Nasarsha (Nasal Polyps) Causes, Symptoms, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Nasal Polyps are fleshy swellings. They develop in the nasal lining and in the lining of paranasal sinuses. They are also defined as benign (non-cancerous) growths of lining tissues or mucosa of your nose.

Read – 6 Simple Home Remedies To Stop Runny Nose

Symptoms of polyps in the nose

Large polyps cause –
Difficulty in breathing
Loss of sense of smell
Blockage of sinuses leading to regular infections and other problems  

Size of polyps
Nasal polyps vary in size. They often appear like teardrops. They look like ‘grapes on a stem’ when they grow up in size.

Color of polyps
Polyps in the nose may be pink or yellowish brown in color.

Where are they found?
Nasal polyps are grown in the nostrils. They may grow in one or both nostrils / nasal passages. They either grow on their own or in clusters.

Stats and facts

Nasal polyps do not present with any significant symptoms most of the time. Thus its incidence cannot be understood to precision.
About 4-40 % of people are estimated to be affected by nasal polyps.
It is more common in males (2-4 times) than in females.
They can arise at any age but are initially found to develop in young or middle aged adults.
They are most common in adults over 40 years of age. Children under 10 years of age rarely get them. If children of this age get nasal polyps, cystic fibrosis might be the cause.
Read – Karnini – Causative Factors, Symptoms, Pathogenesis, Treatment

Who is more prone to develop nasal polyps?

Individuals suffering from below mentioned conditions are more likely to develop nasal polyps –
Asthma
Allergies
Frequent sinus infections
Children with cystic fibrosis

Symptoms of nasal polyps

Some people will not have any signs or symptoms. When present, the below mentioned are the common symptoms –
Runny nose – this may run a long course and get chronic. The patients will feel that they are always affected by cold.
Stuffy / blocked nose – is persistent and may cause breathing and sleeping difficulties
Obstruction of nasal passages and sinuses
Chronic sinusitis
Sneezing
Postnasal drip – a feeling that the phlegm / mucus / secretions of the nose are dripping back from the nose into the throat
Problems with perception of smell – the patient may not have any sense of smell or may have poor sense of the same
Problems with perception of taste
Facial pain and headache
Snoring
Itching around the eyes
Double vision – will occur in severe cases of polyps associated with cystic fibrosis or allergic fungal sinusitis

Obstructive sleep apnea (stoppage of breathing during sleep) – occurs in severe cases and is a serious condition
Infections
Most common symptoms – runny, stuffy or blocked nose

Other symptoms –
Wheezing
Sinus infections
Sensitiveness to fumes, odors, chemicals and dust- Severe allergy to aspirin
Change in shape of nose (large polyps)
Read – Atrophic Rhinitis: Ayurvedic Treatment, Home Remedies, Herbs, Medicines

Risk Factors

Allergic fungal sinusitis
Rhinitis / Rhino-sinusitis
Asthma
Allergy, intolerance or sensitivity to NSAID’s or aspirin
Cystic fibrosis
Churg-Strauss Syndrome
Young and middle aged adults
Individuals having parents having nasal polyps (genetic predisposition)

Causes

No etiological factors are found in most of the nasal polyp cases. They are also not in any way related to polyps occurring in the uterus or digestive system. In many cases non-allergic asthma is thought to be causal but no allergic / respiratory triggers have been found to confirm the hypothesis.

Some others opine that one of the below mentioned might be a trigger –
Bacterial infection
Viral infection
An allergy
Immune response to a fungus
According to some experts, disturbances in the immune system might be contributory. Nasal polyps also have something to do with chemical makeup in the lining of the nose and sinuses.

Nasal polyps are also linked to –

Allergic rhinitis
Sinus infections
Infections – acute or chronic
Foreign body in the nose
Cystic fibrosis
Asthma
Read – Vasomotor Rhinitis – Kshavathu – Meaning, Causes, Symptoms, Treatment

Pathogenesis

According to some researchers these polyps are formed due to the swelling in the nose or sinuses. The exact mechanism of pathogenesis of polyps is anyways unknown.

Nasal polyps grow around the inflamed tissue of nasal mucosa. When an infection or allergy induced irritation occurs it causes swelling and redness of nasal mucosa. Fluids drip out of the mucosa. This mucosa will form a polyp when it is irritated for a prolonged time.

Where do we find nasal polyps?
Nasal polyps can develop anywhere in the nose – in the nasal passages and most frequently near the openings of sinuses.

Diagnosis of nasal polyps

Interrogation
Nasal endoscopy
CT scan
Cystic fibrosis test (especially in children)
Skin prick allergy test
Blood tests to check levels of vitamin D

Treatment

Use of steroids and other medicines – in the form of spray, drops or tablets. These will shrink polyps. Antihistamines, antibiotics and antifungal drugs are also used to treat this condition and to control inflammation associated therein as and when needed depending on the causative agent.

Surgery – is preferred when there is not good response to medicines and other forms of treatments and also if the polyps are very large in size. Polypectomy is the most common procedure for the removal of polyps.

Natural Remedies
Tea tree oil, steam bath and vitamin D are used to treat nasal polyps. However their effectiveness in the treatment has not been confirmed.

