General information

Nasal polyps are lumps that grow inside the nose and sinuses.

Polyps  in the nose and sinuses are not cancerous.  Instead, they are caused by swelling and irritation in the nose and sinuses.  As the swelling becomes worse, the lining forms lumps.  These lumps become more swollen and they can start to look like bunches of grapes.

The polyps block the nose and sinuses as they get larger.  That makes it hard to breathe through the nose. It also prevents the sinuses from draining.  When mucus builds up in the sinuses, it can lead to more irritation and swelling.  That makes the symptoms worse.

Many of the symptoms from polyps are related to the swelling and inflammation.  Sometimes, there can be actual bacterial sinus infections.  When there is a bacterial sinus infection, the nasal drainage gets thicker and can be foul smelling.

Allergy issues and asthma problems often go hand-in-hand with sinus problems and nasal polyps.  Nasal irritation from allergies is one of the things that can cause polyps to grow.  But anything that causes a lot of swelling can lead to polyps.

Some people with polyps have a sensitivity to medications like aspirin or ibuprofen.  This type of sensitivity causes extra swelling in the nose, sinuses, and lungs.  This usually cases really severe nasal polyp problems.

Diagnosis

The best way to diagnose nasal polyps is through an evaluation by a doctor trained in the evaluation and management of nasal problems.  Your doctor will first learn about your symptoms after reviewing your medical history.  Things like a history of environmental allergy problems and aspirin allergy are common in patients with polyps. 

After learning about your symptoms, the diagnosis is made by looking at the inside of the nose and sinuses.  Sometimes, it is easy to see polyps just by looking at the front of the nose.  This type of exam is called anterior rhinoscopy.  However, to see the inside of the nose in a detailed way, a sinus doctor will get a detailed look using a tool called a nasal endoscope.  This tool is like a skinny flashlight and camera. It provides a magnified view of the inside of the nose, allowing the doctor to look for things like polyps.

Another way to “look” inside the nose and sinuses is through a sinus CT scan.  A sinus CT scan is a special type of x-ray that gives us a high resolution image of the nose and sinus areas.

In our office, we can perform the endoscopy and obtain the CT scan all in one place at the time of your office appointment.  We can then review this information with you to during your visit to come up with a treatment plan that is best for you.

Treatment

Polyps can be treated a few different ways.  Swelling and inflammation are what cause the polyps to form in the first place, so treating the swelling can help shrink the polyps.  The inflammation can be treated with medications. Some of the types of medications that help treat polyps include steroid pills, steroid nasal sprays, and allergy medications.  If the swelling goes down, the polyps will shrink.  When that happens, breathing and sinus drainage can improve.

Medications do help many patients with polyps.  For some, though, the inflammation is so severe and the polyps are so large that medications have a very limited effect.  In these cases, surgery can be very helpful.

Surgery for nasal polyps is aimed at removing the polyps, enlarging the sinus openings, and helping to improve the amount of space in the nose and sinuses.  This is an outpatient procedure performed at a surgery center. The procedure is performed under anesthesia. The work is done using an endoscope inserted into the nostrils.

Most patients with polyps do feel significantly better after surgery.  Having better nasal and sinus openings makes it easier to maintain the hygiene of the sinus areas with things like nasal irrigations.  The better openings also make it easier for nasal sprays and similar medications to get into the sinus areas. This can help keep the swelling under better control on a long term basis.

For many patients, there is no “cure” for nasal polyps.  Patients often ask if polyps come back after surgery. Polyps do often recur, even after surgery and after using medications.  But, for many patients, the polyps do not become swollen enough to cause symptoms that are as severe. Most patients also have many years of relief before needing any additional procedures for polyps.

For those patients who have sensitivity to medications like aspirin, other treatments can also be helpful after polyp removal and sinus surgery.  Some patients undergo aspirin desensitization under the care of an experienced allergy doctor. This can help decrease the swelling in the nose, sinuses, and lungs.  By decreasing the swelling, the nasal and lung symptoms are typically much better.

Other medications have also become available in recent years.  The FDA has also approved a new biologic medication for treating nasal polyps.  The medication is called dupilumab (brand name: Dupixent).  The medication is given by an injection every two weeks, either at home or in the doctor’s office.  It works by blocking two proteins (called interleukins) that contribute to inflammation in patients with polyps.  It can shrink polyp size and improve congestion and sense of smell.  Patients may also need fewer steroid medications if they respond to dupilumab.