IMAGINE not being able to enjoy the smell of life's simple pleasures like freshly baked bread, a hot cup of coffee or even of a newborn baby.
Our sense of smell and the ability to breathe and take in our surroundings on a daily basis are often things that people overlook, and something that individuals living with nasal polyps, or chronic rhinosinusitis with nasal polyps (CRSwNP) don’t get to experience.
Instead, they often deal with persistent nasal blockage, loss of smell, a runny nose, have difficulty breathing and sleeping, and sometimes even experiencing facial pain and chronic headache.
To shed some light on how significantly the loss of sense of smell affects an individual, a global survey involving 6,000 adults found that most people could not imagine what life would be like without it.
The survey revealed that:
- Nearly 70% reported being afraid to lose it
- 88% claimed that smell affects their appetite
- Almost 90% highlighted that a smell could evoke vivid memories such as favourite family foods
- Nine in 10 respondents acknowledged the importance of smell in detecting danger, from spoiled food to gas or smoke.
What causes nasal polyps?
Inflammation of the sinus or nasal passages that lasts more than 12 weeks at a time (1) indicates chronic rhinosinusitis (CRS). It causes poor quality of life and impacts personal productivity in up to 10% of the adult population.
CRS is a fairly common condition that affects approximately 12% of people across the globe, says ear, nose and throat surgeon Prof Dr Tang Ing Ping.
“CRS is a fairly common condition that affects approximately 12% of people across the globe. Of these, around 20% also have nasal polyps (2), which are non-cancerous growths in the nose,(3),” according to ear, nose and throat (ENT) surgeon Prof Dr Tang Ing Ping.
Nasal polyps can develop at any stage of CRS, and it is caused by a complex interplay of various genetic, environmental, and immune factors.
It can occur in anyone, but it is more common in middle-aged males and people with asthma, aspirin sensitivity and allergic rhinitis.
Allergies, chronic infections, genetic factors, environmental factors, abnormal immune responses and structural abnormalities of the nasal and sinus structures may contribute to the development of nasal polyps.
“However, not everyone with these risk factors will develop the condition and the exact cause may vary from person to person,” he shares.
There is Type 2 inflammation, which is a type of immune response in nasal polyps and is caused by immune cells called Th2 cells that release cytokines, which lead to inflammation and tissue damage.
This type of inflammation is different from Type 1 inflammation, which is typically associated with infections.
There are various scientific findings which help people to understand more about the condition. Along with nasal polyps, it is also common for individuals with CRS to have other conditions such as asthma and atopic dermatitis as these conditions are also driven by Type 2 inflammation, a systemic allergic response to triggers in the environment.(4.5.6)
A constant blocked or congested nose is one of the symptoms of nasal polyps.
Symptoms of nasal polyps
When nasal polyps are small, they may not produce symptoms, but larger growths can block the sinus, allowing mucus to build up and cause inflammation. This can lead to recurring infections and symptoms.
Those living with nasal polyps are constantly dealing with a stuffy nose, sinus pain, diminished sense of smell and even sleeping difficulty.
“It can be very frustrating to live with CRSwNP. While nasal polyps are usually not cancerous and the condition is generally not life-threatening, they can significantly impact a person’s quality of life,” he says.
“In Malaysia, CRSwNP prevalence is estimated at 4.3% among adults, with a higher prevalence in urban areas compared to rural areas, though the actual figure may be higher as many remain undiagnosed and untreated.”
To help improve understanding among the public as well as healthcare professionals, Global CRSwNP Awareness Day is celebrated on April 20 to share knowledge and raise awareness of this condition, to enable more people to identify the symptoms and seek early treatment to enjoy better quality of life.
Diagnosis of nasal polyps
Diagnosing nasal polyps involves a combination of medical history, physical examination and imaging studies.
“During the physical examination, a doctor will look inside the nose and use a nasal endoscope to visualise the nasal cavity and sinuses,” says Prof Dr Tang.
Imaging studies such as computerised tomography (CT) scans may also be used to assess the extent of the disease. In addition, a nasal swab may be performed if complicated with infection. An allergy test may be performed if an allergic reaction could be elicited. A nasal tissue biopsy is performed if the nasal polyps look suspicious such as inverted papilloma or nasal tumours that mimicking nasal polyps.
“It is important to see a specialist such as an ENT doctor for an accurate diagnosis, as the symptoms of nasal polyps can overlap with other conditions or mimicking nasal polyps.”
