operation, bleeding is possible, and the surgical intervention itself is not painless: when the doctor inserts a loop into the nasal cavity and puts it on the polyp, the loop touches the other walls and septum of the nose. This may be quite sensitive for the patient, despite the effect of local anesthesia.

However, surgery with a Lange loop also has advantages. It can be performed under local anesthesia; the operation is inexpensive for both the patient and the clinic - hence the prevalence of this method in public healthcare structures.

Radio wave method for removing nasal polyps

This method of surgical intervention is close to removal with a Lange loop. But, despite the similarity of methods, radio wave removal polyps in the nasal cavity has a greater advantage: at the moment of cutting the polyp, the radio wave immediately coagulates the polypous tissue and reduces the risk of bleeding to zero. Also, the advantages of this operation include the ability to carry it out in outpatient setting and avoid inserting nasal packings into the nasal cavity after surgery.

The disadvantage of removing polyps with radio waves is the risk of relapse - the polyp is also cut off at the base. Radio wave polypotomy involves the removal of only large and medium-sized polyps.

Laser removal

Laser polypotomy involves surgery under endoscope control. The operation is performed on an outpatient basis and, most often, under local anesthesia. This is the optimal method for removing polyps in children.

Under the control of an endoscope, a laser knife is brought to the place where it is necessary to remove the polyp. Then, under the influence of a heating beam, it evaporates and decreases in size.

The advantages of this method are speed, efficiency and accuracy of execution. Laser polypotomy has a minimum of contraindications and is available to almost everyone.

Difficulties may arise if there are many polyps and they vary in shape and size. In this case, it will be difficult to remove them all. Another disadvantage is that the effect of laser polypotomy is limited to the nasal cavity. That is, if the formations are located in the paranasal sinuses, they are not removed with this method.

All methods are performed without interventions on the paranasal sinuses and their anastomoses, but can be supplemented with endoscopic polysinusotomy.

Removal of nasal polyps using a shaver (endoscopic method)

Endoscopic method - latest technology. Endoscopy is performed under general anesthesia and, in addition to thoroughly removing polyps, makes it possible to open all the cells and sinuses of the nose from where they grow, prolonging remission for years. Before the operation, the patient undergoes a computed tomography scan in order to accurately determine the localization of the process. Careful removal of polypous tissue from the paranasal sinuses using the endoscopic method, supplemented by polysinusotomy, is a significant advantage over other methods. It allows you to extend the period of remission for years or even for life.

During endoscopy, shaver polypotomy is used. A shaver or in other words a microdebrider is a tool that has a cutting and suction function. When removed, it cuts the polyp tissue and sucks it in at the same time. This operation is much faster, since there is no need to evacuate the removed tissue from the nasal cavity. Shaver polypotomy allows you to remove the source of polyp formation. The endoscopic method is the least traumatic for the patient and the most convenient for the surgeon.

Comparative characteristics of methods for removing nasal polyps

	Removal of a polyp with a loop	Radio wave method	Laser removal method	Endoscopic removal method
What is used	Metal Lange loop	Surgitron device (with a radio wave polyp loop or knife attachment) Video endoscope	Laser radiation Video endoscope	Microdebrider (a tool with a blade at the end) Video endoscope
Anesthesia	Local anesthesia	children under 7 years old - general anesthesia children aged 7 years and older - local anesthesia; if the process is widespread, it can be performed under general anesthesia.	children under 7 years old - general anesthesia children aged 7 years and older - local anesthesia; if the process is widespread, it can be performed under general anesthesia.	children under 7 years old - general anesthesia children aged 7 years and older - local anesthesia; if the process is widespread, it can be performed under general anesthesia; for interventions on the paranasal sinuses - only under general anesthesia.
Advantages	Common and affordable	No bleeding, the ability to perform surgery on an outpatient basis	High speed, minimal contraindications	Removal of the focus of polyp growth, prolongation of remission, high speed of execution.
Flaws	The likelihood of relapse, bleeding and discomfort.	Probability of relapse, removal of only large and medium-sized polyps	If there are many polyps and they differ in size, removal will be difficult. It is carried out only in the nasal cavity.	No

Local anesthesia

In children over 7 years of age and adults, polypotomy can be performed under local anesthesia. Before the operation, the child is given a sedative intramuscularly. An anesthetic solution (10% lidocaine solution), vasoconstrictors to relieve swelling from the mucous membrane and better review. Afterwards, a less concentrated anesthetic solution (2% lidocaine or ultracaine) is injected into the mucous membrane of the nasal cavity to enhance the analgesic effect. During the operation, the patient is conscious and perceives everything around him. Local anesthesia is indicated only in the case of surgical interventions limited to the nasal cavity - polypotomy.

General anesthesia (anesthesia)

In children under 7 years of age, polypotomy is performed under general anesthesia, so the intervention takes place without pain and, which is especially important for the child, without psychological stress. The clinic uses drugs of a high safety class, they are non-toxic and do not cause complications, so anesthesia is easily tolerated even in childhood and feels similar to normal sleep. Also, under anesthesia, endoscopic polysinsotomy (FESS) and polypotomy, in case of a large volume of intervention, are performed in children and adults. The type of anesthesia is selected by the operating physician together with the anesthesiologist according to indications.

Doctors anesthesiologists

They work in the clinic experienced anesthesiologists, specialists from children's clinical hospital them. N.F. Filatov, who have academic degrees of candidates and doctors of medical sciences. Our specialists use an anesthetic apparatus from the German company Drager, medicines latest generation. All this allows the removal to be carried out in a manner that is safe for the patient’s health. general anesthesia(anesthesia) with fast recovery in the postoperative period.

Anesthetics

Anesthesiologists use the drugs Sevoran, Diprivan, Esmeron, Enfluron, Isoflurane, Dormicum and others. The choice of a specific drug is at the discretion of the anesthesiologist and depends on each specific case, test results and other factors.

Selection of removal method and anesthesia

The choice of polyp removal method depends on the indications and contraindications. Before surgery is scheduled, the patient undergoes an examination and computed tomography. Next, the doctor carefully examines the location of the process. If it is limited to the nasal cavity and the cells of the ethmoid labyrinth, polypotomy is prescribed under local anesthesia, along with hormonal drugs necessary for remission. If the process is in all paranasal sinuses, a polysinusotomy is performed under general anesthesia.

If there are contraindications to anesthesia, the scope of the operation is reduced. Surgical intervention will be aimed only at removing polyps from the nasal cavity and improving nasal breathing.

Contraindications may be:

• pregnancy;
• severe chronic (congenital or acquired) somatic diseases.

The decision to perform an operation under anesthesia is made after a thorough examination of the patient together with the therapist and anesthesiologist.

The operation time is related to the extent of the process. If this is a single polyp, then under local anesthesia the operation will take no more than 15 minutes, and if the polypous process is localized not only in the nasal cavity, but also in the paranasal sinuses, the duration of the operation can be one hour or more.

Our clinic uses the best methods of surgical interventions for nasal polyposis and polyposis rhinosinusitis:

• radio wave polypotomy
• laser polypotomy
• endoscopic shaver polypotomy (using a microdebrider), if necessary, supplemented by interventions on the paranasal sinuses and their anastomoses (polysinusotomy, FESS-functional endoscopic sinus surgery).

