polyps | The New York Otolaryngology Group

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I am a teacher with a vocal cord polyp. What can I do to reduce it?

Question:

I have been teaching for 24 years. I suffer with laryngitis. March 5th, 2014, the ENT told me I have a polyp in my throat and by April 23rd, 2014 he said it had grown a little bigger. What can I do to reduce it? If I can’t reduce and need surgery, what would be the cost?

Answer:

Thank you for your question.  Vocal cord polyps are growths on the vocal cords.  It is first, most important, to make sure that these are not tumors or cancers.  Often, your ENT doctor can tell pretty well by the examination- but not always.  If there is any question, a vocal cord polyp needs to be removed and biopsied-  This is generally done in the operating room, with a microscope and a lighted tube in the throat, and takes but a few minutes to do in the operating room as an outpatient.   Generally,  but not always, the voice will improve from this procedure.

Benign vocal cord polyps and nodules may be caused by vocal abuse- and are quite frequent in teachers.  It your doctor feels that is the case,  he or she would likely recommend voice/speech therapy.  Additionally, we might recommend vocal rest (difficult for teachers) and sometimes a brief course of prednisone to bring down swelling.   Speech therapy is to help train you to project your voice in the suboptimal acoustic environment that is the classroom, without as much trauma as you may be having.  We may also treat for reflux, as gastric acid can irritate the vocal cords and predispose you to forming polyps and nodules.  Of course, smoking and alcohol are also risk factors for developing growths on the vocal cords- and can predispose to both benign and cancerous growths.

Most benign vocal cord polyps and nodules are medically treatable, and do not frequently require removal- especially since they are likely to come back if the cause has not been resolved.

Robert Pincus MD, FACS

NY Otolaryngology Group- NY Voice Center

Associate Professor Otolaryngology NY Medical College

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Can you send any encouraging word?

Question:

On 10/1, my 41 yo daughter had surgery for removal of a moderate-sized nasal polyp and sinus surgery. For months prior to the procedure, she received antibiotic & steroid therapy in an attempt to help with chronically infected & painful frontal sinuses & a blocked passage.

Unfortunately, on the second post-op day, she developed excruciating headache and eye pain on the side of surgery (R). It became so severe that she was told to see the surgeon yesterday, 10/5, when she reported stabbing pain along the right cheek, into her eye & head.  The surgeon suctioned her of quite a bit of debris, started her on saline rinses and told her to take two Vicodin q 6 h, and one Aleve  at the midway point of the Vicodin doses. Additionally, she is on 30 mg of Prednisone daily x5 days, to decrease tomorrow to 20 mg daily x 5d, then 10 mg daily x5d, then discontinue.

My apprehension about her pain has grown tremendously since googling sinus post-procedural pain & the rare risk of eye or brain issue following this procedure.  My daughter had an MRI in addition to the normal  CT scan prior to procedure since the surgeon felt he needed to more definitively tell whether or not the lesion in her nose was a polyp vs encephalocele, due to its position. Following surgery, he did state that it definitely was not an encephalocele. Although it is the weekend, my daughter was told to call (the surgeon) if any vision problems at all occurred, which thankfully has not happened.

I would so appreciate any information or tips you may give.  I assume it is too early to think about having my daughter see an ENT or other specialist (?) at the Univ. of Miami at Jackson Memorial, a 1-2 hr trip from home.  I am not sure how soon she could be seen either, but am afraid of “waiting this out” to see if her vision becomes affected????  Any help would be MOST appreciated.

Can you send any encouraging word?

Answer:

Thanks for your note.

I wish I could answer completely without knowing your daughter and her surgery more personally.  However, as you know, complications with the eye and even intra-cranial (brain) complications are possible, but quite rare with nasal and sinus surgery.  As a surgeon, I would be quite concerned should my patient have significant pain after surgery (it is rare as well).  However, it sounds like the surgeon checked to see that there was no complication at the visit.  Should there have been a complication with the eye, one would be most concerned about visual loss, double vision, getting black and blue around the eye or loss of vision.  It sounds like she has not had any of those issues.  Intracranial complications (brain fluid leaks, etc) rarely cause such pain either.  One would most likely see a clear fluid discharge-  Headache would be possible if there were meningitis- but one would expect other findings as well, such as a stiff neck.

It sounds like she is in good hands (appropriate to have checked to see with MRI as well as CT that this was not an encephalocele) and I would follow up as your daughter’s surgeon suggests.
Should she have questions or concerns, of course we’d be happy to see her up here at the NY Sinus Center.  One wonderful sinus specialist closer to you is Donald Lanza- in Tampa.  But by your description alone, I do not see anything that makes me feel your daughter’s care has been anything but good or that she needs other urgent intervention.

I hope this helps clear things up.

Robert Pincus MD
NY Sinus Center

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Sense of Smell Lost – But Returns Temporarily With Oral Steroids

Question:

I haven’t been able to taste or smell for about a year and a half. I recently (May 14) had sinus surgery to remove polyps. The question nobody can answer is that when I am on steroids for a sinus infection my smell and taste return and once done with the steroid or as it tapers off I lose them again. Do you have any ideas on how to correct this? I believe if it works while on steroids then it isn’t really broken?

Answer: 
While we tend not to think of smell and taste as important as our other senses, clearly its loss can interfere with the enjoyment of life-and our safety. We use the senses of smell and taste to help us avoid spoiled foods as well as to alert us to noxious/unsafe chemicals and fire.
Taste fibers are on the bottom of our tongue, and not really affected by nasal and sinus disease.  But since smell is such a large part of what we perceive as taste, we perceive the loss of taste as well.
Smell fibers are located in the top of the nose-  and extend directly into the brain from there. We lose the ability to smell if there is a damage to these fibers (often from an infection or trauma) or if air doesn’t get there. We all have noticed the loss of the ability to smell when we are congested with a cold or bad allergies. Nerve damage is often permanent. Loss from nasal obstruction may be transient.
If the sense of smell returns at times, this is not a permanent loss. In your case, it is likely the congestion of the nasal lining around the smell fibers that obstructs your sense of smell. When we remove polyps from the nose, we usually cannot remove all of the swelling around the smell fibers as they are quite close to the thin wall separating the nose from the brain (cribiform plate).  In any case, whatever causes the polyps in the first place, is likely to continue to cause the nasal and sinus lining to be swollen after surgery. Oral steroids, such as medrol or prednisone, are the most effective medications we have in shrinking down polyps and in your case are effective enough to bring back your sense of smell. However, because of the side effects of prolonged use, we try to minimize the use of oral steroids. We prefer to use other medications that are less likely to cause side effects- but these also are often less effective. We use nasal steroids- sprays, rinses and/or nebulizers that are less likely  enter the blood stream. We use oral and nasal antihistamines if one is allergic-  we would suggest other medications such as singulair- and allergy desensitization if you are allergic.
There is the possibility that there are further polyps to be removed surgically- and this should be evaluated. Lastly, some patients and their sinus doctors will use the smallest dose of oral prednisone from time to time that works judiciously- balancing against the potential for long term side effects. I have one such patient who chooses to take a small dose of steroids once or twice a year, before his vacations.
In your case, I would try to use all of the more conservative measures on a regular basis first. We have found Budesinide rinses and nasal nebulizer treatments to be two of the more promising topical treatments that are often overlooked. I would speak to your sinus specialist and explain your concerns and come up with a regimen that works for you and your life style. We of course would be willing to see you if you’re in the NYC area.
I hope this helps.
Robert Pincus MD
co-Director NY Sinus Center
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