Read – Sinusitis: Ayurvedic treatment, Remedies, Preventive tips

Complications

Large polyps will block the airflow and draining of fluids from sinuses or nasal cavities. As a consequence the one or more of the below mentioned complications might occur –
Chronic / frequent sinus infection
Obstructive sleep apnea- Double vision and wide set eyes (especially in cystic fibrosis)
Asthma flare-ups

Prevention

Humidifier – Use a humidifier if the air in your home or room is dry.
Hygiene – Wash your hands regularly. This reduces the risk of bacterial and viral infection which might cause inflammation of nasal passages and sinuses.
Avoiding irritants – including chemicals, allergens, airborne pollutants etc.
Allergy management – If asthma and allergy are promptly treated, nasal polyps are less likely to develop.

Nasal lavage / nasal rinse – Nasal lavage or saline spray may be used to rinse the nasal passages. This will help to remove allergens and irritants and also to improve the flow of mucus.

Ayurveda Understanding of Nasal Polyps

A condition called as Nasarsha explained in the context of nasal disorders in Ayurveda treatises shall be compared to nasal polyps. Nasarsha = Nasa (nose) + Arsha (pile like outgrowth). Nasal polyps are also treated on the lines of nasarsha.

Read – Arshas (Hemorrhoids), Ayurvedic Types, Causes And Symptoms

Nasarsha

The term Arshas is correlated with piles. Protrusions as seen in piles if manifested inside the nasal cavity will be called nasarsha. Master Sushruta has mentioned the symptoms of nasarsha in Nidana Sthana Chapter 2 (Su.Ni.2/19).

Important facts to know regarding Nasarsha in relation with arsha

With this we may understand that nasarsha is mentioned on the basis of its resemblance in terms of shape with piles. The etiological factors, pathogenesis and symptoms of these two conditions will not be the same. Some causative factors might be the same in both conditions because they disturb the same doshas and contaminate the same tissues to produce these two different conditions at different places of the body.
The symptoms are in accordance with the site of manifestation.

Read – Yonyarsha – Meaning, Causes, Types, Symptoms, Treatment, Remedies

Etiological factors

Etiological factors for the causation of nasarsha have not been mentioned. Here are few causes applicable for nasarsha based on inference and explanation given with respect to piles.
Foods and activities which aggravate the doshas
Suppression of urges, especially that of sneeze or forcibly producing the urge
Irritating or scratching the interior of the nasal passages by introducing foreign objects like stick (pen, pencil, needle), any hard substances which can cause injury to the nasal mucosa, exposure to irritants – dust, smoke (chemicals), cloth etc.
Not maintaining the nasal hygiene

Pathogenesis

Pathogenesis is explained on the basis of description given in the ‘pathogenesis of piles’.
1. According to Master Sushruta

Doshas either individually or collectively mixed with blood tissue get spread out in the body through the arteries of the body. When these doshas reach the nasal passages, they contaminate the nasal passages and mucus layers therein. When this happens fleshy outgrowths take place in the nose. These are called Nasarsha.

2. According to Master Vagbhata
The vitiated doshas contaminate the skin, muscles and fat tissue around the nasal cavity and cause fleshy outgrowths of various kinds and shapes. These are called Nasarsha.
Read – Ayurvedic Treatment For Non Bleeding Piles: Shushka Arsha Chikitsa

Symptoms of Nasarsha

Pratisyaya – cold
Atimatra kshavathu – excessive sneezing
Krichra uchvasata – difficulty in breathing
Putinasyam – foul smell in the nose
Sanunasika vakyatvam – the spoken words appear as if coming and pronounced from the nose
Shiro dukha – headache

Sanskrit verses

Treatment of Nasarsha

Treatment of nasarsha have not been mentioned in Ayurveda treatises. Since the condition is explained in the context of piles and its treatment, the same principles should be used for the treatment of nasarsha.

The basic 4 principles of treating nasarsha (just like arsha) are –

Medicines
Use of kshara alkali – internal and external use
Agnikarma – Use of fire cautery
Surgical methods

Formulations used in nasarsha

Grihadhuma taila – Oil processed with the below mentioned herbs should be instilled in the form of drops on the outgrowths –
Grihadhuma – soot of the kitchen chimney
Pippali – Piper longum
Yavakshara – alkali of barley plant
Turmeric
Devadaru – Cedrus deodara
Rock Salt
Paste of seeds of Achyranthes aspera

Karaviradi Taila – Oil is processed by taking equal quantities of the paste of below-mentioned herbs, oil four times of the herbs and water four times that of oil. This oil should be applied on the outgrowth of nasarsha.

Karavira – flowers of Nerium indicum
Leaves of jasmine plant
Asana – Pterocarpus marsupium

Chitrakadi Taila – Oil prepared with below mentioned ingredients should be used to apply on the outgrowths of nasarsha –

Chitraka – Plumbago zeylanica
Chavya – Piper retrofractum
Yavani – Trachyspermum ammi
Kantakari – Solanum xanthocarpum
Karanja – Pongamia pinnata
Rock Salt
Arka Taila – oil prepared from Calotropis gigantea

Other formulations
Triphala Guggulu
Varadi Kashayam
Varanadi Kashayam
Chiruvilwadi Kashayam
Guggulutiktakam Kashayam
Abhayarishtam
Dashamularishtam
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