The clinic employs otorhinolaryngologists who are proficient in all surgical techniques. The volume of surgical intervention and the method of anesthesia are selected by the doctor after examining and thoroughly examining the patient.

Rehabilitation after polypotomy

The postoperative period depends on the extent of surgical intervention performed on the patient. If a polysinusotomy was performed, the patient's nasal cavity is tamponed to avoid postoperative nosebleeds. In the case of endoscopic shaver or laser polypotomy without opening the sinuses, tampons are not needed.

Rehabilitation takes up to one week for any type of intervention.

With minimally invasive interventions, this period is reduced to 2-3 days, until the reaction converges postoperative edema mucous membrane. After surgery, it is recommended to limit physical activity for 2-3 weeks.

After surgery, topical steroids are prescribed to prevent the regrowth of polypous tissue. Patients with polypous rhinosinusitis should undergo a course of topical steroids several times a year.

Complications due to untimely treatment of polyps

Firstly, complications are possible with bronchial asthma. If polyposis actively develops and polyps grow, attacks of bronchial asthma become more frequent and are much more difficult to tolerate. Secondly, this is a violation of nasal breathing, which has a bad effect on the entire body. Lack of oxygen leads to the development chronic diseases. In this case, a person will quickly develop problems with the heart and lungs. Also, lack of oxygen leads to chronic fatigue and developmental delay (if the patient is a child).

Polyps contribute chronic inflammation in the nasal cavity, rapid penetration of infection into the lower respiratory tract, and even a common cold can cause complications for a person with polyposis.

Very rarely, it is possible for polyps to degenerate into malignant formations. But in addition, there are diseases, such as inverted papilloma or other neoplasms of the paranasal sinuses, the symptoms of which pass under the guise of a polyposis process, carrying a significant threat.

Prevention of polyposis process

Most the best prevention is timely consultation with a doctor and comprehensive treatment of diseases that contribute to possible emergence polyps. If a person experiences the slightest disturbance in nasal breathing, this should be a signal to action. Any disturbance in the structure of the nasal cavity and disruption of the air flow in it can contribute to the development of polypous rhinosinusitis. People with bronchial asthma should visit an ENT doctor at least once a year and undergo endoscopic examination and, if necessary, do a computed tomography scan of the sinuses.

Cost of nasal polyp removal

The cost of removing nasal polyps in our clinic using local anesthesia is from 18,000 rub. toRUB 35,000 depending on the degree of complexity of the operation.

Removal of nasal polyps under general anesthesia costs fromRUR 70,000. The final cost of the operation can be determined by the doctor, having assessed the amount of work and taking into account the peculiarities of the course of the polyposis process in the patient.

Consultation 980p .

Removal of nasal polyps (nasal passages) using the Surgitron radio wave method 3800p .

4300p .

Polypotomy unilateral nose 1st category of complexity 6300p .

(1448) Removal of nasal polyps with laser, category 1. complexity 11000p.

(1448) Removal of nasal polyps with laser, category 2. complexity 20000p.

Removal of nasal polyps

Not only children, but also adults often put off visiting an otolaryngologist due to fear of surgery to remove nasal polyps. This often happens due to a basic lack of information about how to treat nasal polyps.

At the BIOSS clinic, a radio wave treatment method using the Surgitron apparatus is used to remove nasal polyps. The operation to remove nasal polyps is performed under local anesthesia under endoscope control. The otolaryngologist does not make any cuts or punctures, making the method virtually bloodless and low-traumatic for the patient.

The working head of the device is inserted into the thickness of the polyp, the polyp tissue is evaporated using a radio wave, and the remaining wrinkled membrane is then easily removed from the nasal cavity. This method is used if it is necessary to remove small nasal polyps that cover the anastomosis. In the presence of multiple polyps large size polysinusotomy is used - an endoscopic surgical operation.

During the operation, the doctor rinses the paranasal sinuses to prevent recurrence of nasal polyps. Thanks to the “breathable” gauze tampons used, our patients do not experience discomfort when breathing through their nose; the tampons are removed after a few days, and the rehabilitation period proceeds faster and easier compared to standard surgical treatment.

After removal of nasal polyps, the BIOSS otolaryngologist prescribes antibiotic therapy to prevent possible infectious complications. The operation without incisions, punctures and pain is the most modern method of treating nasal polyps. Come to us for health and free breathing!

Diagnosis of nasal polyps

Diagnosing nasal polyps is not difficult for an experienced otolaryngologist: polyps are easily detected using standard radiography or CT (computed tomography) of the paranasal sinuses. During the study, the doctor assesses the extent of the process and the volume upcoming operation. The diagnosis of nasal polyps is confirmed after posterior rhinoscopy - instrumental research and palpation of the nasopharynx.

Treatment of nasal polyps, according to indications, can be either conservative or surgical. In the event that conservative therapy, immunocorrection and prevention of ENT diseases turned out to be ineffective, the otolaryngologist will recommend surgical treatment of nasal polyps. Generally accepted indications for the removal of nasal polyps are severe deterioration in nasal breathing and purulent-inflammatory processes in the paranasal sinuses.

How to recognize nasal polyps. Symptoms of nasal polyps

• Nasal congestion, difficulty breathing through the nose
• Runny nose, nasal discharge
• Itching in the nose and the desire to sneeze.
• Feelings of fullness in the sinuses and maxillary cavities (with polyps in the sinuses).
• Frequent inflammation of the pharyngeal and palatine tonsils
• Relapses (exacerbations) of existing chronic diseases of the upper respiratory tract- tonsillitis, sore throat, sinusitis, etc.
• Inflammatory diseases of the middle ear (otitis)
• Loss of smell
• Night snoring.
• Frequent headache (as a symptom - heavy morning awakening and a feeling of weakness)
• Nasal voice (in the case of a running process)
• Fatigue, headache

Polyposis is a growth glandular tissue in the nose and paranasal sinuses under the influence of histamines and other inflammatory mediators. Surgery to remove polyps is necessary to normalize nasal breathing, reduce the risk of respiratory diseases and eliminate deformities of the nasal septum caused by polyposis.

If the patient complains of difficulty breathing, altered sense of smell and copious discharge Traditional diagnostics are carried out from the nose. First, the doctor uses a light, then an endoscope, which allows you to assess the condition of the nasal sinuses.

In addition, X-ray methods can be used: computed tomography or magnetic resonance imaging. In such cases, the doctor calls special attention to the paranasal sinuses. Depending on the degree of polyposis and the patient’s condition, a decision is made on treatment methods.

Indications for removal

In some cases, doctors prescribe conservative drug treatment, including a course of various anti-inflammatory, immunomodulatory and other drugs.

However, there are serious indications for surgery to remove polyps:

• large or multiple polyps that are not amenable to conservative treatment;
• curvature of the nasal septum due to tissue proliferation;
• the occurrence of a number of other side effects pathological conditions due to polyposis.

One type of surgery to remove nasal polyps is recommended by the doctor, taking into account the patient’s condition. There are loop, cryogenic, laser removal techniques, as well as using a shaver and radio waves.

General contraindications

There are contraindications to surgery to remove polyps. Local ones are limited to inflammatory processes in the nose of various etiologies (rhinitis, sinusitis, etc.).

System:

• serious blood diseases (leukemia, hemophilia, thrombocytopenic purpura);
• cardiovascular diseases (ischemia, collapse, hypertension);
• bronchial asthma in the acute period.

