Surgical intervention: Philip Dancey, a 51-year-old entrepreneur from Gloucester, had his nasal polyps removed with a new method
Back in May 2012, I started swimming regularly to become fitter. But I soon felt a constant bunged-up sensation in my nose, as if I had a cold. I tried wearing a nose clip when swimming, but that didn’t improve it.
My wife Philippa noticed I’d started snoring, which I’d never done before. I lost my sense of smell, too, and had impaired taste. Four months later I saw my GP, as I didn’t feel better. I’d never had breathing problems and didn’t have asthma or hayfever.
The GP shone a tiny light up my nose and said he could see nasal polyps. Small growths had formed in my nasal cavity and were blocking the airways. Although they’re a nuisance, they aren’t life-threatening.
I was prescribed a three-week course of oral steroids to shrink them, and within a week my sense of smell came back.
But by June 2013, my symptoms returned. I tried oral steroids again but the polyps kept coming back after my course finished. I was also prescribed steroid nose drops, which made breathing easier, but after a few weeks of using them I had nosebleeds.
At one point these were so bad I was admitted to hospital. The doctor believed one of the blood vessels in my nose had ruptured, probably caused by the drops.
At an appointment in October 2014, the NHS consultant said I wasn’t eligible for surgery on the NHS yet, as the polyps weren’t impeding my breathing severely enough. I didn’t want to keep using steroids, so I did some research online.
In December 2016, I learned that a Californian company had invented a device called a Polypvac — a tiny vacuum that sucks polyps away rather than cutting them out with a sharp blade, which is the usual method done under general anaesthetic.
I contacted them, and in June they told me an ear, nose and throat (ENT) consultant, Yakubu Karagama, would be the first surgeon here to offer Polypvac privately. I arranged to have the operation in mid-August — we met for the first time on the day of the surgery.
Cured: After numerous failed attempts to rid the growths in his nose, Mr Dancey became one of the UK’s first to undergo a quicker procedure to remove them using air suction
First, he sprayed a local anaesthetic up my nose, then he put a thin plastic tube attached to a hand-held device up my nostril. The tube has a ‘tooth’ at its opening that is gently pressed against the side of the polyp, to nick it and suck out the fluid from inside it. Although my nose was numb, I could feel gentle vibrations caused by the machine.
It took 30 minutes to remove five polyps from each nostril. The process was totally painless and I left an hour afterwards.
A month later, during a check-up with Mr Karagama, he showed me a split-screen image of my nasal cavity before, compared to now. The difference was amazing.
Immediately after, I no longer had a blocked nose and I stopped snoring, and my sense of smell is gradually returning. It has hugely improved my quality of life.
Yakubu Karagama is a consultant ENT surgeon at the BMI Alexandra Hospital in Cheadle and Manchester Royal Infirmary.
Nasal polyps are fairly common — I see at least two or three cases at each of my clinics every week.
They are painless, benign swellings in the lining of the nose that become inflamed and protrude from the lining of the nasal cavity. Polyps can grow unchecked until they take over the entire nasal passageways and the sinuses —the air pockets behind the nose, eyes and cheeks.
They can be found singularly, but often develop in clusters, and can sometimes grow to the size of a grape. Their exact cause is unclear but they are linked to everyday allergies, for example to pet dander or hayfever, and asthma, which causes irritation of the nasal lining.
Polyps can grow unchecked until they take over the entire nasal passageways and the sinuses —the air pockets behind the nose, eyes and cheeks
Dr Yakubu Karagama
Typical symptoms include a blocked or runny nose. This leads to an impaired sense of smell due to the polyps blocking the air flow, which we need to help us smell. Larger polyps can press on the nerves around the smell receptors and cause permanent damage to them. Taste is often affected, too.
Enlarged polyps can block the airways, making breathing through the nose harder and causing disturbed sleep and snoring.
The first treatment is with anti-histamine tablets to reduce allergy symptoms, or steroid sprays, drops or pills, which stops them growing.