Complications of nasal polyps
Nasal polyps can lead to several complications, especially if left untreated, including recurrent sinus infections, decreased sense of smell and taste, breathing difficulties, sleep disturbances, asthma, orbital complications, and rarely, intracranial complications.
“Nasal polyps can obstruct the sinus passages, leading to recurrent infections, and can interfere with the ability to breathe through the nose, causing sleep disturbances and snoring. In severe cases, nasal polyps can cause eye problems and, rarely, spread of infection to the brain or other parts of the body,” says Prof Dr Tang.
On whether nasal polyps can cause heart problems, he says: “There is no direct evidence to suggest that nasal polyps can cause heart problems. However, the condition has been associated with an increased risk of cardiovascular disease, such as hypertension and stroke. The reason for this association is thought to be related to the underlying inflammation that occurs in nasal polyps, which can lead to systemic inflammation throughout the body and contribute to the development of cardiovascular disease and also long-term complication of obstructive sleep apnea.(7)”
Treating nasal polyps
It can be challenging to treat nasal polyps, as there is no cure for chronic rhinosinusitis(8).
The current approach includes intranasal and systemic corticosteroids or sinus surgery.
However, even with these treatments, patients can develop recurring symptoms (9), and may not improve loss of smell.(10)
“As these options offer only limited relief, there is a significant need for treatments that address some of the underlying disease drivers, such as type 2 inflammation. Biologic therapy recently approved for CRSwNP may offer hope for patients whose disease is not adequately controlled with existing treatment options.”
“Without our sense of smell, we lose one of our primary connections with the world around us – along with our ability to protect ourselves from danger. This burden can be relieved with treatment, so if you or someone you know suffers from persistent sinus pain or stuffiness, I urge you to seek advice from an ENT doctor for diagnosis and advice,” Prof Dr Tang stresses.
Specific diet
There is no specific diet or food that has been proven to cause or cure nasal polyps. “However, some people with nasal polyps find that certain foods, such as dairy products, spicy foods, alcohol, and caffeine, can trigger or worsen their symptoms,(11), says Prof Dr Tang.
So, what should I do, if I think that I may have nasal polyps?
Have an open conversation with your ENT doctor and make a plan on the best treatment that may work for you. Being proactive about managing your nasal polyps may positively influence how you manage the condition, and help improve how you feel on a daily basis.
To learn more about nasal polyps, visit www.thenextbreath.com/nasal-polyps.
References
(1) National Library of Medicine. Chronic Sinusitis. https://www.ncbi.nlm.nih.gov/books/NBK441934/
(2) American Academy of Allergy, Asthma and Immunology. Nasal Polyps. https://www.aaaai.org/tools-for-thepublic/conditions-library/allergies/nasal-polyps
(3) EUFOREA. Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). https://www.euforea.eu/crswnp
(4) Allergy and Asthma Network. When Asthma Is Not Just Asthma: Type 2 Inflammation. https://allergyasthmanetwork.org/news/when-asthma-not-just-asthma-type-inflammation/
(5) Jorge Maspero, et al. “Type 2 inflammation in asthma and other airway diseases”. ERJ Open Research Jul 2022, 8(3) 00576-2021; DOI: 10.1183/23120541.00576-2021. https://openres.ersjournals.com/content/8/3/00576-2021
(6) Newton JR, Ah-See KW. A review of nasal polyposis. Ther Clin Risk Manag 2008;4(2):507-12.
(7) Stevens, W. W., Schleimer, R. P., Kern, R. C. (2016). Chronic rhinosinusitis with nasal polyps. Journal of Allergy and Clinical Immunology, 137(6), 1462-1470. doi: 10.1016/j.jaci.2016.03.001
(8) EUFOREA. No surgery or nose surgery? CRSwNP - setting the new gold standard (Full Episode). https://www.youtube.com/watch?v=ULq0cFVQxs0
(9) A. Khan, et al, “The Global Allergy and Asthma European Network (GALEN rhinosinusitis cohort: a large European cross-sectional study of chronic rhinosinusitis patients with and without nasal polyps.,” Rhinology, vol. 57, no. 1, 32-42, 2019.
(10) N. Claeys et al, “Patients Unmet Needs in Chronic Rhinosinusitis With Nasal Polyps Care: A Patient Advisory Board Statement of EUFOREA,” Frontiers in Allergy, 29;2:789425. https://doi.org/10.3389/falgy.2021.761388
(11) Sd American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS): https://www.enthealth.org/conditions/chronic-rhinosinusitis-with-nasal-polyps/
"A health educational article brought to you by Sanofi Malaysia in conjunction with Global CRSwNP Awareness Day."