Anesthesia

Removal of nasal polyps using radio waves, laser or shaver in children under 7 years of age is performed under general anesthesia. Such anesthesia is used for a significant number of formations. In other cases, local anesthesia is used. Before surgery, a sedative is administered intramuscularly.

Then a 10% solution of lidocaine and vasoconstrictors are sprayed or applied into the nasal cavity to prevent swelling and improve visibility. After this, a 2% anesthetic drug (this can be lidocaine or ultracaine) is injected into the intervention area.

During removal, the patient is fully aware of what is happening. Local anesthesia is only relevant for removing formations within the nasal cavity.

Loop polypectomy

An operation to remove nasal polyps, in which the doctor uses a so-called Lenge hook, which is essentially a cutting loop, is called a loop polyectomy. The removal mechanism is as follows: the doctor inserts an instrument into the nostril, wraps a loop around the polyp and tightens the loop, cutting off the polyp.

In this way, the patient can be relieved of several growths in one session. For a single polyp, the duration of the operation is from 45 minutes to an hour. The cutting loop is used to remove polyps that have grown from the ethmoidal labyrinth. Before starting the process, 2 ml of a 1% novocaine solution is injected into the mucous membrane in the immediate vicinity of the polyp.

At the end of the operation, the mucous membrane is disinfected, and tampons soaked in Vaseline are secured using a cape-like bandage. The patient is under inpatient observation for approximately a week. During this time, the tampons are removed, synthomycin ointment is applied, and rinsing is performed if necessary. The entire recovery period usually takes 10-20 days.

The main disadvantage of the method is the probability of relapse is up to 70%. In this case, it will be necessary to repeat the procedure after 6-12 months.

Radio wave surgery

Surgery to remove nasal polyps using radio waves is offered as a bloodless alternative to traditional removal of growths. This operation can be performed on an outpatient basis without the use of tampons.

However, in this case there is also a high risk reoccurrence formations. In addition, the radio wave method is used only for medium and large polyps, usually single ones.

After removing nasal polyps using the radio wave method, you need to follow a number of rules that will help the body recover faster after surgery:

• avoid strenuous physical activity;
• minimize contact with people suffering from ARVI, influenza or other airborne infections;
• adhere to a diet excluding spicy, fried, salty foods;
• refrain from hot food (to prevent bleeding).

Complications after loop and radio wave removal

Even experienced doctors are not always able to perform an operation without subsequent complications.

They might look like this:

• Slight bleeding appears from the nose due to damage to the capillaries and their slow recovery.
• Often, 2-3 months after surgery, the patient develops adhesions. In this case, the patient usually complains of renewed problems with nasal breathing. The only solution to the problem is cutting the adhesions under local anesthesia and subsequent hospital observation.
• Recurrence of growths. Most often, this is caused by insufficiently high-quality removal of formations or their presence in the paranasal sinuses.
• Inflammatory process due to bacterial infection. Rare case when at the time of surgery the patient has in the sinuses or nasal passages acute phase an infectious process developed.
• Low-grade fever is considered almost the norm after this type of surgery.
• Often, headaches occur against the background of fever. Usually patients complain about it for no more than 5 days.
• Edema and a weak sense of smell or its absence are also frequent companions of the postoperative period. Usually these symptoms go away within 3-4 days.

Endoscopic surgery

This type of surgery is usually performed under local anesthesia and includes two types: laser removal and shaver removal. In both cases, an endoscope with a camera is inserted into the nostril, which transmits the image to the monitor.

This technique allows you to examine in detail all the details of the formations and remove them without damaging healthy tissue. In addition, using an endoscope, it is possible, if desired, to correct the structure of the nose, for example, to save the patient from a displacement of the nasal septum caused by polyposis.

After such an operation, the patient will not have scars or cicatrices, only unpleasant sensations that soon pass. For the first 2-3 days, bloody or mucous discharge may be observed. The patient is observed in the hospital only for the first day; after 3 days he can begin work.

Contraindications

Endoscopic intervention is postponed during exacerbation of bronchial asthma or chronic bronchitis, as well as during the flowering of plants that provoke allergic rhinitis. Women should plan surgery so that it does not fall during their period.

Shaver removal

This is a convenient and popular way to remove growths. The operation is performed using endoscopy. The doctor, using a special attachment, examines the affected area, precisely cuts off the detected polyp, and then crushes it there and sucks it out.

The advantages of the method are its high precision, the ability to perform an inspection of the paranasal sinuses, and extremely low morbidity. The operation time varies from 45 minutes to 1 hour depending on the severity of the disease.

At the end of the operation, tampons are placed in the nose, which are removed after a day. Usually the patient is under inpatient observation for 2-3 days. If the degree of polyposis is small, he can be sent home immediately after the intervention. The functions of glandular tissue and olfactory abilities are gradually restored over about a month.

If there are many polyps and if they are large, special preparation will be required. This is largely due to the need to use general anesthesia in such cases. The patient gives general analysis blood, biochemical and clotting.

It is also necessary to do a computed tomography scan and conduct a thorough endoscopic examination, the results of which will clarify the expected duration of the operation, the duration of hospital observation and subsequent prognosis.

7 days before the intervention, the patient takes 40 mg of Prednisolone daily. If surgery needs to be performed urgently, despite an acute infectious and inflammatory process in the nose and sinuses, the symptoms are eliminated with the help of antibacterial therapy. For this, drugs are usually used local action.

In addition, a week before surgery, it is necessary to stop taking Aspirin, anti-inflammatory drugs and vitamin E, since these substances have a strong effect on blood clotting. Subsequently, it is not recommended to use them for some time after the operation.

As for food, the last meal before surgery may take place the day before surgery. This should be a light dinner. No food or drink is allowed on the day of the intervention. To relieve thirst, you can suck on ice or rinse your mouth with water.

During the entire postoperative period it is prohibited:

• mechanically remove crusts from the nose (picking with fingers or other objects). Washing is suggested as an alternative. saline solutions;
• blow your nose intensely and forcefully;
• consume hot food or drinks;
• the same applies to a hot bath, sauna, inhalations. All this provokes excessive blood flow and can cause bleeding;
• experience significant physical activity;
• drink alcohol, because it dilates blood vessels.

Complications after surgery

Despite careful adherence to supportive measures, any patient may experience unpleasant complications:

• heavy bleeding;
• inflammatory process due to rhinitis or rhinosinusitis;
• tissue scarring and adhesions;
• recurrence of new polyps. With this method, the probability of recurrent polyposis is 50%. At the same time, the interval between the occurrence of formations can be from 4 to 7 years.

Laser surgery

Laser removal of nasal polyps is recognized as the most advanced method. A doctor may perform the surgery on an outpatient basis using an endoscope and local anesthesia. Most often, this method is used to get rid of growths in children.

The laser blade literally evaporates the polyp using a heating beam. It gradually decreases and disappears. Healthy tissues are not harmed and there is no bleeding. Laser surgery has a minimum of contraindications and can be performed at any age.

It is the fastest (no more than 20 minutes), accurate and efficient. During the operation, the laser “seals” the blood vessels, which greatly reduces the risk of infection in the postoperative period. In this regard, tampons are not placed in the nose.

