Overview

Nasal polyps are often the results of chronic inflammation and are associated with recurring infections, asthma, allergies, certain immune disorders, and drug sensitivity. They do not cause symptoms, especially if they are still small and do not need treatment. Large nasal polyps may block the normal drainage coming from the sinuses, leading to breathing problems, or cause the loss of sense of smell. The nasal polyps become infected when there is mucus buildup in the sinuses.

Nasal polyps vary in size. They may be pink or yellowish-brown. As the polyps grow, they look like grapes on a stem.

Polyps may grow in one or both nostrils at the same time. They either grow on their own as form clusters.

Nasal polyps effect from four to forty percent of the general population, and they are 2 to 4 times more common in males than females. Nasal polyps tend to develop in people who are young or middle-aged adults but may arise at any age.

Individuals with frequent sinus infections, allergy problems, and asthma are more prone to nasal polyp problems. Children with cystic fibrosis may also develop nasal polyps.

Causes of Nasal Polyps

Scientists have not established yet what causes nasal polyps. A significant number of cases of nasal polyps are believed to be caused by non-allergic asthma, but in some cases, there is no allergic or respiratory trigger found. 

Nasal polyps are not associated with uterine or colonic polyps in the uterus or digestive system, respectively. Unlike uterine and colonic polyps that are usually cancerous, nasal polyps are rarely cancer.

Polyp formation is believed to be the result of inflammation in the nose or sinuses. Polyps, however, are not classified as a disease.

There is some evidence that polyps occur in people whose immune system responses and chemical markers in the mucous membranes are different than those individuals who do not develop nasal polyps.

Nasal polyps may appear in different areas of the sinuses or nasal passages. Still, most often, they appear in the area where sinuses, cheekbones, and nose all drain through the winding passages into the nose.

Nasal polyps are not painful to touch. They are usually treated by medications or surgery, although they might come back.

Diagnosis and Treatment of Nasal Polyps

Diagnosis

A doctor can diagnose nasal polyps after asking you the symptoms and examining your nose. A doctor can view the polyps with the help of a lighted instrument.

The doctor may also ask to take the following tests:

• Nasal endoscopy -This test involves the insertion into your nose of a narrow tube with a small magnifying lens or camera.
• CT scan – A test that enables your doctor to see your nasal polyps and other problems that may cause chronic inflammation. Through this test, your doctor will identify other obstructions in the nasal passage.
• Skin prick allergy test – If your doctor suspects that allergies may have contributed to the development of polyps, your doctor may conduct an allergy test.
• Cystic fibrosis – For a young patient, the doctor usually orders a cystic fibrosis test, an inherited condition that affects the glands that produce tears, mucus, saliva, sweat, and digestive juices. The usual test for cystic fibrosis is a sweat test, a noninvasive procedure that determines whether the child’s sweat is saltier than the perspiration of other people.
• Blood test – Your doctor may ask you to take a blood test to determine if you have low levels of vitamin D, which is usually associated with nasal polyps.

Symptoms

Individuals with nasal polyps usually have chronic inflammation of the lining of the nasal passages and sinuses or chronic sinusitis. If the polyps are large or there are clusters, expect the nasal passages and sinuses of the patient to be obstructed.

Some individuals with small nasal polyps do not manifest any signs or symptoms. The following are the common symptoms of nasal polyps:

• Persistent blocked or stuffy nose – The blockage in some cases may cause the patient to find it difficult to breathe through the nose, causing problems in sleeping
• Runny nose – This may be a chronic condition, with the individual feeling as if he has a cold always
• Postnasal drip – This is a feeling that there is mucus that continually runs down the back of the throat
• Reduced sense of smell or no sense of smell at all – This feeling may not improve even after the treatment of the polyps
• Reduced sense of taste – This condition may not also improve after the polyps are treated
• Headache
• Pain in the face
• Snoring
• Obstructive sleep apnea – This occurs in severe cases of nasal polyps, a severe condition where an individual with nasal polyps may stop breathing during sleep
• Itchiness around the eyes
• Double vision – This condition is likely to occur when the patient has cystic fibrosis or fungal sinusitis.

