I am a Vacuflex and reflexology therapist and have a client with nasal polyps. These were removed four years ago by surgery. What causes polyps, why do they recur and what alternatives to surgery are available? He has heard of cranial manipulation helping this condition, but is not sure how safe this is. J P, Stonehaven......
Nasal polyps, small, grape sized growths of inflamed nasal mucus membrane, are, in effect, benign tumours, usually near the open areas of the ethmoid sinuses at the top of your nose. These annoying growths can block up the nose, decrease your sense of taste and smell, aggravate or cause sinusitus and generally make it hard to breathe. As they narrow the nasal passages, they can also cause a "blocked drain" a sinus backup preventing normal drainage, which can become infected, causing a thick discharge. Children with polyps usually suffer from a perennial runny nose and tend to become mouth breathers.
Polyps go hand in hand with other respiratory conditions: asthma, hay fever and chronic sinus conditions. About a quarter of people with cystic fibrosis also have polyps.
Some researchers maintain that chronic viral or bacterial infection of the sinuses such as from staphyloccus A infection is the cause of polyps. But the majority of evidence points to allergy. In one study in Thailand, where hayfever allergies occur all year round, 60 per cent of patients with nasal polyps registered a positive skin prick test, indicating they were allergic. The researchers concluded that people suffering from respiratory allergies were six times more likely to develop polyps (Asian Pac J Allergy Immunol, 1999; 17: 13-5). Other studies have shown that allergies are present in two thirds of patients with polyps (J Investig Allergol Clin Immunol, 1997; 7: 234-7), and in 57 per cent of children with the condition (South Med J, 1978; 71: 911-3).
At least one study has made a connection between nasal polyps and chronic inflammation due to house dust mite and house dust allergies, particularly in patients under 40 (HNO, 1991; 39: 307-10). Aspirin intolerance and aspirin induced asthma can also cause polyps to form (Acta Otolaryngol, 1999; 119: 277-80; Rhinology, 1999; 37: 16-20).
The standard treatment is to attempt to shrink the polyps with drugs before resorting to surgery. As with all types of inflammation, the drug of choice is steroids. Often, your doctor will attempt a "medical polypectomy" by giving you a one to two week course of oral steroids (usually 40 mg a day of a drug like prednisolone).
This is often followed by three or four weeks of antibiotics, supposedly to remove the infection, and then indefinite use of intranasal steroids, usually applied topically.
Another, less drastic approach is to use histamine inhibitors.
Not surprisingly, this cocktail doesn't often work, and the patient is referred for surgery. Although the procedure requires a nasal endoscopy (a notorious spreader of infection), the surgery itself is considered minor and is usually done on an out patient basis.
The problem with this approach, of course, is that it doesn't address the cause; if the source of inflammation isn't removed, polyps tend to grow back. Doctors attempt to minimise the chances of this occurring by prescribing intranasal steroids after surgery (Auris Nasus Larynx, 1999; 26: 49-55); although this approach appears to offer some short term clinical improvement, long term use of steroids, even the topical variety, replace a benign but irritating problem with a serious one. Topical steroids have been shown to cause all the side effects of their oral cousins, including osteoporosis, growth retardation in children and thinning skin.
The most sensible approach would be to find out what your patient is allergic to. Don't fall into the trap of thinking that a respiratory allergy has to be inhaled. His symptoms can also be caused by something he's eating. In one instance, a woman's allergy to legumes was responsible for her polyps (Allergol Immunopathol, 1995; 23; 38-40).
It may be sensible for your patient to undergo a complete allergy testing programme, in which he is tested for inhaled and environmental pollutants. This is best accomplished by a enzyme potentiated desensitisation test. For food allergies, most clinical ecologists agree that no test can match the accuracy of the food elimination diet. As slow as the process is, it will give you definitive answers (see future editions of our sister publication, Proof!, which will be featuring allergy testing).
Otherwise, there is some evidence that electric acupuncture works well in preventing the recurrence of polyps (Otorinolaringol,Mar-Apr 1990; 2: 10-2).