However, it also has its shortcomings. The laser is not used if there are several polyps, especially if they differ in size. Also, laser surgery can only be performed within the nasal cavity.

Cryosurgical removal

If the laser affects the polyp through elevated temperatures, then the cryosurgical method is often called freezing. Few people choose it. It, like the laser, is one of the most non-traumatic types of removal of formations, both on the mucous membranes and on the skin.

The doctor directs the jet liquid nitrogen on the area of ​​the polyp, the fluid in its tissues is frozen, the cells are destroyed, and the polyp ceases to receive nutrition through the bloodstream. The duration of freezing is usually 30 seconds, then the doctor pauses and repeats the cauterization until the polyp tissue is sufficiently destroyed.

The procedure is performed under local anesthesia with 2% solutions administered by injection. In some cases, applicative application of more saturated solutions(up to 10%). After several days, the growth deprived of nutrition falls off. If it does not exfoliate, repeated surgery is necessary. This is possible only after 3 weeks.

For successful rehabilitation, the patient must follow a few simple rules:

• wear a sterile bandage that will protect the nose from dust and pathogens getting on the mucous membranes;
• Take systemic antibiotics as prescribed by your doctor. In this case, consultation is necessary to get rid of the consequences of such prevention (for example, dysbacteriosis, disorders of mucous microflora);
• use anti-inflammatory drugs in the form of tablets and sprays;
• use painkillers if necessary.

Medications after surgery

An operation to remove nasal polyps involves the use after the operation of a number of drugs that restore the body and preventing the development of relapse:

Price

The cheapest option is to use polyp removal services using a cutting loop. This method is usually practiced in demons paid clinics. If you contact a paid institution, the cost of the procedure will be approximately 2000 rubles.

The price for endoscopic removal varies from 15 to 30 thousand rubles. The cost of the operation is affected by the status of the clinic, the location and number of polyps, and the duration of the required hospital treatment. Laser removal costs 8-10 thousand rubles.

The operation, which takes place under general anesthesia, is not affordable for everyone, as it costs about 70 thousand rubles. In addition, the cost of the operation may vary depending on the region of residence.

Modern medicine offers operations to remove nasal polyps, performed using different methods. In the conservative treatment of polyposis, maintaining and activating the immune system plays a significant role.

The same can be said about the postoperative period. Regardless of the type of surgery you choose, following the recommendations for the postoperative period will reduce the risk of relapse and reduce the likelihood of complications.

Video about surgery to remove nasal polyps

Getting rid of nasal polyps:

Removing nasal polyps without surgery:

Nasal polyps are benign growths
which look like small rounded formations and are formed as a result of prolonged irritation of the nasal mucosa and paranasal sinuses.

The presence of nasal polyps leads to the development of a number of undesirable symptoms, which can only be eliminated through surgery.

Removal of polyps in the sinuses. Indications for surgery

Before performing surgical intervention in connection with polypous neoplasms of the nasal cavity, it is necessary to determine whether there are indications for their removal. There are absolute and relative indications for surgical removal of nasal polyps.

If you don’t want to go under the surgeon’s knife, then read about modern treatment nasal polyps.

Absolute indications for surgery to remove nasal polyps:

• Complete absence of nasal breathing.
• Increased frequency of bronchial asthma attacks.
• Anosmia (complete lack of smell function).
• Addition of symptoms of inflammation of the paranasal sinuses.
• Frequent nasal discharge with an unpleasant odor and blood.
• Development of deformation of the nasal septum.
• Chronic course of purulent-inflammatory processes of the nose and paranasal sinuses.

Relative indications for surgery:

• The appearance of snoring.
• Change in voice (drooling).
• Hyposmia.
• Periodic occurrence of headache and dizziness.
• Sensation of a foreign body in the nose.

Contraindications to surgical intervention

The presence of polypous tumors in the nose is not in all cases an indication for their removal during surgery. There are local and systemic contraindications to polyp removal.

Systemic contraindications to surgery to remove polypous tumors:

• An attack of bronchial asthma.
• Blood diseases such as hemophilia, acute leukemia, thrombocytopenic purpura.
• Decompensated cardiac conditions vascular system(myocardial infarction, coronary heart disease, hypertensive crisis, collapse, etc.).

Local contraindications for surgery:

• Acute diseases of the nose and paranasal sinuses (acute rhinitis, acute sinusitis).
• Allergic rhinitis.

If you have a history of oncological pathology of the nasal cavity, you should consult with an oncologist before surgery.

There are a large number different methods surgical removal polyps. Today, surgery to remove nasal polyps is performed under general anesthesia. The essence of surgical intervention comes down to excision of pathological neoplasms. Polypotomy (surgery to remove polyps) is performed with the patient in a sitting position.

Technique for performing surgery to remove nasal polyps:

1. First of all, anterior and posterior rhinoscopy should be performed using nasal speculum.
2. Sanitate the nasal cavity and paranasal sinuses using a hypertonic solution or the pharmacological agent Humer.
3. Dry the nasal cavity using a cotton swab.
4. Lubricate the nasal mucosa twice successively with a 10% dicaine solution to reduce its sensitivity during surgical excision of tumors.
5. Find out the location of the polyp stalks, their number and size.
6. Insert the loop of the loop into the nose under visual control.
7. Inspect the nasal cavity using a loop tap.
8. Place the loop around the polyp or group of polyps (if they are small).
9. Move the loop up to the head of the polyp.
10. After you feel the hard consistency of the polyp head, tighten the loop.
11. Remove the loop with polypous masses from the nasal cavity and place it in a special tray.

Especially important!

An important criterion to prevent recurrence is the removal of the polyp along with the stalk. Therefore, you should carefully tighten the loop so as not to cut off the head of the polyp, but to pull the polyp along with the stem from the nasal cavity.

Modern methods of surgery to remove polyps help avoid the formation of scars and adhesions in the nasal cavity. In addition to conventional polypotomy, there are the following methods for eliminating polyposis:

• Endoscopic surgery. Endoscopic removal is one of the most precise methods removal. The operation is performed using a special medical endoscope with a camera. This allows you to achieve complete removal even the smallest formations without damaging the surrounding structures of the nasal cavity.
• Removal using a shaver (microdebrider). The essence of this technique is to crush the tumors and absorb them. The operation is low-traumatic and is performed under the control of a screen monitor.
• Laser removal of polyps. Under the influence of laser beams, the tumor disappears. Advantage this method is an additional coagulation of blood vessels and an obstacle to the spread of infection to surrounding structures.
• Removal with Lange hook. Using a Lange hook, it is possible to remove not only nasal polyps, but also polyps localized in the choanae area.

With all this, there are methods for removing polyps without surgery!

Methods for removing nasal polyps:

In the vast majority of cases, the postoperative period proceeds without significant complications.

In particular cases, postoperative symptoms include:

• Development of minor bleeding. This symptom develops as a result of damage to the vessels of the nasal cavity.
• Formation of adhesions and adhesions after surgery in the nasal passages. This symptom develops 2-3 months after surgery. Patients again complain of difficulty in nasal breathing. This symptomatology requires surgical dissection of newly formed adhesions.
• Recurrence of the disease. The development of relapses is possible if the polyps are incompletely removed or the doctor removed only the head of the polyp.
• Addition of infectious complications. Infectious complications occur if the operation is performed in acute period diseases of the nose or paranasal sinuses. Infectious agents can spread hematogenously or lymphogenously and lead to systemic manifestations infectious disease.
• Headaches. Headaches are transient symptom, which disappears after 3-5 days. The temperature after removal of nasal polyps remains at 37.
• Difficulty in nasal breathing and loss of sense of smell as a result of the development of edema. This symptom is a physiological reaction to surgery. Normal recovery of respiratory and olfactory function nose infection occurs 3-5 days after surgery.

