Conditions: Nasal Polyps
Nasal polyps are soft, noncancerous swellings of the nasal and sinus lining that result from long-lasting inflammation.
What are Nasal polyps?
Depiction of nasal polyps.
Nasal polyps are soft, benign (noncancerous) growths that form on the lining (mucous membrane) of the nose and the sinuses, the air-filled spaces in the bones around the nose and eyes. They are not tumors and are not cancer. Polyps are usually painless and often appear as smooth, teardrop- or grape-shaped swellings that can be gray-white, pale, yellow, or pink.
Polyps most often grow from the lining high inside the nose, near where the sinuses drain into the nasal cavity. They usually develop on both sides of the nose. When they become large or numerous, they can block the nasal passages and the sinus openings, limiting nasal airflow and creating a favorable environment for sinus infection.
What symptoms do nasal polyps cause, and how are they diagnosed?
Nasal polyp
Symptoms. The most common symptoms of nasal polyps are:
Nasal blockage or congestion: a persistent stuffy feeling with difficulty breathing through the nose.
Reduced or lost sense of smell: often also affecting taste, and a hallmark symptom (see olfactory dysfunction).
Nasal drainage: a runny nose or mucus dripping down the back of the throat.
Facial pressure or fullness: a heavy sensation over the cheeks, forehead, or around the eyes.
Poor sleep is also common. Larger polyps tend to cause more blockage, but polyp size does not necessarily predict how severe the other symptoms will be.
Diagnosis. Diagnosis usually combines the history of symptoms with a direct look inside the nose:
Medical history: a review of nasal and sinus symptoms lasting more than three months, along with any history of asthma, allergies, or reactions to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).
Nasal endoscopy: a thin, lighted tube with a camera is passed gently into the nose in the office, allowing polyps to be seen and the diagnosis confirmed. Very large polyps can sometimes be seen with a simpler nasal exam.
CT (computed tomography) scan: detailed CT imaging of the sinuses is generally used to map the extent of disease when medical treatment has not worked, to plan surgery, or to look for other conditions.
What is the inflammation behind nasal polyps?
Nasal polyps are the result of long-lasting inflammation of the lining of the nose and sinuses. Because of this, they are considered a form of a broader condition called chronic rhinosinusitis, which is sinus and nasal inflammation lasting more than about three months. Chronic rhinosinusitis is divided into two main groups: with nasal polyps and without nasal polyps.
In most people with polyps, particularly in Western countries, the driving process is a specific pattern of immune activity known as type 2 inflammation. In this pattern, a white blood cell called the eosinophil builds up in the nasal lining, along with immune signaling molecules (including interleukin-4, interleukin-5, and interleukin-13). This ongoing inflammation causes the lining to swell, retain fluid, and gradually reshape itself into polyps. The same type 2 inflammation is often at work elsewhere in the airway, which helps explain why polyps frequently occur alongside conditions such as asthma.
How common are nasal polyps, and who is affected?
Nasal polyps affect roughly 1% to 4% of adults. They become more common with age, reaching a peak around the fifties and sixties, and they are more common in men than in women. Polyps are uncommon before adulthood. When polyps are found in a child, an underlying condition such as cystic fibrosis is looked for carefully.
What conditions are associated with nasal polyps?
Nasal polyps frequently occur together with other conditions, most of which share the same underlying airway inflammation:
Asthma: very commonly linked. A large share of people with nasal polyps also have asthma, and having both often means more severe disease in the nose and sinuses.
Aspirin-exacerbated respiratory disease (AERD): a combination of nasal polyps, asthma, and reactions (such as nasal congestion, wheezing, or breathing trouble) after taking aspirin or other NSAIDs. AERD tends to involve more severe polyps that come back more readily.
Allergic fungal rhinosinusitis: extensive polyps together with a strong allergic reaction to fungus in the sinuses and a thick, allergic mucus. It is more common in warmer climates.
Cystic fibrosis: an inherited condition that is considered especially when polyps appear in children or young people.
Primary ciliary dyskinesia: an inherited condition in which the tiny hair-like structures that clear mucus from the airways do not work properly, leading to chronic sinus and lung disease.
Allergies (allergic rhinitis): nasal allergies commonly coexist with polyps. Allergy is not thought to directly cause polyps, but allergy testing may still be part of the evaluation.
What other conditions may appear to be polyps but are not?
A few other conditions can resemble nasal polyps, which is why specialist evaluation, and sometimes a biopsy (a small tissue sample), may be needed. This is especially true when a growth is only on one side of the nose or is accompanied by bleeding.
Benign or cancerous nose and sinus tumors: a growth on only one side of the nose, particularly with bloody drainage, raises concern for a tumor and calls for further evaluation.
Inverted papilloma: a benign but locally aggressive growth that can mimic a polyp and usually requires removal and examination under a microscope.
Granulomatosis with polyangiitis (formerly Wegener's granulomatosis) and related conditions: inflammatory or autoimmune diseases of the blood vessels that can affect the nose and sinuses, often with additional symptoms elsewhere in the body.
Encephalocele or meningocele: a rare situation in which brain lining or tissue protrudes into the nasal cavity (present from birth or after injury) and can be mistaken for a polyp.
Because of these possibilities, one-sided growths are approached with caution, and imaging or biopsy may be undertaken before treatment.
Why do nasal polyps tend to come back?
Nasal polyps have a strong tendency to recur, even after effective medication or surgery. Treatments address the polyps themselves, but the underlying type 2 inflammation in the nasal lining usually continues. Recurrence is more likely with a high number of eosinophils in the tissue, with asthma, and with aspirin-exacerbated respiratory disease. For this reason, ongoing maintenance treatment is typically needed even after polyps have been removed, and some people require more than one procedure over time.
How can nasal polyps affect quality of life?
Nasal polyps can substantially affect daily life. Constant congestion, loss of smell and taste, drainage, facial pressure, and disturbed sleep can interfere with eating, work, concentration, and overall well-being. The impact on quality of life can be considerable, which is one reason treatment focuses not only on shrinking polyps but also on relieving symptoms over the long term.
Treatment in brief
Treatment generally begins with steroid nasal sprays and saltwater (saline) rinses, sometimes with short courses of steroid pills for more severe symptoms. When symptoms are not controlled, sinus surgery to remove polyps may be considered, with continued nasal sprays afterward to help keep polyps from returning. For difficult or recurrent cases, newer injectable medicines (biologics) that target the underlying type 2 inflammation are an option. Details are on the sinus infection treatments page.
how to get the most from your SINUS appointment
Appointment time is valuable. Here are some suggestions to make the most of your appointment. This preparation will help you and your doctor maximize efficiency and accuracy, freeing up time for questions and answers.
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