What Are Nasal Polyps?

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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, headache, 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 unable to be helped by typical allergy medications. =

Other common symptoms include:

  • Runny nose with clear or colored mucus
  • Loss or decreased sense of smell and taste
  • Headache
  • Sinus pressure: Facial pain is much more common in people with chronic sinusitis compared to those with nasal polyps.

Polyps vary in size. Small nasal polyps may cause no symptoms. Larger polyps may bring symptoms and block the nasal passages. If polyps block the nasal passages, a sinus infection can develop.

A person with severe nasal polyps may actually be able to see the polyps in their nostrils. They are a glistening translucent gray color, resembling clumps of clear gelatin.

Long-standing nasal polyps can lead to a widening of the nasal bridge, which can result in the eyes appearing to be farther apart.

Causes

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

It appears that nasal polyps are more common in people with non-allergic rhinitis and non-allergic asthma, rather than allergic types of these conditions.

Nasal polyps can also be a sign of immunodeficiency diseases. For example, nasal polyps in children can be a sign of cystic fibrosis. Other immunodeficiencies, such as primary ciliary dyskinesia, Churg-Strauss syndrome, selective IgA deficiency, and common variable immunodeficiency (CVID), can be associated with nasal polyps, too.

Diagnosis

In some situations, a physician can make a nasal polyp diagnosis by visually examining the nasal passages.

Diagnosis may come via nasal endoscopy, which entails placing a small camera into the nose to get a better look at the nasal passages. More commonly, however, a CT scan ("cat scan") of the sinuses is needed to make a diagnosis.

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 both surgical and medical therapies.

In severe cases, or in cases where medication is ineffective, sinus surgery is often required to remove large nasal polyps and resolve any accompanying sinus infection. With an endoscopic procedure, which uses a long lighted tube inserted into the nostril, you can usually be sent home the same day.

It's important to note that even after successful surgery, polyps may recur.

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 physicians use nasal steroid drops, rather than sprays, in order to better penetrate the nasal passages and reach the nasal polyps.

Corticosteroids

Oral corticosteroids, such as prednisone, can quickly shrink the size of nasal polyps and are helpful in people with 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), are theoretically beneficial in people with nasal polyps, especially those with an aspirin allergy.

People with an aspirin allergy are known to have high levels of leukotrienes, so medications that block these chemicals should help to reduce symptoms of chronic sinus disease and polyp formation.

Nasal Saline Irrigation

Nasal saline irrigation can be especially helpful in people with nasal polyps and chronic sinus infections. This is especially true for those who have had sinus surgery, as saline can rinse out the sinuses and not just the nasal passages.

Allergy Shots

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

The best data for the use of allergy shots is in those with allergic fungal sinusitis. Allergy shots may also prove helpful in those with nasal polyps and evidence of significant allergic triggers.

Antibiotics

These may be prescribed in cases of sinus infection.

Biologics

In 2019, the U.S. 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 doctor will know if dupilumab is appropriate for you.

Know that even if polyps are successfully eliminated, loss of smell or taste does not always improve following treatment with medicine or surgery.

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  1. American Academy of Allergy, Asthma, and Immunology. Nasal Polyps.

  2. National Institutes of Health. MedlinePlus. Nasal Polyps. Updated August 12, 2019.

  3. Bachert C, Han JK, Desrosiers M, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials [published correction appears in Lancet. 2019 Nov 2;394(10209):1618]. Lancet. 2019;394(10209):1638‐1650. doi:10.1016/S0140-6736(19)31881-1