Medical treatment Because nasal polyps are the result of long-term inflammatory reaction of nasal airway mucosa, corticosteroids can not only make polyps smaller or even disappear, but also delay or prevent the recurrence of postoperative polyps. There are two ways to administer glucocorticoids: systemic administration is suitable for the following situations without contraindications to the application of glucocorticoids: ① it is inconvenient to introduce instruments into the nasal cavity when polyps are large; ② The newly diagnosed patients are willing to take oral prednisone mg every day for several days, and then decrease the mg daily for no more than two weeks. This short-term short-term assault treatment will not cause obvious systemic side effects in clinic, and the volume of polyps can be significantly reduced through the above treatment. Some patients can relieve nasal congestion and improve their sense of smell after taking it for a few days, and can be taken out surgically or applied locally to the nose.
The advantage of topical application of corticosteroids in nasal cavity is that it can not only avoid the systemic side effects of corticosteroids, but also maintain the local effective concentration of drugs. Local application is suitable for: ① patients with small polyps and no more than the lower edge of middle turbinate at the time of initial diagnosis; ② Patients with better response after oral prednisone are willing to continue medical treatment; ③ Aerosol is the most common dosage form for intranasal application of adrenocortical hormone to prevent recurrence after surgical resection. In addition, nasal drops require patients to take the correct nasal position when using, but the preparation process is simple and the cost is low. The corticosteroids used in the nose are mainly clomiphene propionate, flunisolone, budesonide and other corticosteroids, which are not easily absorbed into the blood by the nasal mucosa and cause systemic side effects. In recent years, Johansen () compared the efficacy of budesonide aerosol and nasal drops in the treatment of nasal polyps. Results The efficacy of the two dosage forms was similar. () The application of triamcinolone acetonide nasal drops has also achieved good results. The following conditions can obviously affect the curative effect of nasal medication: ① nasal polyps are too large to enter the nasal cavity, so nasal medication should be given after surgery to prevent recurrence; ② Mixed infection of nasal cavity and sinuses exists at the same time. Antibiotic therapy or sinus cleaning should be performed at this time; ③ Polyp itself is in the active stage and grows too fast.
Surgical treatment seriously affects the physiological function of most or all nasal cavities. The patient should be given a general examination before the operation. For example, patients with cardiovascular diseases and asthma will be operated after their condition is stable. There are two main surgical methods: simple nasal polypectomy and intranasal ethmoidectomy.
Simple resection of nasal polyps is used to remove pedicles. For those who have no previous history of nasal polypectomy, the nasal polyp snare is used to tighten the pedicle under local anesthesia, and then it is pulled out from the nose, and the polyp is taken out together with the pedicle. If there is a residual pedicle, it can be removed with forceps, and sometimes the ethmoid sinus can be opened. At this time, if the intraethmoidal mucosa has polypoid degeneration, intranasal ethmoidectomy should be performed at the same time.
Endoscopic sinus surgery in recent years provides an accurate and effective method for ethmoid sinus resection. By fully opening ethmoid sinus mucosa and completely removing polyps in sinus, the recurrence rate of polyps can be significantly reduced.
In short, the treatment of nasal polyps should refer to the following principles:
For newly diagnosed patients, such as polyps, which seriously affect nasal function, surgery should be performed first; Small polyps and light nasal congestion can be treated by internal medicine for several months, and those with poor curative effect can be treated by surgery again.
For those with sinus infection, anti-infection or nasal polypectomy should be performed first, and sinus drainage should be opened.
Recurrent nasal polyps after ethmoidectomy should be treated with intranasal corticosteroids for ~ years.
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