What Are Nasal Polyps?

Nasal polyps are growths that result from inflamed mucous membranes in the sinuses and nasal passages. They can extend to the opening of the nostrils or even down to the throat area and can block the nasal passages, causing congestion, headaches, and loss of smell, among other things.

Nasal polyps are often related to other chronic diseases and tend to last for long periods of time. They can even grow back after medical treatments or surgical removal.

Nasal Polyp Symptoms

The majority of people with nasal polyps will experience nasal congestion, which may be severe and might not improve with standard allergy medications.

Other common symptoms include:

• Runny nose with clear or colored mucus
• Loss or decreased sense of smell and taste
• Postnasal drip
• Headaches
• Sinus pressure
• Facial pain

Nasal polyps vary in size, and small polyps may not cause symptoms. Larger polyps may block the nasal passages, cause symptoms, and lead to a sinus infection.

Long-standing nasal polyps can lead to widening of the nasal bridge, which can make the eyes appear to be farther apart.

Causes

Nasal polyps can occur with other respiratory diseases, such as:

• Allergic rhinitis (hay fever)
• Chronic sinusitis (due to bacterial and fungal infections)
• Asthma
• Aspirin exacerbated respiratory disease (AERD)
• Cystic fibrosis

Nasal polyps can also be a sign of immunodeficiencies or autoimmune disorders, such as primary ciliary dyskinesia and eosinophilic granulomatosis with polyangiitis (EGPA).

Diagnosis

In some situations, a healthcare provider can make a nasal polyp diagnosis by visually examining the nasal passages using an otoscope (a simple lighted tool usually used to look inside the ears). Diagnosis may come via nasal endoscopy, which entails placing a small camera into the nose to get a better look at the nasal passages. The majority of patients can be diagnosed with either nasal endoscopy or visual inspection.

Sometimes, a CT scan ("cat scan") of the sinuses is needed to make a diagnosis. The sinus CT scan allows for better characterization of the extent of disease, especially in sinuses that cannot be reached through endoscopy.

Since other diseases are often present when a person has nasal polyps, further diagnostic tests may need to be performed.

Treatment

Nasal polyps may be treated with surgical or medical therapies.

In severe cases, or when medication is ineffective, sinus surgery is often required to remove large nasal polyps that lead to recurrent sinus infections. With an endoscopic procedure, which uses a long lighted tube inserted into the nostril, you can usually go home the same day.

The best therapy for nasal polyps usually involves the use of surgical therapies followed by medical therapies, as this approach helps reduce the chance that the polyps will grow back.

Nasal Steroid Sprays and Drops

Topical nasal steroid sprays, such as Flonase (fluticasone propionate) and Nasonex (mometasone furoate), can help reduce the size of nasal polyps and prevent polyps from growing back after surgery.

Some healthcare providers use nasal steroid drops rather than sprays in order to better penetrate the nasal passages and reach the nasal polyps.

The FDA recently approved XHANCE, a spray that enters further into the nasal passages than a typical nasal spray by using breath activation.

Corticosteroids

Oral corticosteroids, such as prednisone, can quickly shrink the size of nasal polyps and are helpful for people who have severe symptoms.

After a short course of corticosteroids (about one to two weeks), however, topical nasal steroid sprays are usually able to control symptoms better and prevent the polyps from growing larger.

In some cases, such as when fungal sinusitis is the cause of nasal polyps, low-dose oral corticosteroids may be required for weeks to months after surgery in order to prevent polyps from growing back.

Antileukotriene Medications

Oral antileukotriene medications, such as Singulair (montelukast), may be prescribed for people who have nasal polyps.

Nasal Saline Irrigation

Nasal saline irrigation can be especially helpful for people with nasal polyps and chronic sinus infections. This is especially true if you've had sinus surgery, as saline can rinse out the sinuses and not just the nasal passages.

Allergy Shots

Some allergists use allergy shots in an attempt to treat or prevent nasal polyps from growing back after surgery.

Some data support the use of allergy shots in those with allergic fungal sinusitis.

Antibiotics

These may be prescribed in cases of sinus infection.

Biologics

In 2019, the Food and Drug Administration (FDA) approved Dupixent (dupilumab) for treatment of rhinosinusitis with nasal polyps.

Dupilumab is a monoclonal antibody initially approved for treatment of dermatitis and asthma, but the drug also targets inflammation that may cause polyps.

Studies have found polyp patients treated with dupilumab enjoyed reduced polyp size and severity of symptoms, and the drug was well tolerated. Your healthcare provider will know if dupilumab is appropriate for you.

Xolair (omalizumab) and Nucala (mepolizumab) are two other monoclonal antibodies that have been approved for the treatment of nasal polyps. Additional therapies are being evaluated for safety and efficacy in treating nasal polyposis and may be available in the future.