Pain or headaches are common occurrences when the patient has a sinus infection in addition to nasal polyps.

Treatment

If you feel the signs and symptoms of nasal polyps, you should see your doctor so he could check. Your doctor uses a nasal endoscope – a medical device with a camera or magnifying lens – to get a detailed view of your nose and sinuses. There are some cases when the doctor orders more tests or take a biopsy of the polyp.

1. Medications

If treatment is needed, your doctor is likely to start you with a nasal corticosteroid spray, which in many cases, can shrink or get rid of nasal polyps. Some individuals take corticosteroids like prednisone by mouth for at least a week.

Nasal polyps tend to come back if the allergy, irritation, or infection continues. You may end up using corticosteroid spray and see your doctor from time to time.

Medications such as decongestants and antihistamines do not manage nasal polyps quite well. Still, antihistamines may be needed to control your allergies like sores in mouth or antibiotics to treat your infection before you can start using steroids.

2. Surgery

Surgery is only in the treatment of nasal polyps if they are very large, or if you don’t respond well to other treatments.

Polypectomy is the usual procedure for the removal of polyps. Local or general anesthesia is administered. A thin tube will then be inserted into your nose and sinuses. The tube has a video camera that allows the surgeon to see what goes on inside.

The polyps are cut out through the use of micro-telescopes and surgical instruments. The surgeon may remove small bone pieces from the nose to open up the nasal passageway. 

Corticosteroid spray is typically prescribed after surgery to help prevent the recurrence of nasal polyps. Your doctor may also recommend the use of saline rinse to hasten post-surgical healing.

Possible future nasal polyps treatments

Some studies aim to find out the influence of biologic drugs such as asthma medications in reducing nasal polyps and providing relief to their symptoms. Biologics target specific cells or proteins to reduce swelling and irritation. Early research suggested that the drug may be options for people whose nasal polyps do not respond to corticosteroids or surgery.

Risks of Having Nasal Polyps

Risk factors of nasal polyps include the following:

• Asthma
• Sensitivity to aspirin – People with an allergic response to aspirin and other NSAIDs are more likely to develop nasal polyps.
• Allergic fungal sinusitis – This is an allergy to airborne fungi.
• Cystic fibrosis – It is a chronic disease that affects various organs such as the liver, pancreas, lungs, and intestines.
• Rhinitis or rhinosinusitis – This is an inflammation of the sinuses and nasal passages that usually lasts 12 weeks or more. The condition also includes hay fever.
• Churg-Strauss syndrome – This is a disease that results in the inflammation of blood vessels.
• Genetics – Persons whose parents had experienced nasal polyps are at a higher risk of getting them.
• Age – Nasal polyps may occur at any age, but they are more common in young and middle-aged adults.

When to Seek Medical Attention

If you have the signs and symptoms of nasal polyps, seeing your primary care physician should be your first course of action. Your primary care doctor may refer you to an ENT specialist or other specialists who can diagnose and treat you.

You must be prepared for your appointment so you can give your doctor a good idea of your condition. 

The following are things you should do before seeing your doctor:

• Know your restrictions, such as fasting if you need blood work. Know also other things that you have to prepare for, such as diagnostic tests.
• Write down all your symptoms, including those that may not be related to your nose or sinuses. Your doctor will ask you when your symptoms started and if there is anything that makes the symptoms better or worse.
• Take someone with you, particularly a person who can help you recall the information provided by the doctor during the appointment.
• Share with your doctor a list of your medical conditions, such as asthma or allergies.
• Share with your doctor a list of all the medications you are currently taking.
• Write down the questions you want to ask your doctor. His time is minimal, so making the list of questions will help you make the most out of your appointment.
• Be ready to answer the questions of your doctor, such as when you started experiencing the symptoms, and others.

Table of Medications

• fluticasone
• Nasonex
• mometasone
• Xhance
• beclomethasone
• Beconase AQ
• Sinuva
• Propel