What are nasal polyps?
Nasal polyps are soft, fleshy growths that develop in the nose and sinuses. They look like teardrops or grapes hanging down from the mucous membrane lining, often in clusters. They usually affect both sides of the nose or sinuses and are not cancerous. If a growth occurs on only one side, it is more likely to be a tumor rather than a polyp. Polyps are most likely to grow at the opening between the nose and sinuses.
Some polyps are very small and don’t really cause symptoms. People with these small polyps may not even realize they have them. In other cases, polyps are large or numerous and cause noticeable symptoms. This includes nasal congestion or even blockage, postnasal drainage, and loss of the sense of smell.
Nasal polyps often develop after a sinus infection or as a result of chronic rhinosinusitis (CRS). CRS is sinusitis symptoms, such as congestion and facial pain, lasting more than 12 weeks. It is a very common condition, affecting about 12% of adults. About 20% of those with CRS will have nasal polyps.
Doctors do not fully understand nasal polyp causes and why they develop. Chronic, long-term inflammation most likely plays a role, but they can also occur for no obvious reason. Having conditions associated with inflammation increases the risk of nasal polyps. This includes asthma, allergies, recurrent sinus infections, drug sensitivities, and immune disorders.
When polyps develop after a sinus infection, they may resolve on their own once the infection clears. Other times, the polyps grow slowly and don’t go away. For persistent cases, nasal polyp treatment usually starts with steroid nasal sprays and saline rinses. This approach may successfully shrink the polyps and improve symptoms. In some cases, more aggressive steroid treatments, such oral steroids, are necessary. Surgery is an option when polyps don’t respond to other treatments. However, nasal polyps are very likely to recur. This makes it necessary to continue medical therapy even after surgery.
See your doctor promptly if you are having difficulty breathing through your nose and the problem is persisting. In general, nasal polyps themselves do not require urgent care. However, any underlying sinusitis or infection can lead to complications. Seek immediate medical care if you have vision problems, severe swelling around the eyes, trouble breathing, or severe headache with a high fever.
What are the symptoms of nasal polyps?
It is possible to have nasal polyps and not know it. Small polyps that aren’t very numerous may not cause any symptoms. The polyps themselves don’t have sensation. Symptoms are more likely when polyps are large or there are a lot of them.
Common symptoms of nasal polyps
Common nasal polyp symptoms include:
- Frequent sinus infections
- Loss of the sense of smell and sometimes taste
- Nasal congestion and stuffiness
- Postnasal drainage
- Problems breathing through your nose, which can include complete obstruction and lead to snoring
Serious symptoms that might indicate a serious condition
In some cases, nasal polyps that occur along with sinusitis can lead to a serious condition, such as meningitis or an abscess. Seek immediate medical care (call 911) if you, or someone you are with, have any of these potentially serious symptoms including:
- Difficulty breathing
- Inability to tip your head forward
- Severe headache with a high fever
- Severe swelling around the eyes or trouble moving your eyes
- Vision changes or problems, such as seeing double
If you have persistent nasal congestion or trouble breathing through your nose, see your doctor. Generally, this means nasal symptoms that last for more than 10 days.
What causes nasal polyps?
Doctors believe nasal polyps may be the result of long-term inflammation of the mucous membranes lining the nose and mouth. However, the exact reason this happens is not clear. While nasal polyps are associated with chronic rhinosinusitis (CRS), not everyone with CRS develops them. Of people with CRS, about 20% will also have nasal polyps.
Research suggests people with nasal polyps may have an altered immune reaction and high levels of eosinophils. This type of white blood cell plays a role in allergic responses. Investigators continue to study the base cause of nasal polyps.
What are the risk factors for nasal polyps?
Nasal polyps can develop at any age, but they are most likely to affect people in their 30s and 40s. Similarly, anyone can get nasal polyps, but certain conditions seem to increase the likelihood of them. This includes:
- Allergic fungal rhinosinusitis (AFRS), which is an allergic reaction to airborne fungi, occurs in up to 10% of cases.
- Allergic rhinitis (hay fever)
- Asthma, which may be present in more than half of people with CRS with nasal polyps. Some people with both conditions get worsening symptoms and problems breathing if they take aspirin or NSAIDs (nonsteroidal anti-inflammatory drugs). This is called aspirin exacerbated respiratory disease (AERD). It occurs in about 10% of cases.
- Churg-Strauss syndrome, which is a rare disease
- Cystic fibrosis (CF), which is a genetic disorder. Up to 86% of CF patients have nasal polyps.
Reducing your risk of nasal polyps
It isn’t always possible to prevent nasal polyps. You may be able to lower your risk of developing them (or of them recurring) by:
- Asking your doctor about maintenance nasal sprays
- Controlling allergen exposure and avoiding irritants
- Humidifying the air in your home in arid or dry conditions
- Treating allergies and asthma
- Using saline rinses to flush your nasal cavities
Nasal polyps frequently recur. If you have had treatment for nasal polyps, talk with your doctor about the steps you should take to try to prevent them from coming back.
How are nasal polyps diagnosed?
If you have symptoms of nasal polyps, your doctor will probably ask about your medical history. It’s important to mention any related conditions, such as hay fever or asthma.
Doctors can usually see nasal polyps by examining the nasal passages with a nasal endoscope. This is a small, flexible tool with a camera for viewing the inside of the nasal cavities. In some cases, doctors may recommend a CT (computed tomography) scan to gauge the extent of the nasal polyps.
How are nasal polyps treated?
The goal of nasal polyps treatment is to shrink the polyps and improve breathing and other symptoms. For small polyps, this may only involve using corticosteroid nasal sprays and saline rinses. Sometimes, oral corticosteroids are also necessary. There are also newer forms of corticosteroid treatment, including large volume nasal rinses and exhalation delivery systems that go deeper into the sinuses.
Other medications may include allergy medicines, such as antihistamines, and dupilumab (Dupixent). Dupilumab is a monoclonal antibody that can help treat nasal polyps with chronic sinusitis. It also carries indications for asthma and eczema.
When polyps are large or do not respond to medical therapy, surgery is often necessary. Doctors use a nasal endoscope to remove the polyps. Unfortunately, recurrence is common. It is almost always necessary to continue medications after surgery to try to prevent them from returning.