More modern methods surgical influence prevents the development of postoperative symptoms.

Correct patient tactics in the postoperative period will help avoid relapses of the disease and the development of multiple dangerous complications(recurrence of the disease, bleeding, etc.).

1. In the first days after surgery to remove polyps, you should take antibacterial drugs (Ceftriaxone, Suprax). These pharmacological drugs will help avoid the development of complications of an inflammatory nature. Antibiotics should be taken for 3-5 days of the postoperative period.
2. Also, after surgery, otolaryngologists recommend instilling oil-based drops (Pinosol, sea buckthorn oil) into the nasal cavity, as they promote faster healing of the postoperative wound and prevent the formation of adhesions and adhesions in the nasal passage.
3. The next step after surgery is regular sanitation of the nasal cavity using saline or the pharmacological agent Humer. Sanitation should be carried out from 5 to 14 days after surgery.
4. In the first days of the postoperative period, topical steroids (Nasonex) are recommended. These medications do not cause side effects on other organs and systems and at the same time prevent the development of relapses of the disease.

When treating after removal of nasal polyps, it is recommended to use 30% propolis ointment. Swabs are wetted and placed in the nose. Duration of the procedure: 2 weeks

Propolis ointment after removal of nasal polyps

Rehabilitation after removal of nasal polyps does not require long-term measures. In order to avoid complications after surgery, you should follow the doctor’s instructions for five days:

• Follow a gentle regimen.
• Do not consume hot food or drinks. Hot drinks and food lead to dilation of blood vessels and provoke the development of bleeding.
• Do not lift heavy objects. Increased systemic blood pressure is also a risk factor for bleeding.
• Avoid prolonged exposure to the sun.
• Not located in a dusty room.
• Do wet cleaning in the house twice a day
• Provide timely ventilation in the apartment.
• Do not contact with infectious patients

Increasing the general resistance of the body and the positive psychological attitude of patients will also help to avoid complications in the postoperative period.

Removal of nasal polyps video:

Polyps are outgrowths of the mucous membrane due to excessive proliferation of its glandular tissue. Polyps can form anywhere in the body where there is mucous membrane. The nasal cavity is no exception. It is believed that about 4% of the population have nasal polyps.

The causes of polyps are different, mainly:

• Violation of the aerodynamics of the nasal cavity.
• Chronic inflammatory process in paranasal sinuses.
• Allergy, in this case polyposis is usually combined with bronchial asthma.

Polyps can form both from the mucous membrane of the nasal cavity itself, and (more often) from the mucous membrane of the paranasal sinuses. In this case, polyps that arise in the nasal sinuses “fall out” through the anastomosis into the nasal cavity and continue to increase in size and block the nasal passages. In children, antrochoanal polyps (originating from the maxillary sinus) are more common; in adults, ethmoidal polyps (growing from the cells of the ethmoidal labyrinth) are more common.

Polyps in the sinuses are usually multiple, and in appearance they resemble a bunch of grapes. With excessive growth, they come out of the sinus anastomoses and are located in the nasal cavity.

Why do you need to remove polyps?

IN initial stage They try to treat polyps conservatively, but usually these measures have no effect. Sooner or later they still have to be removed surgically.

Polyp removal is one of those operations that many patients themselves ask doctors to do. Mainly because impaired nasal breathing greatly disrupts normal life. A person cannot breathe through his nose, this makes him feel not very good, it prevents him from working, and no one relieves him from work.

1. The main problem that polyps cause is difficulty in nasal breathing. That is, when they grow, they mechanically block the nasal passages, air cannot freely pass into the nasopharynx. Vasoconstrictor drops in in this case will be ineffective. The patient breathes through his mouth, which is not physiological and even unpleasant.
2. The second problem that often accompanies patients with polyps is a violation of the sense of smell. Polyps cover the mucous membrane of the olfactory zone. Lack of sensitivity to smells greatly reduces the quality of life.
3. By blocking the natural communications of the paranasal sinuses with the nasal cavity, polyps lead to disruption of the cleansing of the sinuses from mucus and microbes, which causes a chronic inflammatory process in the sinuses. And that's already enough serious complication. So, purulent sinusitis may lead to severe consequences up to meningoencephalitis and sepsis.
4. If a person breathes not through the nose, but through the mouth, then the air is not warmed, not purified and not properly moistened. All this increases the risk of developing pharyngitis, tonsillitis, laryngitis, bronchitis, pneumonia and bronchial asthma.
5. Inadequate nasal breathing leads to some hypoxia of the brain, as a result of which a person experiences frequent headaches, poor sleep, fatigue, and impaired performance.

Who is indicated for polyp removal?

Intervention indicated to the following groups patients:

• Patients with complete nasal congestion.
• Combination of polyposis with a deviated nasal septum.
• A combination of polyps with chronic rhinitis, chronic sinusitis, not amenable to conservative treatment.

Preparing for surgery

During the first examination, the ENT doctor performs a rhinoscopy at the appointment. Polyps are usually clearly visible during rhinoscopy.

However, to clarify their number, size, degree of damage to the nasal mucosa and sinuses, clarifying examinations are usually prescribed:

1. X-ray of the paranasal sinuses.
2. Computed tomography of the sinuses.
3. Video endoscopic examination of the nasal cavity and sinuses.

When the indications and scope of the operation are determined, it is necessary to choose the appropriate time and prepare for it. Thus, for purulent rhinitis or rhinosinusitis, it is necessary to undergo a course of antibacterial therapy based on the results of bacterial culture of purulent discharge.

Operation is not prescribed:

• During the flowering season, when the flow intensifies allergic rhinitis and asthma.
• For acute infectious diseases
• Decompensated course of chronic diseases of the heart, liver, kidneys.
• Blood clotting disorders.
• During pregnancy.

2 weeks before surgery you must undergo:

1. General blood and urine tests.
2. Coagulogram.
3. Biochemical analysis.
4. Electrocardiography.
5. Chest X-ray.
6. Blood for markers of viral hepatitis, syphilis, HIV.
7. Examination by a therapist.

A few days before surgery, medications that prevent blood clotting (aspirin, warfarin) are discontinued. Decongestant and anti-inflammatory drugs (ketotifen, dexamethasone) are prescribed.

Types of operations to remove nasal polyps

To date, the following types of interventions are carried out:

• Ordinary polypotomy. The oldest, most traumatic, but also the cheapest operation.
• Endoscopic removal of polyps.
• Removal of polyps with laser.
• Radio wave polypotomy.

It must be said that nasal polypotomy is very often combined with other operations:

1. With drainage of the paranasal sinus with chronic sinusitis, ethmoiditis, sphenoiditis.
2. With correction of deviated nasal septum.
3. With resection of the nasal concha (conchotomy).

Conventional polypotomy

Removal of polyps is carried out with a special polyp loop: the loop is thrown over the polyp and gradually tightened at its base, pulled out and torn off. The art of the surgeon should be not to cut the polyp with a loop, but rather to pull it out with the stem (“with the root”). The risk of relapse with such correct removal is much less.

