Nasal Polyps

What are nasal polyps?

Nasal polyps are non-cancerous growths that develop as a result of chronic inflammation within the nasal cavity. They may be associated with allergies, asthma, or recurrent sinus infections.

These soft, painless growths can vary in size and may lead to symptoms such as nasal congestion, a reduced sense of smell or breathing difficulties. Although nasal polyps are not harmful in themselves, they can significantly impact quality of life and often require medical management or treatment.

What are the types of nasal polyps?

• Antrochoanal polyps: Typically arise from the maxillary sinus, extend into the nasal cavity and grow towards the back of the nose (the posterior choana).
• Inflammatory polyps: Arise from inflammation, for example in patients who have chronic rhinosinusitis with nasal polyposis. These may be unilateral or bilateral and may be associated with other conditions like severe asthma, NSAID-exacerbated respiratory disease, eosinophilic granulomatosis with polyangiitis, and allergic fungal rhinosinusitis.

What are the symptoms of nasal polyps?

When polyps become large or numerous, they may block normal drainage and airflow.

In addition to nasal obstruction, other common symptoms include:

• Runny nose
• Postnasal drip (a sensation of mucus draining down the throat)
• Nasal congestion or stuffiness: Large or multiple polyps can obstruct the nasal passages, leading to persistent nasal congestion and difficulty breathing through the nose.
• Loss or reduction of sense of smell: Polyps may interfere with the olfactory (smell) receptors, resulting in a partial or complete loss of the sense of smell.
• Snoring and sleep disturbances: Obstructed airways may cause snoring or contribute to sleep apnoea, disrupting normal sleep patterns.
• Facial pain or pressure: Inflammation or blockage in the sinuses caused by polyps may result in a sensation of pressure or pain around the eyes, forehead or cheeks.
• Headache
• Frequent nosebleeds (less common)
• Chronic sinus infections or frequent episodes of sinusitis
• Mouth breathing (especially in children)
• Cough (often worse at night)

When should you see a doctor?

You should see a primary care physician if you experience persistent nasal congestion or obstruction that does not improve with oral antihistamines or if you have recurring sinus infections.

Additionally, consult a primary care physician if you notice a significant loss of smell, ongoing facial pain, facial pressure, or if symptoms are affecting your quality of life. They should typically start treatment with corticosteroid nasal sprays and review you after you have completed using at least one bottle of the sprays, to see if you have improvement with this treatment. If symptoms are persistent despite the use of corticosteroid nasal sprays, referring to an ENT specialist will then be appropriate.

What are the potential complications of nasal polyps?

Complications of nasal polyps may include:

• Frequent sinus infections: Blocked sinuses can lead to recurring or chronic sinusitis due to poor drainage and retained mucus.
• Asthma exacerbation: In individuals with asthma, nasal polyps may worsen symptoms and increase the frequency of asthma attacks.

How can you reduce the symptoms of nasal polyps?

While nasal polyps cannot be prevented entirely, you can reduce the symptoms of it by reducing inflammation and avoiding triggers that irritate the nasal passages. Here are some measures to help reduce the chances of developing nasal polyps or experiencing recurrences:

• Manage allergies and asthma: Follow your doctor's advice to control underlying conditions with prescribed medications or immunotherapy.
• Avoid irritants: Limit exposure to substances such as smoke, dust, strong odours and pollutants that can inflame the nasal lining.
• Maintain nasal hygiene: Use saline nasal sprays or rinses regularly to keep the nasal passages moist and free of irritants.
• Treat sinus infections promptly: Seek medical attention for recurring or chronic sinus infections to prevent prolonged inflammation.
• Adhere to medication regimens: If prescribed corticosteroid nasal sprays or other treatments, use them as directed to reduce inflammation and prevent polyp reformation after surgery.

Why do nasal polyps occur in some people?

Nasal polyps develop due to chronic inflammation of the nasal lining, often associated with allergies, asthma, recurring infections or altered immune system responses. This prolonged inflammation can lead to the formation of soft, painless growths within the nasal passages or sinuses.

However, it is not known why some people get nasal polyps, and others do not.

What are the risk factors for nasal polyps?

Several factors may increase the likelihood of developing nasal polyps, including:

• Chronic sinusitis: Persistent inflammation of the sinuses
• Asthma: A respiratory condition associated with airway inflammation
• Allergies: Particularly sensitivity to airborne allergens like pollen or dust
• Cystic fibrosis: A genetic condition that affects mucus clearance
• Aspirin / NSAID sensitivity: A reaction that may cause respiratory symptoms in some individuals and increase the risk of polyp formation. These patients have concomitant asthma as well.
• Autoimmune disease: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune disease characterized by inflammation of small and medium-sized blood vessels. Also known as Churg-Strauss Syndrome, it is typically associated with elevated levels of eosinophils (a type of white blood cell), and patients often have asthma and nasal polyps. Other organs, like the skin, heart, kidneys, and nerves, may also be affected.

How are nasal polyps diagnosed?

The diagnosis of nasal polyps may involve the following:

• Medical history: The doctor reviews symptoms and any underlying conditions, such as allergies or asthma.
• Nasoendoscopic examination: A detailed examination of the nasal cavity is performed using a nasal endoscope, a thin tube with a light and camera, to confirm the presence of polyps as well as to evaluate the extent of disease.
• Imaging tests: A CT scan or MRI may be used to determine the extent of the polyps in some cases, as well as to identify any other possible obstructions within the nasal cavity. More often, CT scans are performed as part of planning for surgery for nasal polyps.
• Allergy testing: Conducted to identify potential allergens contributing to chronic inflammation.
• Testing for underlying conditions: In some cases, tests for conditions such as cystic fibrosis or immune system disorders may be recommended.

How are nasal polyps treated?

Treatment for nasal polyps may involve a combination of lifestyle changes, medications and surgical options:

Lifestyle changes

Stop smoking to reduce inflammation and improve nasal health.

Medications

• Intranasal corticosteroids: Used for the treatment and control of nasal polyps
• Oral corticosteroids: Prescribed for larger polyps or more severe cases
• Antihistamines: Used to manage allergies that may contribute to polyp formation
• Saline irrigation: Recommended for allergic rhinitis and rhinosinusitis with/without polyps
• Monoclonal antibodies: In certain patients with severe inflammation where polyps recur after comprehensive sinus surgery and ongoing intranasal steroid irrigations, these new biological agents, administered as an injection every few weeks, are effective in controlling polyp recurrence and improving quality of life.

Surgery

• Surgery is needed:
  • If medication fails to shrink or eliminate polyps, with persistent ongoing symptoms that affect quality of life.
  • If there is suspicion of cancerous growths.
• The extent of the surgery will depend on the location and size of the polyps.
• Functional endoscopic sinus surgery: Widening of the natural opening of the paranasal sinuses to reduce inflammatory load, remove all polyps, and allow better delivery of intranasal medications after surgery.

References

Kim, J. (2023, February 24). Nasal polyps. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/nasal-polyps

Nasal polyps - ear, nose, and throat disorders. MSD Manual Consumer Version. (n.d.). https://www.msdmanuals.com/home/ear-nose-and-throat-disorders/nose-and-sinus-disorders/nasal-polyps

Nasal polyps. Mass Eye and Ear. (n.d.). https://www.masseyeandear.org/conditions/nasal-polyps?TRILIBIS_EMULATOR_UA=%2C%2C%2C

A review of nasal polyps. (2019). Medical & Clinical Research, 4(11). https://doi.org/10.33140/mcr.04.11.02