Dr. Ashok Yadav1, Dr. Kanika Agarwal2, Dr. Yogita Kumari2
1 Professor & Head of Department, Department of Practice of Medicine, Dr. MPK Homoeopathic Medical College, Hospital & Research Centre (under Homoeopathy University), Jaipur, Rajasthan, India
2 PG Scholar (Part-I), Dr. MPK Homoeopathic Medical College, Hospital & Research Centre (under Homoeopathy University), Jaipur, Rajasthan, India
Nasal polyps are hypertrophied oedematous mucosa and sub mucosa of nose and paranasal sinuses appearing as smooth, round, semi-translucent pale masses. Their aetiology remains unclear, but they are known to have association with allergy, asthma, infection, cystic fibrosis, and aspirin sensitivity. Patients with nasal polyposis may present clinically with complaints of nasal obstruction, congestion, hyposmia , rhinorrhea, postnasal drip, headaches, and snoring. Nasal polyps can be managed and treated with homoeopathic medicines which are selected on the basis of symptom similarity.
KEYWORDS- nasal polyp, homoeopathy
Nasal Polypi are non-neoplastic masses of oedematous nasal or sinus mucosa. Depending on the site of origin they are divided into two main varieties: Bilateral ethmoidal polyp and Antrochoanal polyp. Ethmoidal polyp are more common ,generally multiple, nearly always bilateral ,appear as grape like masses and are usually visible on anterior rhinoscopy or may even appear at the nostril . Antrochoanal polyp arise from mucosa of maxillary antrum and its assessoy ostium, comes out of it and grows in choana and nasal cavity. It is usually unilateral and diagnosed by posterior rhinoscopy.
The exact etiology of nasal polypi isnot well understood but it may arise in inflammatory conditions of nasal mucosa( rhinosinusitis), disorders of ciliary motility or abnormal composition of nasal mucus. Various diseases associated with it are chronic rhinosinusitis, asthma, aspirin intolerance, cystic fibrosis, nasal mastocytosis, young syndrome and kartagener’s syndrome.
Polypi are the end product of prolonged edema in the mucosa of nose and sinuses. The submucosa around the middle meatus is especially lax and easily waterlogged, causing swelling of the tissues. Although polyps can grow from any part of the nose or sinus but they commonly originate in region of middle turbinate and ethmoids. Similarly in the small cells of ethmoidal labyrinth the mucosa membranes swells to occupy all the lumen, and then projects through the ostia into the nose. Then it becomes constructed at ostia thus forming the polyp.
Nasal stuffiness due to nasal obstruction, partial or total loss of smell, headache due to associated sinusitis, sneezing and watery discharge of nose due to associated allergy and mass protruding out of nostril are the presenting symptoms in nasal polyp.Voice may become dull due to hypo nasality
Bilateral ethmoidal polyp are seen on anterior rhinoscopy as smooth and glistening, grape like masses often pale in colour, which may be sessile or pedunculated. Antro chondral polyp are seen on posterior rhinoscopy as globular, smooth grayish mass covered with nasal discharge. A large polyp may protrude from nostril and show pink congested look on its exposed partor hang down behind the soft palate and present in oropharynx.
They are insensitive to probing and do not bleed on touch
- Blob of mucus: It may look like a polyp but disappears on blowing the nose.
- Hypertrophied middle turbinate: It is pink in color and hard like bone and can be easily differentiated from polyp with probe testing.
- Angiofibroma: It usually occurs in adolescent males and present with profuse recurrent episodes of epistaxis. If suspected, it should not be probed because that can cause brisk bleeding. X-ray lateral view soft tissue nasopharynx shows presence of a column of air behind the polyp. 
- Malignancy: They are fleshy pink in appearance, friable in nature and have tendency to bleed on touch. Some time a polyp may masquerade a malignancy, so all polyps are subjected to histology. 
- Pediatric masses: Mucoviscidosis, gliomas and encephalocele. Encephalocele, which should be aspirated (CSF), as they presents like a polyp. 
Nasal polyps can be easily clinically diagnosed by anterior and posterior rhinoscopy.
Investigations like PNS-X ray, X-ray lateral view-soft tissue nasopharynx, CT scan and histopathological examination can be done to rule out other pathology.
MANAGEMENT AND TREATMENT
Small polypi occasionally undergo spontaneous regression if the cause is removed with the help of antihistaminics and steroids. However in majority of instances polypi must be removed surgically.
Homeopathy is a system based on “Law of Similars” which means it treat the disease with medicine producing similar symptoms when given in healthy individuals. Therefore medicines are selected on the basis of Totality of Symptoms.
It is evident from past researches that homoeopathy is effective in management of nasal polyps. A prospective, open, non-randomized, single arm, observational trial of pre-post comparison design was conducted on 44 patients suffering from symptomatic nasal polyps. Sino-nasal outcome test (SNOT-20) and European Quality of Life (EQ-5D-5L) questionnaires were taken as the primary and secondary outcome measures respectively; assessed at baseline and after 3 months. Individualized homoeopathic medicines were prescribed on ‘totality of symptoms’. has revealed complete regressions of polyps in 23 (58%) cases. Statistically significant improvements were observed in both the subjective patient-rated outcomes – mean reduction of SNOT-20 scores.