The operation is usually performed under local infiltration anesthesia novocaine, lidocaine or ultracaine. Additionally, the anesthetic is applied as an application to the nasal mucosa (together with vasoconstrictor drugs).

The patient's position is sitting, with a tray placed under the chin to allow the blood to flow out. The duration of the operation is 40-60 minutes.

Usually all polyps visible during anterior rhinoscopy are removed. Those polyps that were not noticed during the first operation are removed after 1-2 weeks.

After removing one or more polyps, the nasal cavity is packed with turundas lubricated with Vaseline and a sling-shaped bandage is applied.

The next day, the turundas are removed, the nasal cavity is washed with antiseptics and salt solutions. After 3-5 days at favorable course the patient is discharged from the hospital.

Disadvantages of the method:

• The operation is the most traumatic and is always accompanied by bleeding of varying degrees.
• Longest recovery period.
• This method can remove polyps only growing in the nasal cavity. That is, if a polyp grows from the sinus, it is impossible to completely remove it to the base.
• This method is most often accompanied by relapses (up to 70%). That is, polyps grow again within a year.

The advantages of the method include its accessibility and low cost, since in this case expensive equipment is not required.

Endoscopic surgery

Endoscopic surgery of the nasal cavity and paranasal sinuses is increasingly gaining a niche surgical treatment this area. Using a microendoscope, you can perform almost all operations in the nose, including the removal of polyps.

The endoscope displays a multiply magnified image on the monitor screen. This allows the surgeon to carry out manipulations with maximum precision both in the nasal cavity and in the cavities of the paranasal sinuses.

Endoscopic removal of polyps can be performed under local or general anesthesia. The choice of anesthesia depends both on the volume and expected duration of the operation, age (children under 7 years of age are given general anesthesia), and on the preferences of the patient.

Endoscopic removal of polyps can be done in three ways:

1. Polypotomy with microinstruments without shaver.
2. Removal of polyps using a shaver (microderiber).
3. Shaver removal with navigation.

removal of polyps with a shaver

Removing polyps with a shaver is the most convenient method of this type of operation. A shaver is a special tool that has a tip with a set of various cutting attachments and suction. The use of a shaver allows you to very accurately, within healthy tissues, with minimal trauma, remove all polyps both in the nose and sinuses.

The shaver is brought to the polyp, cuts it off along with the stalk, crushes it and sucks it out.

The use of video navigation allows for an inspection of the paranasal sinuses and removal of all polyps in them (mainly in the cells of the ethmoid labyrinth).

The whole procedure lasts 50-60 minutes. After the operation, the nasal cavity is packed for a day. The duration of inpatient treatment is 2-3 days. Sometimes the patient can be sent home immediately.

Video: endoscopic shaver removal of nasal polyps

After polypotomy

Typically, the patient remains in the hospital for several days for observation. A day later, the turunda is removed, the nasal cavity is washed with antiseptics and lubricated with syntomycin ointment or petroleum jelly to soften the crusts. For the same purpose, irrigation of the nasal cavity with saline solutions or the use of oil drops (Pinosol, sea buckthorn oil) is used.

Antibiotics are prescribed to prevent infectious complications. A week after removal of polyps, the use of anti-inflammatory and antiallergic drugs (Nasonex spray) is recommended.

In the postoperative period you cannot:

• Picking scabs in the nose.
• Blow your nose hard.
• Eat hot food.
• Accept hot bath or shower.
• Lift weights.
• Drink alcohol.

According to patient reviews, nasal breathing is restored within a few days, and the sense of smell is restored within a month.

Complications that may occur after polypectomy:

1. Bleeding.
2. Inflammation – rhinitis, rhinosinusitis.
3. Formation of adhesions.
4. Recurrence of polyps (unfortunately, recurrence of polyps is the main problem even in endoscopic surgery; the recurrence rate is about 50%).

Removal of polyps with laser

Laser removal of polyps is perhaps the most safe method polypectomy. Removal of polyps with a laser can be performed on an outpatient basis, under local anesthesia.

It is often used to remove polyps in children and people with chronic diseases.

The essence of the operation is that the polyp tissue is simply “evaporated” under the influence of high-precision laser energy. The operation is performed under the control of an endoscope. The procedure is quick, takes no more than 15-20 minutes. In this case, no bleeding is observed, since the laser seals the vessels. The risk of infection is also minimal. No nasal packing is required.

However, the use of laser polypotomy is limited: this method can only remove single polyps, and only those located in the nasal cavity. For multiple polyps and polyposis of the paranasal sinuses laser treatment will not solve the problem.

Radio wave polypotomy

It is carried out with the Surgitron apparatus using a radio wave loop. The operation is also almost bloodless and can be performed on an outpatient basis. Used to remove only large and medium-sized polyps.

Key Findings

Let's summarize:

• Surgical treatment of polyps is a thankless task. None of the operations to remove nasal polyps guarantees their regrowth.
• The lowest percentage of relapses results from complete endoscopic removal of polyps in the nasal cavity and paranasal sinuses. When deleting using this method, the deadline is up to re-education polyps stretch up to 5-6 years.
• If the patient has the opportunity to choose, then he needs to choose a clinic with modern video endoscopic equipment and sufficient experience in performing such operations. Of all the methods, the most effective is shaver removal of polyps with navigation.
• It is advisable to simultaneously eliminate all defects that may contribute to the re-formation of polyps (correct a crooked nasal septum, resect a hypertrophied turbinate).
• After removal of polyps, it is necessary to follow all recommendations, as well as use drugs that inhibit the growth of polypous tissue (mainly topical hormonal drugs), undergo examination and treatment by an allergist.

Cost of operations to remove polyps

The most budget option is polypotomy in the usual way using a polyp loop. It can be performed free of charge in any ENT department. In paid clinics it costs from 2000 rubles (on the one hand).

Endoscopic removal of polyps will cost from 15 to 35 thousand rubles (depending on the scope of the operation, the rank of the clinic, and the duration of hospital treatment). An operation under general anesthesia will cost up to 70 thousand rubles.

Laser removal of a polyp will cost approximately 8-10 thousand rubles.

Video: removal of nasal polyps in the Health program

Nasal polyps are growths of epithelial tissue in the mucous membrane of the labyrinth or maxillary sinus. Some ENT specialists classify them as benign tumors. Others prefer to treat polyps separately because their structure is more consistent with unchanged, normal tissue.

The average prevalence of the disease in the world is 1-4%. It does not belong to the category of dangerous, but is recurrent: in 70% of cases, polyps appear again after removal.

Reasons for the formation of polyps

Nasal polyps (official medical name diseases - polypous rhinosinusitis) can have completely different etiologies. However, such a remark can be made in relation to most tumors and similar growths. Among the most common reasons are the following:

• Allergy and accompanying symptoms (runny nose, sneezing, cough).
• Chronic infectious diseases associated with the nose or paranasal sinuses (sinusitis, rhinitis).
• Some physiological conditions accompanied by hormonal changes (pregnancy).
• Deviated nasal septum, nasal injuries.
• One of the latest theories expressed in the domestic literature is a violation of arachidonic acid metabolism. Note. This compound is involved in the formation of substances that transmit signals between nerve cells. The products of arachidonic acid, prostaglandins, are particularly responsible for regulating the inflammatory process.
• Cysts in the nasal cavity and sinuses. They are small fluid-filled formations.
• Hereditary diseases leading to disruption of the normal functioning of the mucous membrane (for example, cystic fibrosis).
• Taking medications or products with aspirin if you are intolerant to it.