Although steroids are successful at treating smaller polyps, they aren’t as effective on bigger ones. In some cases, we suggest surgery. Between 30 to 40 per cent of people with polyps eventually have them removed.
We usually use a very powerful device called a microdebrider to slice polyps away under a general anaesthetic. A tiny camera is inserted up the nose so the surgeon can see the polyps on a screen as they operate.
There’s a small risk that the debrider could cause damage to the eye, or even the brain, if the slicing is in the wrong part of the airway. Also, general anaesthetics are not suitable for everybody.
There’s a small risk of infection when using the Polypvac device to remove nasal polyps, but a week-long course of antibiotics should alleviate it.
There could be a small amount of bleeding that can be controlled with ice packs.
‘This device does appear to effectively remove polyps, but they do grow back,’ says Matthew Trotter, a consultant ENT surgeon at Spire Parkway Hospital, Birmingham. ‘We still don’t know why some people with allergies develop them. But in the meantime, anything that can remove polyps successfully is welcomed, because having them is debilitating.
‘Not having a general anaesthetic is often better for the patient as it will reduce their recovery time.’
Patients are allowed home later that day with wadding in their nose to soak up any blood, and I advise avoiding rigorous activity for two weeks due to the effects of the anaesthetic — some people can have vomiting and dizziness following it, too.
Although this surgery usually improves breathing, polyps often return because we haven’t identified their underlying cause.
This year I began using the Polypvac, which uses air suction rather than electricity to power a blade, so is gentler than the debrider. Philip was the first patient I used it on.
I put the device, which is attached to a pistol-like handset, up his nose along with a tiny camera. Because the polyps are very soft, the suction power easily breaks the tissue when it touches the ‘tooth’ before sucking away the liquid inside.
Once a polyp has been broken down, it only takes a few seconds to remove the fleshy sac that contained the fluid. Even a grape-sized polyp can be removed in less than 60 seconds. This is about the same as the debrider, but is safer as the vacuum isn’t as powerful and doesn’t damage other tissue.
I then use the tiny camera to ensure I’ve removed all the polyps. A filter collects the polyp tissue, to be analysed in a lab later if required.
The procedure usually takes about 30 to 40 minutes. As the patient hasn’t undergone a general anaesthetic, they can go home an hour later and get on with their lives as normal, using a steroid spray for three months to slow any polyp regrowth.
The patient’s sense of smell doesn’t usually return immediately — this takes time while the lining of the nose heals and the nerve cells regrow.
In most cases polyps grow again, regardless of the surgical method used. But this is a less invasive way of taking them out.
So far, the treatment in the U.S. has had a 90 per cent success rate, according to the results of a patient questionnaire.
The seven patients I’ve used it on here are impressed with the results so far.
The treatment costs about £1,450 privately.
ASK THE PHARMACIST
Question: Can bicarb of soda help acid reflux?
Answer: Bicarb of soda is recognised as a home remedy to help with acid reflux. As it is alkaline it may help neutralise acid in the stomach. But check with your pharmacist to make sure it doesn’t interact with any other medicines you’re taking.
Alternatively you could try an over-the-counter remedy that has the same, neutralising effect (there are other products that actually reduce acid production).
If acid reflux problems persist for more than two weeks, it is important to see a GP to check for an underlying cause.
QMy osteoporosis pills give me heartburn. What can I do?
AHeartburn is a well-known side-effect of one of the most common osteoporosis pills — alendronic acid, taken once a week.
To avoid it, take the tablet with a full glass of water half an hour before breakfast when the stomach is completely empty (water is best, as other drinks can interact with the pills). After this, sit or stand — don’t go back to bed or lie down — for at least 30 minutes.
This way the pills can get right down into the stomach, where they’re absorbed, before food arrives, thereby minimising the chance of heartburn.
If you’re taking the medicine correctly and heartburn is still a problem, seek some medical advice.