The development of nasal polyps is associated with a variety of factors and is highly prone to recurrence, especially in children, where the recurrence rate is higher than in adults. Therefore, comprehensive treatment is currently advocated, and recurrence is inevitable with a single surgical treatment without focusing on perioperative related treatment.
Drug treatment Mainly glucocorticoid therapy, due to the use of hormones, there is a certain impact on children, should be reasonable and standardized.
(1) Smaller nasal polyps: If the polyps are small and located in the middle or common nasal tract, nasal spray hormone can be used directly twice a day for about 4 weeks, and if the polyps become smaller or even disappear, the nasal spray hormone can be discontinued after reducing the dosage.
(2) Initial larger polyps: maxillary sinus polyps with larger polyps that have reached the front of inferior turbinate or have protruded into the posterior nostril, while using nasal spray hormone twice daily, oral prednisone is also needed, once daily before 8 am for 7 days, after which the dosage should be reduced, not more than 2 weeks, and the drug should be discontinued. Antibiotics are used appropriately to fight inflammation and prevent infection. The total amount of nasal spray hormone in children should not be used continuously for more than 3 months, and those who are ineffective should consider surgical treatment.
(3) After nasal polyp surgery: nasal spray hormone treatment is still needed. Generally, nasal spray hormone is used continuously for 12 weeks after surgery, with regular review, after which the dosage should be gradually reduced and then discontinued to avoid the rebound phenomenon.
Surgical treatment For children whose conservative treatment is ineffective, surgical treatment should be considered. Currently, the mainstream is nasal endoscopic polyp removal surgery, which should open the maxillary sinus opening and open the septal sinus to reconstruct the middle nasal tract structure while thoroughly removing the polyp tissue, and should reduce the damage to the nasal mucosa to prevent recurrence.
For maxillary sinus polyps and posterior maxillary sinus nasal polyp, which are common in children, in the past 2 years, our department has used urology to effectively dilate the maxillary sinus opening with a balloon catheter and then remove the polyps in the maxillary sinus and in the nasal cavity. This procedure is simple and well suited to the own anatomical characteristics of the nasal-nasal tract complex in children, with minimal bleeding during surgery, little operating time after skilled operation, and quick postoperative recovery without common complications of traditional FESS surgery such as middle nasal tract stenosis or adhesions of the middle turbinate and lateral nasal cavity wall. Meanwhile, if recurrence occurs, it is an effective, easy and safe new method for treating maxillary sinusitis, maxillary sinus polyps and posterior maxillary sinus polyps in children because there is less damage to the structure of the middle nasal tract, leaving a larger surgical space for re-operation. The traditional view is that balloon dilation is contraindicated for occupying lesions, but for maxillary sinus polyps, after our clinical surgery and scientific research statistics in the past 2 years, we have achieved good results. Of course, for nasal polyps of combined septal sinuses, balloon dilation has its limitations and is not advocated.
It is worth mentioning that the post-operative follow-up should be strictly carried out, as the disease is very prone to recurrence in children, and the post-operative follow-up should not be less than 1 year. The postoperative nasal spray hormone (e.g., coleus, endosulfan or ryanodine) should be used continuously for three months and then gradually reduced, with the maintenance amount used for more than 6 months. Appropriate use of postoperative antibiotics and mucus promoters is necessary. Most of the children with recurrence are not well managed perioperatively, in addition to their own factors, and this needs special attention.
The treatment of nasal polyps differs from case to case, so the child must go to a regular children’s hospital to let the professional doctor decide on the treatment, and parents can contact me by phone if they have any questions about their child’s treatment.