Nasal polyps: what are their symptoms, their causes and their treatment

Nasal polyps are soft, painless, non-cancerous growths in the lining of the nasal passages or sinuses. These hang like tears or grapes. They are caused by chronic inflammation and are associated with asthma, recurrent infections, allergies, drug sensitivities, or certain immune disorders.

Small nasal polyps may not cause symptoms. Larger growths or clusters of polyps can block the nasal passages, leading to difficulty breathing, loss of smell, and frequent infections.

Nasal polyps can affect anyone, but they are more common in adults. Medicines can often shrink or remove nasal polyps, but sometimes an operation is needed to remove them. Often, even after successful treatment, nasal polyps reappear.

Nasal polyps are associated with irritation and swelling (inflammation) of the lining of the nasal passages and sinuses that lasts longer than 12 weeks (chronic sinusitis).

However, it is possible to have chronic sinusitis without nasal polyps.

Nasal polyps are soft and don’t cause any sensation, so if they’re small, you probably won’t know you have them. Multiple growths or a large polyp can block the nasal passages and sinuses.

Common signs and symptoms of chronic sinusitis with nasal polyps include:

Runny nose Constant congestion Post-nasal drip Decreased or absent sense of smell Loss of sense of taste Facial pain or headache Pain in upper teeth Feeling of pressure on forehead and face Snoring Frequent nosebleeds

Consult your doctor if symptoms last more than 10 days. Symptoms of chronic sinusitis and nasal polyps are similar to many other illnesses, including the common cold.

Seek immediate medical attention or call 911 or the local emergency number if you encounter:

Severe breathing difficulties Sudden worsening of symptoms Double vision, reduced vision, or limited ability to move the eyes Severe swelling around the eyes Increasing headache accompanied by high fever or inability to tilt the head forward

Your doctor can usually make a diagnosis based on your answers to questions about symptoms, a general physical exam, and your nose. Polyps can be seen using a simple lighted instrument.

Other diagnostic tests include:

Nasal endoscopy.

A narrow tube with a lighted magnifying glass or a small camera (nasal endoscope) allows the doctor to examine the inside of the nose and sinuses in detail.

Imaging diagnostic tests. Images obtained from a computed tomography (CT) scan can help the doctor determine the size and location of polyps in deeper areas of the sinuses and assess the degree of swelling and irritation (inflammation).

These tests can also help your doctor rule out other possible obstructions in the nasal cavity, such as structural abnormalities or other cancerous or non-cancerous growths.

Allergy tests. Your doctor will likely suggest patch (skin) testing to determine if allergies are contributing to chronic inflammation. With a skin test, a few small drops of allergens (allergens) are placed by pricking or scratching the skin on the forearm or upper back. The doctor or nurse will examine your skin for signs of allergic reactions.

If a skin test cannot be performed, your doctor will likely order a blood test that detects specific antibodies against various allergens.

Cystic fibrosis screening test. If you have a son or daughter who has been diagnosed with nasal polyps, your doctor may suggest testing for cystic fibrosis, a disease that affects the glands that produce mucus, tears, sweat, saliva, and gastric juices.

The standard diagnostic test for cystic fibrosis is a noninvasive sweat test that determines if your child’s sweat is saltier than most other people’s sweat.

Blood test.

Your doctor may test your blood for low levels of vitamin D, which is associated with nasal polyps.

Chronic sinusitis, with or without polyps, is a disease that is difficult to cure completely.

You’ll need to work with your healthcare team to develop the right long-term treatment plan to manage your symptoms and address factors, such as allergies, that may be contributing to chronic inflammation.

The goal of treatment for nasal polyps is to reduce their size or eliminate them. Medications are usually the first method. Sometimes surgery may be needed, but it may not provide a permanent solution because the polyps tend to recur.

Treatment for nasal polyps usually begins with medication, which can cause even large polyps to shrink or disappear. Drug treatments are:

Nasal corticosteroids. Your doctor will likely prescribe a corticosteroid nasal spray to reduce swelling and irritation. This treatment can shrink the polyps or eliminate them completely.

Nasal corticosteroids include fluticasone (Flonase Allergy Relief, Flovent HFA, Xhance), budesonide (Rhinocort), mometasone (Nasonex, Asmanex HFA), triamcinolone (Nasacort Allergy 24HR), beclomethasone (Beconase AQ, Qvar Redihaler, Qnasl ) and ciclesonide (Omnaris, Alvesco, Zetonna).

Injectable and oral corticosteroids. If a nasal corticosteroid is not effective, your doctor may prescribe oral corticosteroids, such as prednisone, alone or in combination with a nasal spray.

Since oral corticosteroids can cause side effects, they are usually taken for a limited time.

Injectable corticosteroids can be used if nasal polyps are severe.

Drugs to treat nasal polyps and chronic sinusitis.

If you have nasal polyps and chronic sinusitis, your doctor may give you an injection of a drug called dupilumab (Dupixent) to treat the condition. This medication can shrink nasal polyps and decrease congestion.

Other drugs. Your doctor may prescribe medications to treat conditions that contribute to long-term swelling of the sinuses or nasal passages. These may include antihistamines to treat allergies or antibiotics to treat a chronic or recurring infection.

Aspirin desensitization, under the care of an allergist experienced in desensitization, may be beneficial for some patients with nasal polyps and aspirin sensitivity. Treatment involves gradually increasing the amount of aspirin you take while you are under a doctor’s care in a hospital or clinic, to help your body tolerate long-term aspirin use.

If drug treatment does not shrink or eliminate nasal polyps, you may need endoscopic surgery to remove the polyps and correct sinus problems that make them prone to inflammation and polyp development .

In endoscopic surgery, the surgeon inserts a small tube with a lighted magnifying glass or a small camera (endoscope) into one of the nostrils and guides it into the sinus cavities. The doctor uses tiny instruments to remove polyps and other substances that block the flow of fluid from the sinuses.

The surgeon may also enlarge the openings that lead from the sinuses to the nostrils. Endoscopic surgery is usually performed on an outpatient basis.

After surgery, you will likely use a corticosteroid nasal spray to help prevent nasal polyps from coming back. Your doctor may also recommend the use of saline solution to aid healing after surgery.

Researchers are studying the role of biologic drugs, including drugs that treat severe asthma, in helping to shrink nasal polyps and relieve symptoms. Biologics act on specific cells or proteins to reduce irritation and swelling. Early research suggests medications may become options for people whose nasal polyps do not respond to corticosteroids or surgery.