Inverted papillomas are rare noncancerous tumors that arise in your nasal and paranasal sinuses. Surgery is usually required to remove them due to their potential to become cancerous.
Some people with inverted papillomas develop symptoms like feeling like there’s something in their nose or frequent nosebleeds. However, small papillomas often don’t cause noticeable symptoms.
Most inverted papillomas can be removed using a minimally invasive technique called endoscopy. Regular monitoring is required even after their removal since they may return for some people.
This article looks at inverted papillomas in more detail, including symptoms, treatment options, and causes.
What percentage of inverted papillomas become malignant (cancerous)?
A small number of papillomas have the potential to become cancerous. Cancerous changes are seen in roughly 5% to 15% of these growths.
Inverted papillomas develop in the mucus membranes that line your nasal cavity and the inside of your sinuses.
The most common place these growths appear in is the outer edge of the nasal wall near the middle turbinate, a thin bone that splits the left and right sides of the nasal cavity.
When papillomas develop in your sinuses, they most commonly occur in the ethmoid sinus near your eyes and your maxillary sinus under your cheekbones.
Rare cases of inverted papillomas may develop in other areas, such as your:
- middle ear
- throat
- tear system
What’s the difference between an inverted papilloma and a polyp?
Inverted papillomas and nasal polyps are two types of growths that can develop in your nasal passages.
Nasal polyps are soft and painless growths that are commonly associated with inflammation and are common in people with inflammatory
- asthma
- chronic or recurrent sinus infections
- allergies
Papillomas are most often associated with some types of viral infections, such as human papillomavirus (HPV).
It’s not entirely clear what causes inverted papillomas, but they seem to make up roughly 0.5% to 4% of nasal tumors. They’re most common in people in their 40s or 50s and about 2 or 3 times more common in males compared to females. They rarely seem to develop in children.
Inverted papillomas are the most common subtype of three types of sinonasal papillomas. They make up almost two-thirds of cases.
Most inverted papillomas are associated with:
- chronic inflammation
- HPV infection
- Epstein-Barr virus
- smoking
- some occupation and environmental exposure
HPV is a group of viruses that affect the skin and mucus membranes. When these infections occur on the skin, they can cause warts. There are many subtypes of HPV. HPV subtypes 6, 11, 16, and 18 seem to be associated with a higher chance of cancerous transformation.
Research on whether inverted papillomas are associated with Epstein-Barr virus is mixed. One study found evidence that the presence of the Epstein-Barr virus might enhance the transformation of inverted papilloma into sinasal squamous cell carcinoma.
History of smoking and advanced age are associated with recurrence and cancerous transformation.
Many people with inverted papilloma don’t have symptoms, especially when growths are small. When symptoms do appear, they often mimic those of other nasal or sinus conditions, such as:
Some of the most common symptoms include:
Other symptoms may include:
- watery eyes
- cheek numbness
- loss of smell
- speech problems
- bulging eyes
Large growths may cause signs and symptoms such as:
- facial asymmetry
- visible tumor
- tumor that can be felt
A diagnosis for papillomas often starts by visiting your healthcare professional. They’ll run initial tests such as:
- a review of your symptoms
- a review of your personal and family medical history
- a physical exam
Your doctor may refer you to a specialist called an otolaryngologist (ENT) if further testing is needed.
Diagnostic tests used
Endoscopy is the primary test doctors use to diagnose inverted papilloma. During this procedure, a doctor inserts a long tube into your nose to examine the growth and take a sample to confirm a diagnosis and determine whether the growth is cancerous.
Doctors will most likely also use imaging tests such as computed tomography (CT) scans or magnetic resonance imaging (MRI) to determine the extent of your growth.
How do doctors typically stage inverted papilloma?
One of the most common staging systems for nasal papillomas is called the Krouse staging system.
| Stage | Description |
|---|---|
| Stage 1 | The growth is limited to the nasal cavity. |
| Stage 2 | The growth has spread outside of the sinuses or is found to have cancerous changes. |
| Stage 3 | The growth involves the lateral or lower aspects of the maxillary sinuses or extends into the frontal and sphenoid sinuses. |
| Stage 4 | The growth has spread outside of sinuses or is found to have cancerous changes. |
Doctors usually recommend aggressive treatment for inverted papillomas that are fast-growing and destructive and to prevent cancerous transformation.
The main treatment is surgical removal, which is typically performed as an endoscopic procedure. Surgery will remove your growth and the mucus membrane from which the tumor arises.
Open surgery may also be an option if your doctor needs to obtain clear margins around a cancerous growth.
Studies have reported recurrence rates after surgery as high as 34.1%. Due to high recurrence rates, regular follow-ups are needed after your procedure to monitor for recurrence.
Inverted papillomas are noncancerous growths that develop in your nasal cavities and sinuses. They have the potential to become cancerous, so they generally need to be removed with surgery.
It’s important to visit your doctor promptly if you develop any new nasal symptoms, such as unexplained nosebleeds. Your doctor can run tests to rule out cancer or other serious conditions.