Overview
Nasal polyps are soft, painless, non-cancerous growths on the lining of the nasal passages or sinuses. They result from chronic inflammation. Small polyps may cause no symptoms, but larger polyps or clusters can block nasal passages, cause loss of smell, and lead to chronic sinusitis and breathing difficulties.
How common is it?
Nasal polyps affect around 1 to 4% of adults. They are more common in adults over 40, in men (2:1 male predominance), and in people with asthma, aspirin sensitivity (Samter's triad), and cystic fibrosis.
Causes and risk factors
Persistent mucosal inflammation triggers abnormal tissue proliferation and fluid accumulation, forming polypoid tissue. The precise mechanism involves type 2 inflammatory pathways.
Common risk factors
- Chronic rhinosinusitis
- Asthma (30 to 40% of nasal polyp patients have asthma)
- Allergic rhinitis
- Aspirin-exacerbated respiratory disease (Samter's triad: asthma, nasal polyps, aspirin sensitivity)
- Cystic fibrosis
- Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis)
- Non-allergic rhinitis with eosinophilia
Symptoms
- Persistent nasal congestion or blocked nose
- Anosmia or hyposmia (reduced or absent sense of smell)
- Runny nose
- Postnasal drip
- Facial pressure or pain
- Snoring and poor sleep
- Reduced taste
- Recurrent sinusitis
When to see a doctor
See a doctor for symptoms lasting more than 3 months. Sudden unilateral nasal polyp or bleeding polyp needs urgent ENT review to exclude malignancy.
Diagnosis
Nasal endoscopy visualises polyps directly. CT sinuses assesses extent and sinus anatomy. Allergy testing. Nasal swabs for infection. Biopsy if unusual appearance or unilateral.
Treatments
Nasal corticosteroid sprays
First-line treatment. Fluticasone or mometasone sprays used correctly (aimed laterally, not at the septum) reduce polyp size and relieve symptoms in most cases. Used long-term. Proper technique is critical.
Short course of oral corticosteroids
Prednisolone 25 to 50mg for 5 to 10 days produces rapid reduction in polyp size. Effect is temporary without ongoing nasal steroid use.
Functional endoscopic sinus surgery (FESS)
Endoscopic removal of polyps and opening of blocked sinuses. Provides excellent relief but polyps recur in 40 to 60% within 5 years. Post-op nasal steroid use prolongs remission.
Biologic therapy (dupilumab)
Dupilumab (anti-IL-4/IL-13) is licensed for severe chronic rhinosinusitis with nasal polyps in adults not controlled by nasal corticosteroids and/or surgery. Dramatically reduces polyp burden and is steroid-sparing.
Self-care and lifestyle
- Use nasal steroid spray every day, not just when symptomatic
- Rinse with saline douche morning and evening to reduce crusting and clear secretions
- Avoid aspirin and NSAIDs if diagnosed with Samter's triad
- Treat underlying asthma and allergic rhinitis well
Prevention
Optimal control of asthma, allergic rhinitis, and prompt treatment of sinusitis may reduce polyp formation. There is no reliable primary prevention.