Why Doctor – Nasal polyposis, according to a survey conducted for the Sanofi Genzyme Show, is a poorly understood disease. Can you explain to us what this is?

Dr. Elsa Darnali Nasal polyposis, also known as nasosinus polyposis, is a form of chronic sinusitis. It is an inflammation of the mucous membranes at the level of the upper respiratory tree, ie the nose and sinuses. It concerns about one million patients in France and is a disease that the general public really poorly understands. It is characterized by fairly non-specific signs, nasal obstruction with difficulty breathing through the nose, discharge, pain, a feeling of pressure in the face and forehead, and smell disorders that can lead to a complete loss of this sense, called Have anosmia We speak of chronic rhinosinusitis when the disorder lasts for more than three months.

– How can it be differentiated from a cold or non-chronic sinusitis?

For a simple cold, there is no reason to stay longer than three months! So periods can be challenging and in fact, we do not necessarily have nasal polyposis when we have these signs. To make this diagnosis, an examination should be performed that makes it possible to visualize any polyps, which is carried out at an ENT doctor with nasal endoscopy. Polyps are actually growths that look like tiny grains of grain that can be seen by looking inside the nose. If we have the symptoms we just talked about and have polyps on one side or the other, we can talk about nasal polyposis.

– Could a link exist between nasal polyposis and allergic reactions like hay fever?

There has been a lot of discussion about this. In the current state of knowledge, the answer is no. On the other hand, people with this type of allergy actually have more cases of polyposis and will exacerbate symptoms. But it is not allergies that cause polyposis, nor the other way around.

Does nasal polyposis increase the risk of covid infection?

Recent studies suggest that there is no longer a risk.

– At what age can nasal polyposis appear?

Nasosinus polyposis is a disease of adulthood that tends to occur in your late thirties or early forties. Both sexes can be affected, but males are slightly more likely than females.

– Do we know the causes of this disease?

The reasons are not well known. There are factors that have been discussed, especially the role of the environment, of pollution, but it is not really certain, we are also talking about Staphylococcus aureus … However, from what we do know, is that it is often associated with asthma. Asthma occurs in about 50% of patients with nasal polyposis. It is certain that there is inflammation in the underlying mechanism that is chronic, an imbalance in the inflammatory balance that can lead to inflammation of the respiratory tree.

What effect can this disease have on daily life?

It’s a disease that can be considered benign… although it can have huge consequences: a permanently blocked nose, the fact of a runny nose, it may already have social implications, we don’t feel very comfortable Huh; And then there are sleep disorders that are caused by this congestion of the upper airways, difficulty breathing through the nose, and who’s to say sleep disorders called fatigue, irritability, difficulties at work, and then there are psychological consequences. , patients feel isolated and become somewhat depressed, in which case there is a significant exacerbation of anxiety.

It is said that nasal polyposis can cause loss of smell. Is it for everyone who suffers from it?

There is no loss of smell in 100% of patients. In some patients it may be permanent, but in others it may be intermittent. But smell disturbances are actually part of the signs that point to nasal polyposis, and a significant proportion of patients have odor disturbances that can lead to complete anosmia. This is one of the most troublesome symptoms for patients. People whose polyposis causes anosmia have the highest tendency to have depressive disorders, they suffer from feelings of isolation, a sense of being misunderstood, living like a bubble… above all, they are handicapped on a daily basis, from questions such as “do I smell bad”, to the absence of enjoyment of the table, to being able to feel and share the taste of what they eat. Smell and taste are very linked, And then there’s the possibility of a hazard from sniffing, for example, the smell of gas, fire smoke or the smell of unhealthy food. Many patients say that by losing their sense of smell they lose their compass and that some of their feelings, memories, the aroma in the air and everything that comes with it have been the subject of many literary works. !

– In the survey conducted, some patients developed suicidal urges related to this loss of smell after nasal polyposis. Can its consequences go that far?

This is one of the revelations of this survey, this result comes out very, very strongly from this survey and it was hard to imagine that it went that far. But so far no study has confirmed or refuted this element. The survey data should also be interpreted in the context of the health crisis that has worsened the mental health of the French. But remember that the link between nasal polyposis, loss of smell, and depressive syndrome is real.

How can nasal polyposis be treated?

There are local treatments, general treatments and surgical treatments that are effective. The choice of treatment depends on the severity of the attack. There are many patients who will find relief with local treatments such as a corticosteroid spray sometimes combined with a wash with physiological saline. But there are more severe forms that will not provide relief and that require corticosteroid pills which often provide temporary relief, very useful treatments but which are not abused because of the risk of serious side effects such as gastrointestinal disturbances, heart disease, diabetes or needed. Even osteoporosis. Another level of treatment is surgery, which aims to remove the polyps to open the airway. But not all of these treatments cure the root cause and the risk of recurrence exists for some patients, including after surgery.

– Does surgical treatment include major interventions?

In the majority of cases, this is done through the endonasal route with general anesthesia. The postoperative effect is mainly nose bleeds, but these operations may involve risks of eye or cerebrovascular complications because of the proximity of the sinuses to these organs.

– In case of anosmia, what is the management?

The mechanism of anosmia in polyposis is not yet fully understood. There are several components: first nasal obstruction and an inflammatory phenomenon affecting the mucous membranes. surgery will help free the obstruction; Corticosteroids can treat inflammation. There are new treatments that should be available soon, for polyposis when it causes anosmia, these are biotherapies that will target a specific element in inflammatory dysfunction. They show efficacy on various aspects of polyposis. These treatments by long-term subcutaneous injection will be addressed specifically to patients suffering from severe forms that have not been relieved by current care.

Below: Program question aux specialist on the therapeutic turn of biotherapy in nasal polyposis: