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Nasal Papillomas

A nasal papilloma is a benign epithelial tissue overgrowth within the intranasal mucosa. It may be inverted or exophytic. Inverted papillomas grow into the underlying tissue, usually at the junction of the antrum and the ethmoid sinus; they generally occur unilaterally and sometimes are associated with squamous cell carcinoma. Exophytic papillomas, which tend to occur singly, arise from epithelial tissue, commonly on the surface of the nasal septum. Both types are most prevalent in males. Recurrence is likely, even after surgical excision.

Causes

Some people who are allergic to aspirin develop both asthma and nasal polyps.

Nasal polyps often plug the nose, usually one side at a time. People with allergic rhinitis are so used to having a stopped up nose they may not notice the difference when a polyp develops. Other polyps may be closer to a sinus opening, so airflow is not obstructed, but mucus becomes trapped in the sinus. In this case, there is a feeling of fullness in the head, no sense of smell, and perhaps a headache. The trapped mucus will eventually get infected, adding pain, fever, and perhaps bloody discharge from the nose.

Signs and Symptoms

The patient with inverted or exophytic papillomas typically complains of unilateral nasal stuffiness, postnasal drip, headache, shortness of breath, dyspnea and, occasionally, with exophytic papillomas, epistaxis. The patient may also have a history of nasal polyps, nasal polypectomy, or polypoid masses.

With inverted papillomas, inspection of the nasal mucosa usually reveals large lesions that are bulky, highly vascular, and edematous, with a color and consistency that varies from dark red to gray and firm to friable. Exophytic papillomas are commonly raised, firm, rubbery, and pink to gray in color. They're securely attached to the mucous membrane by a broad or pedunculated base.

Diagnostic tests

Tissue biopsy for histologic examination is used to confirm the diagnosis. A computed tomography scan shows bone destruction or erosion.

Treatment

The most effective treatment is wide surgical excision or diathermy with careful inspection of adjacent tissues and sinuses to rule out extension. Aspirin or acetaminophen and decongestants may relieve symptoms.

Prevention

If aspirin is the cause, all aspirin containing medications must be avoided.

Since most nasal polyps are the result of allergic rhinitis, they can be prevented by treating this condition. New treatments have greatly improved control of hay fever. There are now several spray medicines that are quite effective. Spray cortisone-like drugs are the most popular. Over-the-counter nasal decongestants have an irritating effect similar to the allergy they are supposed to be treating. Continued use can bring more trouble than relief and result in an addiction to nose sprays. The resulting disease, rhinitis medicamentosa, is more difficult to treat than allergic rhinitis.



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