Nasal Polyps After Rhinoplasty

Rhinoplasty is becoming popular these days for its definitive perks of getting a nose of dreams. But it does come with its downsides. It is not uncommon to have a runny nose, irritation and polyps post rhinoplasty. However, with the right knowledge and understanding of the ‘post rhinoplasty nasal polyps’ concept, it can be managed effectively.

This article is your thorough guide to understand the nasal polyps after rhinoplasty, causes, prevention and treatment options.

Intranasal polyposis or in simple terms nose polyps are benign, non cancerous and soft tissue growth inside the nose. They are usually soft and nontender to touch and appear like grapes and are often associated with chronic inflammation.

After rhinoplasty, the inside lining of the nose often becomes inflamed and may start having grape-like small polyps on it. There are some theories supporting evidence that long term inflammation after nose reshaping surgery may cause it. It is also associated with altered nasal physiology and impaired mucociliary clearance.

How Do Nasal Polyps Affect The Quality Of Life?

Sometimes polyps are too small to be noticeable but sometimes they can be large and interfere with the normal functioning of the nose. Here are some symptoms associated with post nose job nasal polyps:

• Stuffy or runny nose
• Feeling of nasal blockade
• Nasal congestion
• Breathing difficulties
• Feeling uncomfortable with foreign body sensation in nose
• Post nasal drip
• Sore throat
• Recurrent ENT infections (mild, moderated or severe)
• Loud snoring
• Obstructive sleep apnea
• Anosmia or dysosmia ( reduced or disruptive smelling sensation)
• Sinus or facial pain

What Causes Nasal Polyps After Nose Job?

Some patients complain of the appearance of growths inside the nose after rhinoplasty. Exact mechanism and reasons for nasal polyps to occur remains unknown. However, here are some risk factors associated with it:

• Asthma
• Allergy
• Cystic fibrosis
• Aspirin sensitivity
• Frequent nasal infections
• Inflammation and swelling after surgery
• Churg- strauss syndrome
• Immune system defects
• Genetic predisposition
• Chronic rhinosinusitis

How To Prevent Nasal Polyps After Rhinoplasty?

Polyps are unexpected but not an unavoidable complication after rhinoplasty. Here are some preventive measures you can adopt to avoid this unforeseen disadvantage of the procedure:

• Carefully follow your surgeon’s advice for nose job aftercare.
• Take timely medication either oral or in the form of nasal sprays as prescribed by your surgeon.
• Regularly attend follow ups with your doctor.
• Keep track of your symptoms and problems after nose job.
• Effectively manage your allergy and asthma symptoms.
• Maintain hygiene of the surgical area.
• Use normal saline to irrigate the nasal passages.
• Use humidifiers if necessary to keep the area moist as needed.
• Blow your nose gently when required.
• Avoid smoking, alcohol and caffeine.

How Can Nasal Polyps Be Diagnosed?

Nasal polyps can be diagnosed by:

• History – History of the patient is very crucial in this regard. Presence of medical conditions like allergy, sinusitis and asthma predispose to the nasal polyps.
• Examination – Your surgeon carefully examines the inside of the nose with the help of nasal speculum and rhinoscopy (both anterior and posterior) for provisional diagnosis.
• Nasal Endoscopy – A small camera attached to the tube is inserted in the nasal cavity to visualize the inside of the nose. Sometimes it is combined with tissue biopsy when cancerous tissue is suspected.
• CT Scan/MRI – CTs and MRIs give the understanding of the extent of the polyps and allow surgeons to decide about the surgical approach for treatment.
• Allergy Test – This investigation helps in finding about the allergen causing continuous inflammation to the internal nose.
• Blood Tests – High number of eosinophils in CBC raise suspicion of allergy. IgE antibodies are also raised in presence of asthma, allergy or sensitivity reactions.
• Test For Cf – Cystic Fibrosis is one of the leading causes of nose polyps. Sweat chloride test is used to confirm CF, so that it can be managed effectively.

How To Treat Nasal Polyps After Rhinoplasty?

There are both medical and surgical options available for post rhinoplasty nasal polyps. But the surgeon decides about the mode of treatment depending upon the condition of the polyps and concomitant issues. Let’s have a look on these:

Medical Treatment

• Steroid Nasal Drops: Steroids are the first line of treatment in nasal polyps. They come in the form of topic nasal drops. Steroids shrink the size of the polyps and calms down the inflammation.
• Nasal Sprays: Topical steroids also come in the form of nasal sprays. Also help in relieving symptoms of nasal congestion and breathing difficulties. These nasal sprays contain fluticasone, budesonide, triamcinolone, betamethasone stc.
• Antibiotics: Antibiotics help in eradicating infections and inflammation produced by bacteria and fungi. Recurrent bacterial sinus infection requires a 7-10 days antibiotic course.
• Anti-Allergics: These include antihistamines and disease modifying leukotrienes such as Montelukast. They help in alleviating the allergic and asthma symptoms.
• Biologics: These include Dupilumab and omalizumab. These drugs are approved by FDA specifically for chronic rhinosinusitis with nasal polyposis.
• Oral Steroids: Oral steroids serve the same purpose in reducing inflammation and allergic reaction. They have improved efficacy than topical steroids but have more side effects.

Surgical Treatment

• Endoscopic Sinus Surgery: A camera or endoscope is used to visualize the polyps and nasal cavity. Tiny instruments are used to cut the nasal polyps and reduce the size of the turbinates.
• Intranasal Polypectomy: It is a traditional surgical method with a more extensive approach. Surgical instruments are entered through the nostrils or oral cavity to ligate the polyps.
• Drug-Eluting Stents: These stents are placed after endoscopic sinus surgery. They continuously release small amounts of steroids and are used to reduce inflammation and improve wound healing.
• Balloon Ostial Dilation: A balloon-like equipment is used to open the nasal passage and does not involve removal of any tissue.

What Can I Expect During My Appointment?

During follow-up after rhinoplasty, your surgeon will examine your nose and ensure the process of smooth healing. The surgeon will ask you about any symptoms. You should prepare beforehand about all the queries and concerns.

If polyps are suspected you are advised to have certain investigations. The doctor will then decide about the management plan. You may require further follow ups and appointments in future to keep track of disease progression.