Most Effective Nasal Polyps Home Remedies
Nasal polyps are the result of nasal mucosal inflammation and edema. On examination, nasal polyps are usually silver-gray in color and may be translucent. If there is associated infection, polyps can appear erythematous or may be obscured by mucus. Polyps cause significant and sometimes complete nasal obstruction but are painless and insensate. Nasal polyps predispose the patient to sinusitis and often cause anosmia. The exact cause of nasal polyps is unclear. Polyps are often associated with reactive airway disease and less often with environmental allergies. In children the presence of polyps should prompt testing for cystic fibrosis. Sinonasal tumor or fungal involvement should be considered, especially if the polyps are unilateral. If polyps are identified, further evaluation includes allergy and asthma testing and CT scan.
Environmental exposure also appears to be an important factor in the etiology of asthma. Patients with occupational asthma develop the disease late in life upon exposure to specific allergens in the workplace. Exposure to second-hand smoke after birth increases the risk of childhood asthma.1 Adult-onset asthma may be related to atopy, nasal polyps, aspirin sensitivity, occupational exposure, or a recurrence of childhood asthma.
Patients with aspirin-sensitive asthma are usually adults and often present with the triad of rhinitis, nasal polyps, and asthma. In these patients, acute asthma may occur within minutes of ingesting aspirin or another nonsteroidal anti-inflammatory drug (NSAID). These patients should be counseled against using NS AIDs.1 Although acetaminophen is generally safe in this population, doses larger than 1 gram may cause acute asthmatic reactions in some patients.43 Patients with aspirin-sensitive asthma may tolerate cyclooxygenase-2 inhibitors however, given the potentially serious adverse events that could occur in aspirin-sensitive asthmatics, the first dose of a cyc-looxygenase-2 inhibitor should be given under the observation of a health care provider with rescue drugs available.44
The strongest risk factors for developing asthma are exposure to household smokers and a family history of asthma or atopy (asthma, atopic dermatitis, or allergic rhinitis). Family history of nasal polyps or aspirin hypersensitivity can also suggest risk for IgE-mediated atopic disease. Data are mixed on the impact of early childhood infections and bottle feeding versus breastfeeding on the development of asthma, although both are clearly associated with wheezing episodes in the first 3 years of life. Data showing a paradoxical protective effect of early childhood exposure to pets, farm animals, and bacterial antigens are still controversial (Adler et al., 2005 Platts-Mills et al., 2005 Remes et al., 2005 Waser et al., 2005).
In addition to general history-taking, a detailed history of respiratory exposures and risk factors is essential. Smoking is perhaps the most important pulmonary risk factor. A detailed smoking history includes age of first smoking, quantity smoked, number of years as a smoker, other tobacco use, previous attempts to quit, and an assessment of the level of nicotine addiction. Family history can reveal relatives with immunoglobulin E (IgE)-mediated allergy or atopy (allergic rhinitis, asthma, eczema, nasal polyps, or aspirin hypersensi-tivity) or even more serious genetic risk factors, such as cystic fibrosis or a1-antitrypsin deficiency. Perinatal history of premature birth, neonatal respiratory failure, and ventilator care can lead to bronchopulmonary dysplasia and chronic lung disease in children who survive neonatal intensive care.
Two specific conditions aspirin-exacerbated respiratory disease (AERD) and chronic idiopathic urticaria, are important because they are commonly seen. AERD may include asthma, rhinitis with nasal polyps, and aspirin sensitivity.17 Upon exposure to aspirin or a NSAID, patients with AERD experience rhinorrhea, nasal conges IgE-mediated urticarial angioedema reactions and anaphylaxis are associated with aspirin and NSAIDs. Urticaria is the most common form of IgE-mediated reaction. However, most reactions are the result of metabolic idiosyncracies, such as aspirin-induced respiratory disease which may produce severe and even fatal bron-chospasm. This class is second only to ft-lactams in causing anaphylaxis. Most reactions in this class are due to a complex metabolic pattern which causes increasingly recurrent and severe nasal polyps and often refractory asthma. The metabolic problem is constant, once it emerges, accounting for the persistence and difficulty of these clinical problems,...
Aspirin is effective for mild-to-moderate pain however, the risk of GI irritation and bleeding limits frequent use of this drug for pain management. Direct effects of aspirin on the GI mucosa and irreversible platelet inhibition contribute to this risk, which can occur even at low doses. Hypersensitivity reactions are also possible and might occur in 25 of patients with coexsiting asthma, nasal polyps, or chronic urticaria. Of additional concern is the potential for cross-sensitivity of other NSAIDs in
Inflammation in the upper respiratory tract, rhinitis, presents as one or more of the symptoms nasal congestion, rhinorrhea (i.e. runny nose), sneezing and itching. Chronic inflammatory conditions can in predisposed individuals result in benign protrusions of nasal polyps into the nasal cavity, polyposis.
Aspirin desensitization is useful in diseases where low-level antiplatelet action is needed and in the care of patients with aspirin sensitivity and intractable nasal polyps. Lysine aspirin availability in Europe allows desensitization by inhalation at greatly reduced risk. New procedures utilizing ketorolac as a nasal topical application may allow similar reduction of risk in the United States.26 As with all desensitizations, constant daily administration must be maintained once the desired dose is reached. Table
If a nasal speculum is used, the instrument is held in the examiner's left hand, and the speculum is introduced into the patient's nostril in a vertical position (blades facing up and down). The speculum should not rest on the nasal septum. The blades are inserted about 1 cm into the vestibule, and the patient's neck should be slightly extended. The examiner's left index finger is placed on the ala of the patient's nose to anchor the upper blade of the speculum while the examiner's right hand steadies the patient's head. The right hand is used to change the head position for better visibility of the internal structures. After one nostril has been examined, the speculum, still being held in the examiner's left hand, is introduced into the patient's other nostril. The technique of holding the speculum is shown in Figure 11-23. Although the nasal speculum provides the best method of inspection, internists rarely use this instrument. Figure 11-24 shows a patient with nasal polyps, visible...
The most important risk factor for the development of sinusitis is rhinitis (e.g., viral, allergic). Other risk factors include anatomic abnormalities (abnormality within the sinuses, septal deviation, choanal atresia, foreign body, adenoid hypertrophy), nasal polyps (which can also occur secondary to chronic sinusitis), conditions of local or systemic immunodeficiency, cystic fibrosis, primary ciliary dysfunction (Kartagener's syndrome), secondary ciliary dysfunction (cigarette smoking, nasal decongestant abuse, cocaine abuse), gastroesophageal reflux disease (GERD), systemic inflammatory conditions (sarcoidosis, Wegener's granulo-matosis), dental disease, and nasal or sinus tumors. Any of these conditions can mimic or cause rhinosinusitis. Further Sinusitis can also be caused by fungi. Invasive fungal sinusitis (caused most often by Aspergillus or Mucor spp.) can be seen in patients with impaired immune function and poorly controlled diabetes. It is life threatening even with...
The turbinates are usually swollen and edematous and may be mistaken for nasal polyps, which are pearl-gray gelatinous masses and unusual in uncomplicated allergic rhinitis. Below the turbinates, the floor of the nostril is often prominent as a result of mucosal edema. One third to one half of children with allergic rhinitis have eustachian tube obstruction and resultant serous otitis. Otoscopy reveals a retracted or bulging
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