Development of the disease

Despite the heterogeneity of the causes of polyps, the disease develops according to one pattern. The mucous membrane of the paranasal sinuses or ethmoid labyrinth has to function for a long time in conditions increased activity. This is necessary to cope with allergies, inflammation or other unfavorable factors. At first it performs this task, but gradually the reserves dry up, and the effect of the factor does not stop.

Then the body tries to compensate for the insufficient efficiency of the mucous membrane by increasing its area. The tissue begins to grow and a polyp forms. At first it is localized in the organ in which it was formed, but gradually, as its size increases, it begins to hang into the nasal cavity. There it interferes with breathing, making it seriously difficult over time.

The formed polyp looks like this: it is a mushroom-shaped formation on a stalk, which hangs into the nasal cavity with its wide part. The color of the polyp can vary from pearlescent to red depending on how well the blood supply is developed. It is characterized by moderate growth, spherical or cylindrical shape.

The polyp does not affect tissues other than the mucous membrane and does not pose a serious danger to the body.

Symptoms of polypous rhinosinusitis

The main symptom of the disease is nasal congestion. It doesn't go away after taking it vasoconstrictor drugs, gets worse over time. Patients may also complain of:

1. Sinusitis. Inflammation of the paranasal sinuses is often the cause or concomitant disease polypous rhinosinusitis.
2. Rhinitis. Runny nose (allergic or other) often provokes hypertrophic development of the mucosa.
3. Decreased or loss of sense of smell. Due to changes in the size of the mucous membrane, sensitive areas cease to function properly; they become smaller relative to the total surface of the nasal cavity.
4. Headache. Impaired nasal breathing often results in problems with the regular supply of oxygen to the brain. Periodic hypoxia can cause migraines.
5. Voice disorder. Because of constant congestion nasal passages the patient is forced to nasal when talking.

Diagnostics

As a rule, polyps are easily detected during rhinoscopy. An important task of a specialist is differential diagnosis from benign, malignant tumors and other diseases. To do this, conducting research:

• Computed tomography of the nasal sinuses. It is usually carried out before surgery in order to accurately identify the location of the polyp.
• Biopsy. A piece of tissue constituting a polyp is subjected to a comprehensive examination, its structure, size and shape of cells are studied under a microscope.
• Serological study. It allows, in the absence of certain antibodies in the blood, to exclude scleroma, tuberculosis, syphilis, and leprosy. These diseases sometimes produce similar tissue lumps (granulomas) that can be mistaken for polyps.

Diagnosis can be somewhat difficult in children, especially in younger age, when they cannot talk about their problems on their own. Parents should take their child to the doctor if:

1. He is suffering persistent runny nose, which either subsides or resumes again.
2. The child's nose is stuffy and he breathes mainly through his mouth.
3. The baby periodically rubs his nose, showing obvious discomfort.
4. Along with the symptoms described above, the child’s appetite changed and he became moody and irritable.

Treatment of polyps and prevention of relapses

In treating the disease, the doctor should set the following goals:

• Eliminating the cause of the disease when it is identified.
• Restoring normal nasal breathing.
• Polyp removal.
• Prevention of the emergence of new formations.

Important! Combined measures of drug treatment of polyps (conservative therapy) and surgery are currently recognized as the most effective. Exclusive surgical intervention does not make it possible to achieve stable remission (recovery).

Conservative treatment

The main medications taken are steroids. Along with them, antibiotics and antiseptic drugs, general stimulants and immunomodulators. In therapeutic practice, intranasal topical steroid sprays are usually used:

1. Beclomethasone. The drug acts as an anti-inflammatory and antiallergic agent. It inhibits the functioning of certain parts of the immune system, so long-term use can lead to infection of the nasal cavity (most often by fungi of the genus Candida). In this case, do not stop taking it, but combine beclomethasone with antimicrobials. The drug can also affect the adrenal glands, slowing down the growth of the body in childhood. For this reason, it is contraindicated for use under 12 years of age.
2. Mometasone. The drug reduces inflammation, relieves swelling, itching, and fluid accumulation in the nasal cavity. Mometasone reduces the production of arachidonic acid, which presumably may be involved in the formation of polyps. With long-term use, monitoring of adrenal function is necessary.
3. Fluticasone. The drug belongs to the synthetic corticosteroids. Its use in the form of an intranasal spray is permitted from the age of 4. Some of the common side effects from the use of the drug include: nosebleeds; feeling of dryness, unpleasant odor or taste; headache.

The effects of immunomodulatory drugs are currently being studied, but work last decades show their unambiguous effectiveness. They make it possible to treat diseases by influencing the mechanism of its development.

However, the results strongly depend on the method of administration of the drugs (preferably local). They are often used along with surgery. Candidate of Medical Sciences Samolazova S.G. describes the results of using these drugs for polyps (2003): “Local immunocorrection with cycloferon and subsequent surgical treatment lead to an improvement in immunogram parameters ... and an increase in the speed of mucociliary transport.”

Also noted positive action recombinant human interferon 2a. This drug affects cells at the genetic level, preventing their proliferation (excessive growth and reproduction). Research has shown ( Miroshnenko A.P., 2004), that “recombinant a2 interferon is advisable to use in addition to the traditional treatment of polyposis rhinosinusitis.”

Surgical removal of polyps

It is worth noting that getting rid of a polyp without surgery is quite difficult; usually, conservative treatment is stopped only if there are serious contraindications to surgical intervention (asthma during an exacerbation, bleeding disorders, etc.).

There are three main surgical methods:

• Laser removal.
• Endoscopic polypectomy.
• Removal using a Lange loop.

The laser is considered the least traumatic, but it is used only for single polyps. The operation lasts 15-20 minutes and is usually performed under local anesthesia. During the procedure, a device that emits laser beams is inserted into the nasal cavity. They cause coagulation of polyp cell proteins. As a result, they die off. As such, no wound is formed during the process, which minimizes the risk of infection and subsequent complications. Scars also do not appear at the site of the former polyp.

Due to the limitations of the method, endoscopic polypectomy is much more often performed. It allows you to remove any growth even in hard to reach places body. The operation is performed under general anesthesia and carries a slight risk of bleeding. The big advantage of polypectomy is the low risk of relapse. New polyps usually appear no earlier than 5-6 years after surgery.

The doctor observes the entire space in an enlarged form on the monitor screen, which allows him to act with great precision. The actual removal is carried out using a special device - a rhinoscopic shaver. It resembles a pistol in appearance, but instead of a barrel it contains a hollow tube with cutting attachments of different sizes. Depending on the volume of the polyp, the doctor chooses one or another knife. During the operation, the cutting attachments rotate, and at the same time, excess tissue is captured. Shaver removal is an excellent alternative to conventional surgery because... the device acts precisely, leaving the healthy mucous membrane untouched.

