Nasal Polyp Surgery: Removal Procedure, Risks, Recovery Time

Nasal Polyp Surgery or Polypectomy is a surgical procedure done to remove polyps from the lining of the nasal and sinus passageways. The type of procedure required to remove the polyp depends on where the polyps are located in the nasal cavity.

Nasal polyps are noncancerous (benign) growths that may resemble a cluster of grapes. They may be located near the front of your nose or farther back, in your sinuses. They primarily cause breathing problems, loss of olfaction and the development of ongoing and chronic infections in the surrounding area.

Anatomy and Physiology of Nasal Cavity

1. The nasal cavity is referred to the interior of the nose. It extends from the external opening (nostrils) to the pharynx (upper section of the throat) and thus is the first of a series of structures which forms the respiratory system.
2. The cavity is separated down from the middle by a cartilage known as the nasal septum. 
3. Further, the nasal cavity can be divided into:
   1. Nasal vestibule: the dilated area at the nostril.
   2. Respiratory section: the passage through which air enters and exits the body
   3. Olfactory region: the region which contains receptors for smell sensations.
4. The cavity is entirely lined by the nasal mucosa which forms the physical barrier of the body’s immune system. 
5. The structures within the nasal cavity regulate the flow of the air into the respiratory system, regulate the sense of smell, and also is responsible for protecting against the invasion of infectious and allergenic pathogens.

Nasal polyp surgery is generally performed to remove the polyps from the nasal cavity. However, undergoing nasal polyp surgery also help treated conditions such as:

1. Asthma
2. Chronic sinus
3. Sleeplessness
4. Aneurysms
5. Sinusitis

Doctors recommend nasal polyp surgery to adult males and females when medications cannot shrink or eliminate nasal polyps and the following nasal polyp symptoms persist:

1. Difficulty breathing through your nose
2. Decreased sense of smell
3. Decreased sense of taste
4. Recurring sinusitis

Nasal polyp surgery is a minimally invasive surgery that usually takes 30 to 60 minutes to complete depending upon the patient’s age, other medical conditions of the patient, number and size of the polyps. The procedure is performed under general anaesthesia to keep the patient comfortable. The procedure is performed by an ENT (ear, nose, throat) specialist along with other professional medical staff. The following steps are involved during the procedure:

1. The surgeon will advise the patient to be supine on the operation table. In this position, the patient will be lying down on his back.
2. The anesthesiologist will administer general anaesthesia to prevent any discomfort during the surgery.
3. No incisions will be made at any stage of the surgery, and the entire procedure is performed through the nose.
4. Once the patient's condition stabilises after the anaesthesia administration, the surgeon will start the procedure.
5. A surgeon can conduct the surgery by two techniques. The technique chosen depends on the location of the polyp in the nose.
   1. Intranasal polypectomy: 
      1. If the polyp is easily located in the nose, the surgeon conducts an intranasal polypectomy.
      2. The surgeon uses a small surgical grasper to remove the polyp.
      3. In the case of larger polyps, the surgeon may be able to remove them using an instrument called a microdebrider.
   2. Endoscopic nasal polypectomy: 
      1. The surgeon will insert a small tube with a lighted magnifying lens or tiny camera (endoscope) into the nostrils to identify the location of the polyp.
      2. This is the surgeon to see the polyps more clearly, especially when the growths are located deep in the cavities.
      3. Once the surgeon locates the polyps, he/she removes them with a microdebrider or surgical graspers.
6. The patient will then be shifted to the recovery room.

The patient may expect the following before or on the day of the surgery.

Before Nasal Polyp Surgery

A patient may expect the following before the surgery:

1. The patient must consult a doctor if the symptoms persist for more than two weeks as the symptoms are quite similar to the common cold.
2. The doctor would ask the patient about the symptoms, medical history, family history and the medications taken by the patient.
3. The doctor might consider examining the patient’s condition by prescribing some tests: blood test, CT scan and certain allergy tests to clarify the situation.
4. The doctor might also consider testing the vision and eyesight.
5. The patient may be advised to temporarily discontinue some medications, such as aspirin.
6. The patient might also be advocated to reduce the physical activities and exercise until further discussion with the doctor.
7. The doctor might also recommend the patient fast for a certain period before the surgery.
8. The doctor will explain the detailed surgery procedures, duration of the surgery and hospital stay, and how to prepare for the surgery.

