Scope of Homeopathy in Nasal Polyp

Broadly defined, Nasal polyps are abnormal lesions that originate from any portion of the nasal mucosa or paranasal sinuses. Polyps are an end result of varying disease processes in the nasal cavities. They are overgrowths of the mucosa that frequently accompany allergic rhinitis. Generally they are freely movable and nontender.

Nasal polyps are usually classified into antrochoanal polyps and ethmoidal polyps.

Antrochoanal polyps

They arise from the mucosa of maxillary antrum near its accessory ostium, and grow in the choana and nasal cavity. Antrochoanal polyps are usually single and unilateral.

Nasal allergy coupled with sinus infection is its most important cause. Antrochonchal polypi are seen in children and young adults.

Unilateral nasal block is the presenting symptom but it may become bilateral nasal block if polyp grows into the nasopharynx and starts obustructing the opposite choana. Voice may become thick and dull due to hyponasality. Mucoid nasal discharge may be seen on one or both sides.

Ethmoidal Polyps

Ethmoidal polyps arise from the ethmoidal sinuses. They are multiple and bilateral and are usually found in adults.

Though the exact cause is unknown but allergic or vasomotor rhinitis may be an important cause.

Nasal stuffiness leading to total nasal obstruction may be the presenting symptom associated with total loss of sense of smell or/ and headache. Associated allergy may cause watery nasal discharge and sneezing. Mass protruding from the nostril may also present.

The tendency to manifest multiple polyps is referred to as "polyposis".

Pathophysiology

The pathogenesis of nasal polyposis is unknown. Polyp development has been linked to chronic inflammation, autonomic nervous system dysfunction, and genetic predisposition. Most theories consider polyps to be the ultimate manifestation of chronic inflammation; therefore, conditions leading to chronic inflammation in the nasal cavity can lead to nasal polyps. The following conditions are associated with multiple benign polyps:

• Bronchial asthma - In 20-50% of patients with polyps
• CF - Polyps in 6-48% of patients with CF
• Allergic rhinitis
• AFS - Polyps in 85% of patients with AFS
• Chronic rhinosinusitis
• Primary ciliary dyskinesia
• Aspirin intolerance - In 8-26% of patients with polyps
• Alcohol intolerance - In 50% of patients with nasal polyps
• Churg-Strauss syndrome - Nasal polyps in 50% of patients with Churg-Strauss syndrome
• Young syndrome (ie, chronic sinusitis, nasal polyposis, azoospermia)
• Nonallergic rhinitis with eosinophilia syndrome (NARES) - Nasal polyps in 20% of patients with NARES

Most studies suggest that polyps are associated more strongly with nonallergic disease than with allergic disease. Statistically, nasal polyps are more common in patients with nonallergic asthma (13%) than with allergic asthma (5%), and only 0.5% of 3000 atopic individuals have nasal polyps.

Risk Factors

These risk factors increase the chance of developing nasal polyps.

• Gender: males.
• Age: older than 40.
• Aspirin sensitivity.
• Asthma.
• Churg-Strauss syndrome (a rare disease that inflames the blood vessels).
• Cystic fibrosis .
• Hay fever  or other respiratory allergies.
• Frequent sinus infections

Signs and Symptoms

The manifestation of nasal polyps depends on the size of the polyp. Small polyps may not produce symptoms and may be identified only during routine examination when they are anterior to the anterior edge of the middle turbinate. Polyps located posterior to the site are not typically seen during routine anterior rhinoscopy examination performed with an otoscope and are missed unless the child is symptomatic. Small polyps in areas where polyps normally arise (ie, the middle meatus) may produce symptoms and block the outflow tract of the sinuses, causing chronic or recurrent acute sinusitis symptoms.

Symptom-producing polyps can cause nasal airway obstruction, postnasal drainage, dull headaches, snoring, and rhinorrhea. Associated hyposmia or anosmia may be a clue that polyps, rather than chronic sinusitis alone, are present. Epistaxis that does not arise from irritation of the anterior nasal septum (ie, Kiesselbach area) usually does not occur with benign multiple polyps and may suggest other, more serious, nasal cavity lesions.

Massive polyposis or a single large polyp (eg, antral-choanal polyp [see the images below] that obstructs the nasal cavities, nasopharynx, or both) can cause obstructive sleep symptoms and chronic mouth breathing.