Video: removal of nasal polyps, endoscopic surgery

The last method, polypotomy using a loop, is the oldest, “classical” method of getting rid of growths in the nasal cavity. The operation is performed under general anesthesia and can last up to 1 hour. Important! Its main disadvantage is the high relapse rate. After a few months, polyps appear again. This is due to the fact that the surgeon only removes visible part neoplasms, while the growth of a polyp from the sinuses or mucous membrane of the ethmoid labyrinth begins. The advantages of the operation are its accessibility, the possibility of performing it without a highly qualified doctor or special expensive equipment.

Treatment of polyps using traditional medicine methods

At the moment, there is no encouraging data on the possibility of getting rid of the disease on your own. Although homeopathy alternative medicine offers a large number of methods, treatment at home most likely will not bring the desired recovery. However folk remedies the fight against nasal polyps can be considered as maintenance therapy, which will alleviate the patient’s condition before a medical examination or surgery.

For such purposes you can use:

1. Celandine juice, diluted with water 1:2. It is recommended to instill it into the nose for 10 days. You must first make sure that you do not have an allergic reaction to the plant. The solution can also be placed into the nasal passages by moistening a cotton swab with it.
2. St. John's wort juice mixed with sea buckthorn juice. This product is used for long-term use. Homeopaths advise using it for instillation for at least 1 year. The main thing is to monitor the freshness of the solution. It must be stored in the refrigerator, but no more than 10-14 days.
3. Thuja oil. It can be used ready-made or used as part of the same name homeopathic medicine. The oil is sold in specialized pharmacies or can be ordered from people practicing alternative methods of treatment.

Video: treatment of nasal polyps with traditional methods

Nasal hygiene

During illness and as part of its prevention, it is necessary to perform certain hygiene procedures:

• Frequently moisten the nasal cavity.
• Rinse the nose with sea water or iodine-saline solution.
• Inhalation of herbal decoctions with anti-inflammatory properties: chamomile, calendula, sage, etc.
• Wetting the nasal mucosa with Vaseline, almond, and peach oil.

It is also advisable to protect the patient from the effects of additional damaging factors:

1. Smoke from a fire or tobacco smoke;
2. Inhalation of poisons, including insecticides for private use;
3. Dust;
4. Aroma and pollen of flowering plants.

A big plus will be avoiding food allergens that can aggravate the situation: coffee, chocolate, citrus fruits, spicy, salty or smoked foods.

Important! Cure polyps with surgery or by taking steroid drugs it won't work. These methods are purely symptomatic. They are necessary because there is no other way to get rid of polyps. However, to prevent relapses, it is important to identify the causes of tumors and eliminate them.

Polypotomy is a manipulation that allows you to get rid of polyps, restore normal nasal breathing, and also get rid of associated unpleasant symptoms(loss of smell, hearing, sleep, etc.)

Contraindications:

• bronchial asthma;
• poor blood clotting;
• cardiovascular diseases.

Equipment used:

• polyp loops for the nasal cavity;
• radio wave loop for removing nasal polyps;
• rhinoshaver (microdebrider).

Polyps are formations that arise in the paranasal sinuses and descend into the nasal cavity, interfering with normal air circulation and full breathing. Outwardly, they look like small bunches of grapes. When they grow, they not only make breathing difficult, but can cause unpleasant symptoms that cause discomfort and interfere with normal life: loss of smell, hearing, and sleep. People go to the clinic for the removal of nasal polyps only when signs of the disease appear, such as:

• difficult to breathe through the nose; vasoconstrictor drops do not make life easier, and you have to breathe through your mouth;
• due to poor air circulation in the nasal cavity, pathogenic microflora develops, causing frequent viral diseases, accumulation of mucus and pus;
• the patient has the feeling that there is a presence in the nose foreign body;
• frequent headaches.

How to delete?

There are three methods of getting rid of polyps: laser removal of nasal polyps, removal under the control of an endoscope and a loop. The operation itself is called polypotomy.

1. Laser removal is the most delicate and safe method. It is performed under local anesthesia and lasts about 20 minutes. Suitable for those patients who cannot undergo general anesthesia and for children. The only disadvantage of the procedure is that only single polyps can be removed using this method; it is not possible to remove them inside the sinuses. The price for laser removal of nasal polyps in Moscow clinics depends directly on the degree of polyp growth and pricing policy clinics.
2. Using an endoscope, you can see polyps in the most inaccessible corners, including in the sinuses. Moreover, the risk of recurrence of polyposis is sharply reduced. The image from the endoscope camera is displayed on the monitor, and it becomes possible to see the number of polyps and their size. The operation is performed both under local anesthesia and general anesthesia.
3. If the formations are large, they need to be removed with a loop. The loop can be tearing and cutting. The first is used when endoscopic polypotomy is performed for the first time, the second - for repeated surgery. You can use the loop of the Surgitron device - this is a more gentle method. First, local anesthesia is performed with a lidocaine solution, then an injection with an anesthetic. The whole procedure lasts about an hour. Using this method, you can get rid of multiple tumors, but only those located in the nasal cavity. The method is contraindicated in patients with bronchial asthma, poor blood clotting and cardiovascular diseases. An unpleasant consequence of the operation is the possibility of re-formation of polyps within a year.

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After the intervention, great attention must be paid to the hygiene of the nasal cavity. You can't blow your nose sharply. Crusts in the nose must be removed very carefully. You should not eat very hot food. Breathing returns to normal within a few days after endoscopic polypotomy, and the sense of smell returns within 30 days. At home, you need to rinse your nose with products like Aquamaris, Aqualor, etc. and take allergy medications. And of course, observation by an otolaryngologist is necessary.

We have endoscopic polypotomy

The price of surgery to remove nasal polyps depends on several factors. First of all, on the degree of growth of formations. The more advanced the disease, the longer, more severe and more expensive it will cost this operation. The cost in Moscow of this operation also depends on the chosen removal method. Thus, the cost of laser nasal polypotomy in Moscow will be more expensive than conventional polypotomy.

The cost of removing nasal polyps with a laser, loop or endoscope in our clinic has remained unchanged for 3 years.

To find out the exact cost of manipulations, you need to contact the specialists of our clinic for primary diagnosis. ENT doctors will conduct a comprehensive examination, based on the results of which the degree of the disease, the number of formations, their size will be clear, and one of the surgical methods will be proposed. After the examination, the ENT specialist will announce the exact price for nasal polypotomy with a laser, using a loop or an endoscope.

You can find out how much a procedure costs in a clinic on the website or at an appointment with an ENT specialist.

Consultation with an ENT doctor

* - the cost of admission is included in the cost of the operation

ENT diagnostics

ENT manipulations

Possible ENT procedures in the postoperative period

Medical service	Price, rub.
Removing tampons from the nasal cavity with treatment of the nasal cavity	500
Sanitation of the nasal cavity	500
Nasal cavity toilet	500
Laser session photodynamic therapy nasal cavity and nasopharynx	1000
Pawning medicinal ointment into the nasal cavity	500
Ultrasonic medicinal irrigation session (TONZILOR-M device)	1000
Infrared session laser therapy nasal cavity and nasopharynx	200
Session ultraviolet irradiation nasal cavity and nasopharynx	200
Vibroacoustic therapy session in the projection of the maxillary sinuses	200
Magnetic therapy session with the “POLYUS – 2D” device	200
Transcutaneous infrared laser exposure RVB device (Italy)	200

** - discount is provided for complex treatment of the disease