What to Expect With Surgery for Nasal Polyps

Nasal polypectomy is the surgical removal of nasal polyps, which are abnormal noncancerous growths that can form from inflammatory materials in your nasal passages or your sinus cavities. They can cause symptoms, including difficulty breathing and congestion. While not all polyps need to be surgically removed, in some cases you and your healthcare provider may decide that surgery is the best option for you.

When visualized, polyps are a semi-translucent (or glistening) gray color. A nasal polypectomy is not always a cure for nasal polyps. They can grow back if the underlying cause is not treated.

Prevalence and Causes of Nasal Polyps

Most commonly, polyps are found either in the ethmoidal sinus or the middle turbinates. Chronic inflammatory conditions can lead to nasal polyps.

Conditions that commonly lead to the development of nasal polyps include:

• Asthma
• Chronic rhinosinusitis (CRS), nasal allergies
• Aspirin sensitivity—aspirin-exacerbated respiratory disease (AERD)

Nasal polyps are more common in adults. About 1 to 4 out of 100 adults will develop nasal polyps.

Children with cystic fibrosis (CF) are also prone to the development of nasal polyps. Approximately 50% of children with CF will develop nasal polyps, and children without CF will rarely develop them.

Non-Surgical Therapies to Try Before Surgery

Surgical removal of nasal polyps is not a first-line therapy. Typically a nasal polypectomy is only recommended after other therapies have not been effective, or if the polyps have caused severe obstructions (blockage) with uncontrollable symptoms.

Therapies that are often recommended prior to considering surgery include:

• Glucocorticoid nasal sprays may help reduce polyp size. This is typically used if the polyps aren't causing a blockage. These include Flonase (fluticasone), Rhinocort (budesonide), or Nasonex (mometasone)
• Oral glucocorticoids can sometimes be helpful for reducing polyp size.
• Dupixent (dupilumab) is a monoclonal antibody administered by injection every other week.
• Antileukotriene medications, which are often used to treat allergies, can be used, such as Singulair (montelukast).
• Daily sinus lavage with saline can be helpful if there is no nasal blockage.
• Aspirin desensitization therapy can be used if AERD is the underlying cause of nasal polyps.

Decongestants can provide symptomatic relief, but they do not shrink nasal polyps.

When Is Surgery Considered for Nasal Polyps?

If you have nasal polyps with symptoms that have not responded to other therapies, a nasal polypectomy may be considered to remove the polyps.

Before surgery, a computerized tomography (CT) scan of your head is typically performed to determine the extent and locations of polyps in your nasal passages and sinus cavities.

A nasal polypectomy should not be performed if you do not exhibit symptoms or if medications can control your symptoms.

Contraindications for this type of surgery include:

• Cardiac disease
• Respiratory disease
• Poorly controlled diabetes
• Poorly controlled asthma
• Bleeding disorders

Possible Complications Related to Nasal Polypectomy

Because your nasal passages and sinus cavities are located close to many different anatomical structures, there are several potential surgical complications that can occur. Many of these complications are uncommon.

Common complications include:

• Bleeding
• Local infection
• Mucocele (mucus cyst)

These complications generally can be treated effectively, without lasting consequences.

You can have minor, limited bleeding at home after your surgery, and it typically resolves quickly. Your healthcare provider may tell you to contact their office during daytime business hours if bleeding occurs.

Uncontrolled bleeding is a medical emergency. You should seek emergency care if you experience heavy bleeding or bleeding that won't stop.

You should get immediate medical attention for any severe headaches or vision problems.

• Vision problems may occur because the nasal passages and sinus cavities are in close proximity to eye structures.
• Severe headaches can be a sign of a cerebrospinal fluid leak. This is uncommon, but it can occur if the cribriform plate at the very height of the nasal cavity is cracked. This leak is generally a slow leak of clear fluid, and it doesn't always cause headaches.
  

What to Expect Before Surgery

A nasal polypectomy is an outpatient procedure. This means that you will go home on the day of your surgery.

Your pre-operative CT scan will let your surgeon know whether your polyps are isolated to only the nasal passages, or if you have polyps in any of your sinus cavities. This will be important for surgical planning.

Before your surgery, you will likely be instructed on the following things:

1. Do not eat or drink anything after midnight the night before surgery.
2. You may be asked to stop taking any blood thinners.
3. Arrive around an hour to an hour and a half before your scheduled procedure, or whenever you are told to arrive.

Typically, younger children are scheduled in the morning, and adults are often scheduled afterward. If you have any questions regarding the procedure, you should reach out to your surgeon's office.

What to Expect During the Surgery

Nasal polypectomy is performed by endoscopy, a fiber-optic tube with a camera that's inserted into your nasal passages for visualization. General anesthesia is commonly used, which means that you will be put to sleep during your procedure. Sometimes topical anesthesia is used, and you might stay awake during surgery.

While using the endoscope to visualize your polyps, your surgeon will use forceps, a cutting instrument, or a microdebrider to remove the polyps.

Expert guidance recommends cleaning out the sinus cavities if polyps are removed from a sinus; however, your surgeon will determine your individualized needs.

Cauterization is rarely needed to stop the bleeding and is only used if vasoconstricting medications (constricts blood vessels), or hemostatic (stop bleeding) products are inadequate to stop the bleeding.

What to Expect After the Surgery

If you swallowed any blood during the surgery, which commonly can occur, you may be nauseous and vomit following surgery. This is not a medical emergency and usually resolves after vomiting one time.

Your healthcare provider will arrange for you to be seen in a follow-up appointment to evaluate your healing and resolution of symptoms related to the nasal polyps. In some cases, your healthcare provider may use an endoscope to visualize the surgical areas at your postoperative visit.

Follow-Up

Following surgery, you should notice improvement of symptoms related to nasal polyps. The surgery will not fix chronic rhinosinusitis or other underlying causes of your nasal polyps. It is important that you follow your healthcare provider's instructions for continuing therapies to treat your underlying causes. Without continued treatment, polyps can return within a few months to years.