Imaging Studies

• The criterion standard to evaluate nasal lesions, especially nasal polyposis or sinusitis, is a thin-cut (1-3 mm) CT scan of the maxillofacial area, the sinuses axially, and the coronal plane. Perform a compatible CT scan if an intraoperative image-guided system is used. Plain film radiography has no significant value after polyps are diagnosed.
• Also perform MRI in patients with possible intracranial involvement or extension of benign nasal polyps.
• CT scan findings and MRI findings can help diagnose the polyp or polyps; define the extent of the lesion in the nasal cavities, sinuses, and beyond; and narrow the differential diagnosis of an unusual polyp or clinical presentation.

Conservative Medical treatment

Oral and topical nasal steroid administration is the primary medical therapy for nasal polyposis. Antihistamines, decongestants, and cromolyn sodium provide little benefit. Immunotherapy may be useful to treat allergic rhinitis but, when used alone, does not usually resolve existing polyps. Administer antibiotics for bacterial superinfections.

Topical corticosteroid administration generally causes fewer adverse effects than systemic corticosteroid use because of the former's limited bioavailability. Long-term use, especially at high dosages or in combination with inhaled corticosteroids, presents a risk of hypothalamic-pituitary-adrenal axis suppression, cataract formation, growth retardation, nasal bleeding, and, in rare cases, nasal septal perforation.

Surgical Care

Surgical intervention is required for children with multiple benign nasal polyposis or chronic rhinosinusitis who fail maximum medical therapy. Simple polypectomy is effective initially to relieve nasal symptoms, especially for isolated polyps or small numbers of polyps. In benign multiple nasal polyposis, polypectomy is fraught with a high recurrence rate.

Closely monitor children with benign multiple nasal polyps, whatever the cause, because recurrence is likely, whether medically or surgically treated. Postoperative follow-up should occur 3-4 times the first month to monitor healing of the sinus cavities; frequency depends on the patient's own geographic location and symptoms.

Complications

Massive polyposis or a single large polyp (eg, an antral-choanal polyp) that obstructs the nasal cavities and/or nasopharynx can cause obstructive sleep symptoms and chronic mouth breathing. Rarely, massive polyposis, can alter the craniofacial structure resulting in proptosis, hypertelorism, and diplopia.

Prognosis

Polyposis recurrence is common following treatment with medical or surgical therapy if multiple benign polyps are present (see Surgical Care). Single large polyps (eg, antral-choanal polyps) are less likely to recur.

Patient Education

Educating patients about the chronicity of the disease is important to make them aware of the recurrent nature of the problem.

Homeopathic Understanding of Nasal Polyps

Homeopathy medicines have been found to be very effective in cases of Nasal polyp. Not only they save the patient from surgeon’s scalpel but they also help in reducing the associated complaints. The biggest complication of Nasal polyp is its tendency to recur here also homeopathy offers a helping hand and prevents the patient from repeated doctor visitations.

Homeopathy is a holistic science which believes that a person’s disease is due to his increased susceptibility. This superadded with the miasmatic soil present in his body helps the disease to grow. So if this increased susceptibility is normalized then the person fares fairly well against constant environmental and telluric atrocities. As a result no recurrent allergic cold, coryza, no swollen turbinates, no inflammation in nasal mucosa. Now correcting this increased susceptibility is not a child’s play that you add 2 + 2 and get 4, here you have to use all the permutations and combinations to extract the special tailored medicine best suited to your patient i.e similimum to the case. This similimum alone can cure the patient and restore health. Regarding the choice of line of treatment in such cases we opt for:

1. Conservative treatment for present complaints: This can range from Allium cepa, Arsenic-alb, Sanguinaria can, Lemna according to the present complaint.
2. Intercurrents when case stops progressing: These are the remedies that provide a boost to your line of treatment. It can be Calcarea carb, Phosphorus, Psorinum, Thuja, Nitric acid and even Sulphur.
3. Constitutional medicines for holistic treatment: When you get no breakthrough in a case and the patient comes with only general complaints or disease symptoms then a detailed mental and physical case history is considered for prescribing. It is the interrogation to search for the uncommon among the common. In cases where the polyps are due to deep seated chronic disorders like asthma or allergies this constitutional treatment surely helps the patient.
4. Antimiasmatic medicine in slow responding cases and in preventing re-occurrences: antimiasmatic prescribing such as Sulphur, Thuja, Medorrhinum, Nitric acid and even Tuberculinum help to relieve the patient permanently from his complaints.