Representation of nasal polyp related rubrics in Repertories-
|REPERTORY||CHAPTER AND/OR RUBRIC||SUB-RUBRIC||INDICATED MEDICINES|
|Kent||NOSE – polypus (34 medicine are given)||Right||Kali-n.|
|Left||Alumn,Apis, Calc,Merc – i -r|
|Bleeds easily||Calc, calc-p , Phos, Thuj.|
|BBCR||NOSE- Polypi, hypretrophies(21 medicine are given)||Aur, aur-mur, bell, Calc-c, cad-s, con,grap. ,Kali-bi, kali-n, mar. ,merc., merc-aur.,nit-ac., pho., pul.,sang., sep.,sil.,stap.,sul.,thu.|
|Boericke’s Repertory||NOSE-ERUPTIONS,growths||Polypi||Cadm. s., Calc. c., Calc. iod., Calc. p., Caust., Cepa, Con., Formica, Kali bich., Kali n., Lemna m., Merc. i. r., Nit. ac., Phos., Psor., Sang., Sang. n., Staph., Teucr., Thuya, Wyeth.|
|Clarke in ‘The Prescriber’||Polypus||Of NOSE||Thuj.,Formica.,Calc c., Kali nit., Kali bichr., Nit ac., Teucr.|
|Nash in “Leaders In Homoeopathic Therapeutics”||Polypus||Calc., Thuj., Mar-v. |
|Knerr Repertory of Hering Guiding Symptoms||NOSE- Polypus||Antrum Highmorii, 1st in, deforming face, forcing eyeball upward, everting lid, obstructing nostrils into mouth, so that breathing and mastication were impeded||Hecla.|
|Bone, extended to ethmoid, into choanæ and into antrum of Highmore||Teucr.|
|Large, after a severe, badly-treated cold||Teucr.|
|Left side, in||Alumn.|
|Mucous, of pale red color, on left side, and of large size, mostly in anterior nares, and in plain sight||Teucr.|
|Mucous, greenish white, attached to upper turbinated bone, and completely filling nasal cavity and causing occlusion, after repeated attacks of coryza||Teucr.|
|Mucous, large, of right side, distending nose||Kali-n.|
|Nose, with stoppage of, on side he lies||Teucr.|
|Recent, or of long standing||Kali-bi.|
|Removed every 2 or 3 years by operative means, for 30 years||Teucr.|
|Right nostril, in, growing more rapidly after each attack of headache, which was better by camphor||Kali-n.|
|Right nostril, occupying entire, projecting slightly||Teucr.|
|Smell, with loss of||CALC.|
|Water, much discharge of mucus and||Teucr.|
|Weather, enlarges in wet||Teucr.|
|Women, especially among old and middle-aged||Teucr.|
|Year’s, of 1, duration||Teucr. |
Symptomatic indications of some homoeopathic medicines-
- AGRAPHIS NUTANS
Nasal polyps obstruct the nostrils; enlarged and inflamed tonsils; throat deafness.Tendency to catch cold and free discharge from mucus membrane on every exposure to cold wind. 
- ALLIUM CEPA
Sneezing, especially when entering a warm room. Copious, watery and extremely acrid discharge. Feeling of a lump at root of nose. Hay-fever. Fluent coryza with headache, cough, and hoarseness Polypus.
- AMMONIUM MURITICUM
Free acrid, hot watery discharge corroding the lip.Sneezing.Nose sore to touch; ulcerative pain in nostrils. Loss of smell. Obstructed, stuffy feeling; constant and unavailing efforts to blow it out.Itching.
- AMMONIUM CARBONICUM
Discharge of sharp, burning water.Stoppage at night, with long-continued coryza. Cannot breathe through nose. Snuffles of children. Epistaxis after washing and after eating. Ozaena, blows bloody mucus from nose . Tip of nose congested. 
- CADMIUM SULPH
Ozaena. Tightness at root. Nose obstructed; polypus.Caries of nasal bones. Boils on nose. Nostrils ulcerated.
- HEPAR SULPH –
Sore, ulcerated. Soreness of nostrils, with catarrhal troubles. Sneezes every time he goes into a cold, dry wind, with running from nose, later, thick, offensive discharge. Stopped up every time he goes out into cold air. 
- KALI NITRICUM
Sneezing.Swollen feeling; worse, right nostril.Point red and itching. Polypus. 
- LEMNA MINOR
Putrid smell; loss of smell. Crusts and muco-purulent discharge very abundant. Post-nasal dropping.Pain like a string from nostrils to ear. Reduces nasal obstruction when it is an oedematous condition.Dryness of naso-pharynx.
Ozaena, with profuse, offensive yellowish discharges. Nasal polypi. Coryza, followed by diarrhoea.Chronic rhinitis; membrane dry and congested Ears.
- SANGUINARIA NITRICUM
Feels obstructed. Profuse, watery mucus, with burning pain. Enlarged turbinates at beginning of hypertrophic process. Secretion scanty, tendency to dryness. Small crusts which bleed when removed. Post-nasal secretions adherent to nasopharynx , dislodged with difficulty. Dry and burning nostrils; watery mucus, with pressure over root of nose.Nostrils plugged with thick, yellow, bloody mucus.Sneezing.Rawness and soreness in posterior nare.
- STICTA PULMONARIA
Feeling of fullness at the root of the nose. Atrophic rhinitis. Dryness of nasal membrane. Constant need to blow the nose, but no discharge. Dry scabs, especially in evening and night. Hay-fever; incessant sneezing.
- TEUCRIUM MARUM VERUM
Catarrhal condition of both anterior and posterior nostrils. Mucous polypus. Chronic catarrh ; discharge of large, irregular clinkers. Foul breath. Crawling in nostrils, with lachrymation and sneezing. Coryza, with stoppage of nostrils. 
- GERANIUM MACULATUM –
The tincture should be applied over the Nasal Polyps once a day ,the tumour will shrink speedily.
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