Nasal polyps

What is it?

A nasal polyp is a benign (noncancerous) tumor that grows from the lining of the nose or sinuses. These polyps usually occur in both the right and left nasal passages and obstruct the flow of air. They can make your nose feel stuffy, and can decrease your sense of smell. Not all growths in the nose are polyps.

Nasal polyps may result from chronic (long-lasting) inflammation of the lining of the nose, although they often occur for no apparent reason. People with chronic hay fever (allergic rhinitis) are more likely than others to develop nasal polyps. In addition, nasal polyps commonly develop in children with cystic fibrosis.

People with nasal polyps and asthma often are allergic to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. They may experience a sudden, severe shortness of breath if they take one of these drugs.

If you have nasal polyps and asthma, avoid medications containing aspirin or other NSAID. Remember that aspirin and other NSAIDs are present in many over-the-counter pain pills and cold and flu remedies. They also are present in some skin creams.

Symptoms

The key symptoms of nasal polyps are:

• Difficulty breathing through your nose
• Constant draining from your nose
• Persistent stuffiness and facial discomfort
• Frequent sinus infections
• Loss of smell.

Diagnosis

Your doctor will ask about your medical history. He or she probably will ask if you have a history of hay fever, allergic rhinitis, asthma or an allergy to aspirin.

The doctor, most commonly an otolaryngologist (ear nose and throat specialist) will examine your nose and look for translucent grapelike masses colored yellow to gray. He or she usually can detect polyps by examining your nasal passages with a special instrument called a nasal endoscope, a small, flexible tube connected to a camera. Sometimes, a computed tomography (CT) scan may be used to determine the location and size of the polyps. CT scanning also will tell if the polyps are coming from the nose or from the sinuses.

Nasal polyps almost always occur on both sides. If a polyp is seen only on one side, a CT scan should be done to make sure that the growth is not something more serious. The scan also can accurately show the size of the growth.

In addition to examining your nasal passages, your doctor will ask about your medical history. He or she probably will ask if you have a history of hay fever or allergic rhinitis, asthma or an allergy to aspirin.

Expected duration

Unless treatment is started, polyps will persist as long as the cause is present. Treatment (see below) will shrink or eliminate the polyps. Prolonged treatment is usually necessary to prevent recurrence.

Prevention

Prevention can come in a number of ways. One can eliminate the cause for polyps such as eliminating allergens through environmental controls. One can block the stimulating cause through desensitization treatments. Or one can use maintenance therapy with anti-inflammatory medications such as steroid nasal sprays or leukotriene inhibitors. Many times a combination is necessary for optimal prevention.

Treatment

If the nasal polyps are small, your doctor may prescribe a nasal spray containing corticosteroids, perhaps along with a course of corticosteroid pills, such as prednisone. People with chronic sinusitis and nasal polyps not responding to other therapies may be candidates for treatment with one of the FDA approved monoclonal antibodies.

Large polyps that do not respond to medical therapy usually require surgery. In most cases the surgery is an outpatient procedure. The surgeon may use a small tube called an endoscope to do the surgery. This avoids the need to make an external incision on the face. The surgeon will send some of the polyp tissue to a lab for closer examination. In rare cases, what appeared to be a polyp may turn out to be something else.

For unilateral polyps, a biopsy usually should be done or they should be removed to make sure they are benign.

When to call a professional

See your doctor if you experience:

• Difficulty breathing for any reason
• Frequent sinus infections
• Pressure or pain in your face.

Prognosis

Many people with nasal polyps can have their symptoms controlled with medication and allergy treatments. When this fails, surgery can remove the polyps and improve the breathing. Continued medical therapy is usually still necessary after surgery to prevent a recurrence.

Additional info

American Academy of Otolaryngology – Head and Neck Surgery
https://www.entnet.org/