Miasmatic predominance: As Polypus are mucosal overgrowths so they are chiefly Sycotic but they flareup on the Psoric ground. If we give a look to the pathogenesis of polyp we can know the predominant miasm.

Onset age- Since it is common to young and adults so it has predominant Sycotic miasm.

Risk factors: Hypersensitivity to allergens leads to allergic rhinitis and then polypus- this shows its psoric predominance in early developing phase.

Pathology: Appearance like a tumour shows its Sycotic predominance.

So we can conclude that Nasal Polyps are predominantly Sycotic in nature.

Therapeutics:

Allium cepa

Sneezing, especially when entering a warm room. Copious, watery and extremely acrid discharge. Feeling of a lump at root of nose. Fluent coryza with headache, cough, and hoarseness. Polypus.

Alumen

Lupus, cancer, polypi of nose, sanious discharge, especially when ulceration is present.

Calcarea carb

Swelling of nose and upper lip in children, with acrid discharge

•  purulent, thick, or yellow-red discharge, making lip sore
• red itching pustules on upper lip and cheeks
• nose swollen inside and outside
• impaired smell
• epistaxis frequent and profuse, almost to fainting
• loud breathing through nose.

Cadmium sulph

It is very useful in ozena. Polypus, caries of the nasal bones, boils on the nose, ulcerated nostrils, etc. are cured.

Conium mac

fibrous polypi, hard and elastic, pricking and itching after touching or handling, excessively acute smell, with purulent discharge.

Kali bichrom

Great dryness of nose, with feeling of pressure in nasal bones; also extending along frontal sinuses with soreness and burning.

 Tickling, like a hair moving or curling itself in top of left nostril.

• Sneezing (in morning).
• Violent shooting pains from root of nose along left orbital arch.
• Pinching pain in bridge, better by hard pressure.
• Pressure at root of nose.
• Nose stuffed up.
• Nasal speech.
• The sensation of a hard substance compels one to blow the nose, but there is no discharge from the dry nose.
• When blowing nose violent stitches in right side of nose, and sensation as if two loose bones rubbed against each other.
• Expired air feels hot in nose.
• Scab on septum.
• Septum ulcerates.
• Round ulcer in septum.
• Small ulcers on edge of (right) nostril, violent, burning when touched.
• Discharge of large masses of thick, clean mucus from nose; if that ceases he has violent headache; pain from occiput to forehead.
• Watery secretion with great soreness and tenderness of nose.
• Discharge of tough green masses from nose.
• Discharge of hard, elastic plugs (clinkers) from nose.

Lemna minor

Foul smell in nose, or loss of smell.

• Smell of strong-scented flowers before intolerable can now be borne.
• Feeling of cold in nose better, sense of obstruction nearly gone.
• Nose blocked with polypi became almost cleared with Lemna after Calc. 200, followed by Merc. 3 (given for faceache); - previously Lemna had been given without effect.
• Nasal polypi in man, 60; markedly worse in wet weather; after taking Lemna 3x gtt. v. three times a day for a month said, "That is the best tonic I have ever taken"; and he could breathe quite comfortably.
• Polypi which swell in wet weather.
• Nostrils plugged by swollen turbinates.
• Ozaena since childhood in girl of sixteen; odour most offensive; bad taste; takes cold easily in night air or damp; bowels and catamenia irregular, greatly relieved by Lemna.
• Post-nasal ulceration high up, dry feeling at top of throat with flatulence, much catarrhal pharyngitis; two weeks after dose of Lemna nose less blocked and better in every respect; colic and diarrhoea followed.
• Stuffiness of nose relieved; simultaneously an attack of diarrhoea.
• Turbinate bones swollen.
• Crusts form in right nostril, pain like a string extends from right nostril to ear, which is deaf (greatly relieved).

Sangunaria can

Often useful in polypus accompanied with sick headache.

Teucrium m v

Sensation of obstruction in nose.

• Tingling in nose.
• Frequent sneezing, with tingling in nose; with crawling in nose without coryza.
• Stinging, lancinating pain in upper part of the nasal cavity.
• Violent crawling in right nostril, with lachrymation of right eye.
• Sensation as if nostrils were stopped; blowing nose or sneezing does not remove the obstruction; nasal polypus.
• Obstruction of nose.
• Polypus, with stoppage of the nose on the side he lies on; large red pimple under right nostril, near septum, sore and smarting to touch.
• Fluent coryza in open air.