Should you operate on polyps in children?

Nasal polyps are benign, stemmed masses originating from the mucous membranes of the nose or the mucous membranes of the sinus cavities, and they can cause chronic nasal obstruction. This condition is often found in both adults and children. This benign mass can grow in both nostrils or only in one, with the appearance of a translucent, spongy, and protruding mass shaped like a grape. The colour varies, from greyish pink to yellowish.

The cause of the growth of nasal polyps in children is not known with certainty. However, this condition is closely related to chronic inflammation of the airways, especially in the nasal cavity. The appearance of nasal polyps in children is usually accompanied by comorbidities such as chronic rhinosinusitis, asthma, allergic rhinitis, or genetic disorders such as cystic fibrosis, which is a condition in which the mucus in a child's nose is thicker and stickier than others, causing chronic infections and difficulty breathing. Usually this condition was diagnosed when the child was 2 years old.

At first, parents often do not realise that their child has nasal polyps. However, over time, nasal polyps can get bigger and cause symptoms that parents eventually notice.

How can parents know if their child has nasal polyps? In general, the clinical symptoms of nasal polyps depend on their size and location. Some of the symptoms of nasal polyps that are commonly found in children are frequent nasal congestion, which can cause changes in the child's voice to become nasal and make the child breathe through the mouth. Apart from that, children also often experience a runny nose, a reduced sense of smell, and have a habit of snoring during sleep. Snoring during sleep is one of the characteristic symptoms of nasal polyps because when we sleep, the airflow that enters through the nose is blocked by polyps, resulting in snoring. Another distinctive sign is the symptom of postnasal drip, namely the presence of mucus in the oral cavity, which is characterised by the child's habit of clearing his throat to remove the mucus in his throat, accompanied by a sore or itchy throat. Other symptoms that are also frequently reported are headaches and pain around the face.

To determine whether a child has nasal polyps or not, children should be examined by a doctor if they have symptoms related to nasal polyps. The doctor will examine the nasal cavity to determine whether there are polyps or not. Additional examinations may also be carried out with an endoscope if needed, namely a small diameter flexible optical fibre that is inserted through the nostrils to explore the nasal cavity and see abnormalities. The tool is connected to a computer screen so that the doctor can evaluate it.

After it is known that the child has nasal polyps, what is the next step? Should the polyp in the child be removed? Based on the literature, not all children's nasal polyps require surgery. In mild cases, children will be advised to take anti-inflammatory treatment, which can be accompanied by antibiotics. If a bacterial infection is suspected, anti-inflammatory and anti-allergy drugs can also be given, which are sprayed through the nose. However, when the size of a child's polyps is very large or the symptoms of the polyps do not improve after the maximum dose of treatment, the doctor may consider surgical removal of the polyps. That is, the procedure for removing nasal polyps is not always done in children, depending on the symptoms and the doctor's evaluation. Don't hesitate to consult a doctor if your child has nasal polyps.

Created by: Dr. Huriyah Hafizhotul Ummah

Reviewed by: Dr. Deasy Zackiah Madani, Sp.THT-KL

Source : 

1. Di Cicco ME, Bizzoco F, Morelli E, Seccia V, Ragazzo V, Peroni DG, et al. Nasal Polyps in Children: The Early Origins of a Challenging Adulthood Condition. Children [Internet]. 2021;8:997. Available from: http://dx.doi.org/10.3390/children8110997

2. Ta NH. Will we ever cure nasal polyps?. The Annals of The Royal College of Surgeons of England. 2019 Jan;101(1):35-9.

3. Bailey Aubrey, John Carew. Nasal Polyps in Children: [Internet]. Verywellhealth nose & eye allergies. 2021 November. Available from https://www.verywellhealth.com/nasal-polyps-in-children-5206534