Symptoms.
—They produce nasal obstruction, with irritation; more or less discharge of watery or acrid mucus, the latter sometimes leading to excoriation; while by pressure they produce headache, especially when located high in the nose, or deafness, as when they press upon the Eustachian outlets, or symptoms of sinusitis according as they invade one or other of the sinuses. Other reflex symptoms, such as facial neuralgia, reflex cough, lacrymation, and conjunctivitis, frequently accompany them, and mouth breathing and snoring are almost inevitable consequences. The voice becomes impaired, as does occasionally the sense of taste.
In most cases they are easily revealed by artificial illumination and exposure with the nasal speculum. In color they are usually pinkish, and may be seen to move with the respiratory effort. While it is usually easy to see at least some of them, when present, it is difficult to detect their exact point of origin. With the rhinoscopic mirror they may be seen projecting into the nasopharynx. Occasionally one will be detached by violent effort at sneezing or blowing the nose.
Fig. 479
Jarvis snare.
Aside from the danger of retained secretion, which they may bring about, and that attending their extension into adjoining cavities, there is in elderly people at least an actual possible danger of their undergoing malignant transformation, although this is not common. There is, however, good reason for their removal, and none for allowing them to remain, for they are always both irritant and obstructive.
Treatment.
—Almost every other method of treatment has yielded to that of removal by the Jarvis snare, or its equivalent, supplemented by the occasional use of forceps. In order, however, to expose them sufficiently to permit of removal it is often necessary to cut away a portion of the middle turbinate. In extensive polypoid disease this would be practically always required, and it should be done thoroughly, for nasal polypi tend usually to recur unless radically attacked. Local anesthesia is sufficient for the majority of cases, but an aggravated instance will call for complete anesthesia and thorough work, especially if the accessory sinuses have been infected.
The snare figured in [Fig. 479] is a type of instrument which can be used to great advantage in dealing with these cases. When, however, it cannot be made effective by being applied around the actual base of each growth its use should be supplemented by that of the curette. No actual assurance can ever be given that there will be no subsequent development of polypi. Nevertheless it does not follow that new polypoid development is of the actual nature of recurrence. It may occur independently from the same causes that produced its first appearance.