On the day of Nasal Polyp Surgery

1. The patient must reach the hospital before the scheduled time for the surgery.
2. The patient will be asked to sign a consent form before the surgery.
3. The staff will instruct the patient to remove jewellery, dentures, and contact lenses before the surgery.
4. The staff will ask the patient to change their clothes and wear gowns.
5. The staff will also wrap a hospital information band on the patient's wrist. This band will have information about the patient's characteristics and the procedure he/she will undergo.
6. A nurse will place an intravenous catheter in the patient’s hand or forearm, and then general anaesthesia will be administered.
7. The vitals of the patient will also be monitored.
8. The patient will be shifted to the operation theatre for the procedure.
9. The surgeon might also start by cleaning and drying the surrounding area of the nose to reduce the risk of any infection.

A patient who has undergone nasal polyp surgery can expect the following after the surgery:

The recovery process at the hospital

1. Post-surgery, the patient will be moved to the hospital ward so that he/she can recover.
2. The patient will be kept in observation until the after-effect of anaesthesia wears off.
3. The patient might experience some bleeding from the nose shortly after the operation.
4. The patient will be prescribed nasal saline douche (salt water) to rinse the nose and some medications including steroids and antibiotics to prevent infections.
5. Once the patient’s condition stabilises, he/she will be discharged on the same day.

Recovery process/expectation after hospital discharge

1. Instructions provided by the doctor must follow at home.
2. The doctor will probably ask the patient to avoid these things in the first few days after the operation:
3. Blowing the nose
4. Lifting anything heavy
5. Bending over so far that your head goes below your waist
6. The patient might be given a nasal steroid spray to prevent the recurrence of similar conditions in the future.

First follow-up appointment

1. The first follow-up appointment will be scheduled within a week after the surgery.
2. The doctor will check the nasal passage to see if they are healing and if there is any need to remove any other unwanted material in the nasal path.
3. The doctor might also check if there is a need to install some tubes to reduce the risk of inflammation.
4. The doctor might consider the resumption of other medications and drugs that you might have stopped consuming before the surgery.
5. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area.
6. The doctor will advise the patient for further timely follow-ups as well.

Nasal polyp surgery is a simple and safe procedure with several benefits that helps improve the quality of life of an individual. Below mentioned are some of the benefits of nasal polyp surgery.

1. Improve breathing function
2. Prevents rare but serious problems like complex sinusitis
3. Relief from congestion and nasal obstruction
4. Restore the sense of smell
5. Reduces sinus pressure or infections

Like any surgical procedure, nasal polyp surgery has risks and complications. These include:

1. Allergic reaction from the anaesthesia
2. Damage to nerve endings in the nose
3. Damage to eyeballs leading to loss of vision
4. Tear duct damage

When is consultation with the doctor needed?

The patient must consult the doctor immediately if he or she experiences:

1. Severe bleeding from the nose
2. Pain
3. Infection
4. Common cold symptoms

Delaying a nasal polyp surgery can increase the severity of the pain and discomfort in the nose as well as worsen the symptoms of the problems. Below mentioned are some of the common risks of delayed nasal polyp surgery:

1. Chronic sinus infections
2. Asthma or asthma-like conditions
3. Sleeplessness
4. Might lead to meningitis in the areas surrounding the nose
5. Blood clots
6. Aneurysms: Formation of a bulge in an artery
7. Weakening of eyesight

The cost of nasal polyp surgery ranges from ₹25,000 to ₹90,000. The cost varies based on the following factors:

1. Age of the patient
2. Type of the procedure done
3. Technique and equipment used
4. The medical condition of the patient
5. The type of hospital facility availed - individual room or shared.