Definition

Nasal polyps are benign, stalk-like growths in the nose. They are soft and painless and result from chronic or long-term inflammation of the mucosal tissue of the nose. This inflammation may manifest as swelling, irritation, or redness. Nasal polyps are often linked with asthma, recurrent infections, allergies, sensitivity to certain medicines, or specific immune disorders.

While small nasal polyps may not cause symptoms, larger or multiple polyps can obstruct nasal passages, causing breathing difficulties. Loss of smell and frequent infections are common in cases involving nasal polyps.

Although nasal polyps can occur in anyone, they are more prevalent in adults. Medications can help reduce the size or remove nasal polyps, but surgical procedures might be necessary if medications are ineffective. Even after successful treatment or surgical procedures, nasal polyps can recur.

Causes

The exact causes of nasal polyps remain unclear, including why some individuals are more prone to chronic mucosal inflammation or why the inflammation leads to nasal polyp formation in certain people.

The swelling and inflammation occur in the mucous membrane lining the nasal passage and sinus cavities. Research indicates that individuals with nasal polyps have different immune responses and chemical markers in their mucous membranes than those without nasal polyps.

Nasal polyps can develop at any age but are most common in young and middle-aged adults. They can form anywhere in the nasal passages and sinus cavities, though they frequently appear in the sinus cavities near the eyes, nose, and cheekbones, where the fluid typically flows toward the nose.

Risk factor

Any condition causing long-term inflammation of the nasal passages or sinuses, such as infections or allergies, can increase the risks of developing nasal polyps.

Conditions commonly associated with nasal polyps include:

• Asthma, which causes the airway to swell and narrow
• Sensitivity to aspirin
• Fungal allergic sinusitis, an allergy to airborne fungi
• Cystic fibrosis a genetic disorder that makes body fluids, including sinus fluid and nasal mucus, to be thicker and stickier
• Churg-Strauss syndrome, a rare condition causing blood vessel inflammation
• Vitamin D deficiency

Family history may also contribute to the development of nasal polyps, with some evidence suggesting that certain genetic variations can increase the risk.

Symptoms

Nasal polyps are linked to chronic sinusitis or rhinosinusitis, characterized by irritation and swelling of the mucosal lining of the nasal passage and sinus that persist for over 12 weeks. However, chronic sinusitis or rhinosinusitis can also occur without nasal polyps.

Because nasal polyps are usually soft, polyps with small sizes might go unnoticed. Larger or multiple polyps can block nasal passages and sinuses, causing noticeable symptoms.

Common signs and symptoms of nasal polyps include:

• Runny and congested nose
• Postnasal drip (mucus flowing from the nose to the throat)
• Reduced or lost sense of smell
• Loss of sense of taste
• Facial pain or headache
• Upper teeth pain
• A sensation of pressure on the forehead and face
• Snoring
• Nosebleeds

Diagnosis

Doctors diagnose nasal polyps based on patient symptoms, medical history, and physical and nasal examination. Polyps can be visible to the naked eye with the help of a simple flashlight. To further support the diagnosis, the doctor might recommend these tests:

• Nasal endoscopy: A small tube with a magnifying lens or camera at the end and equipped with light will be inserted to help the doctor examine the nose and sinuses in detail.
• CT scan: Images from a CT scan help doctors determine the size and location of polyps deep within the sinuses and evaluate the swelling and irritation. This test also helps rule out other nasal obstructions, like structural abnormalities, tumor, or noncancerous growth.
• Allergy test: A skin test may be recommended to help identify if there are allergic reactions contributing to chronic inflammation. A small amount of allergen is pricked into the skin, which could be at the forearm or upper back, and the doctor will observe for any allergic response. If a skin test isn't possible, a blood test may be done to screen for specific antibodies to allergens.
• Cystic fibrosis test: If a child has nasal polyps, a test for cystic fibrosis might be recommended. This genetic disease affects glands production of mucus, tears, sweat, saliva, and digestive fluid. The sweat test measures salt levels in sweat and is the standard diagnostic test for cystic fibrosis.
• Blood test: The doctor may check vitamin D levels through a blood test, as low vitamin D is associated with nasal polyps.

Management

Chronic sinusitis, whether or not nasal polyps are present, is difficult to cure completely. Long-term treatment involves working with your doctor to manage symptoms and address risk factors like allergies.

The primary goal in treating nasal polyps is to reduce or remove their size. Medication is usually the first line of treatment. A surgical procedure may be necessary in some cases, but it is not a permanent solution, as polyps could recur.

Medications

Treatment for nasal polyps generally starts with medication, which can sometimes help reduce the size or eliminate the polyps. Medications commonly used include:

• Nasal corticosteroid spray. This medication helps reduce swelling and irritation, potentially shrinking or removing polyps. Nasal corticosteroids such as fluticasone, budesonide, mometasone, triamcinolone, or beclomethasone should be prescribed by a doctor.
• Oral corticosteroids and corticosteroid injections. If nasal corticosteroid sprays are ineffective, doctors may prescribe oral corticosteroids alone or together with a nasal spray. Due to serious side effects, oral corticosteroids are used briefly. Corticosteroids injections are only used for really severe polyps.
• Medication for chronic sinusitis and nasal polyps. For cases involving both polyps and chronic sinusitis, doctors may prescribe dupilumab injections, which can reduce polyp size and nasal obstruction.
• Other medications. Doctors may also prescribe antihistamines for allergies and antibiotics for chronic or recurring infections, which could contribute to long-term inflammation of sinus and nasal passage.
• Aspirin desensitization. Under an experienced doctor who is trained in treating allergy, this method may help patients with nasal polyps due to aspirin sensitivity. Under doctor’s supervision, it involves gradually increasing aspirin intake to help the body tolerate it long-term.

Surgery

If medication fails to reduce the size or eliminate nasal polyps, endoscopic surgery may be needed to remove the polyps and correct sinus issues contributing to mucosal inflammation and polyp formation.

In endoscopic surgery, the doctor inserts a small tube with a light tip and magnifying lens or camera into the nostril, guiding it into the sinus cavity. Using special tools, the doctor removes nasal polyps and any growth that obstructs sinus fluid drainage. The sinus openings may also be enlarged to improve fluid flow to the nasal passage. This procedure is typically done on an outpatient basis.

After surgery, you will be prescribed a nasal corticosteroid spray to prevent polyp recurrence. Doctors also recommend rinsing the nose with saline solution to aid healing.

Complications

Nasal polyps can lead to complications by obstructing airflow and hindering sinus fluid drainage. Long-term irritation and inflammation associated with nasal polyps can also contribute to these complications:

• Obstructive sleep apnea. A potentially serious condition where breathing stops temporarily during sleep.
• Asthma attacks. Chronic sinusitis and nasal polyps can exacerbate asthma symptoms.
• Sinus infections. Nasal polyps increase susceptibility to frequent sinus infections.

Prevention

To reduce the risk of nasal polyps or prevent their recurrence, you can consider these preventive measures:

• Manage allergies and asthma. Follow your doctor's advice on treating allergies and asthma effectively. If symptoms persist, seek appropriate medical advice.
• Avoid irritants. Minimize exposure to airborne substances that can trigger nasal and sinus swelling and irritation, such as allergens, tobacco smoke, chemical fumes, dust, and fine particles.
• Practice good hygiene. Wash hands thoroughly regularly to reduce the risk of bacterial and viral infections that can inflame nasal passages and sinuses. 
• Maintain the humidity of the house. Use a humidifier to keep indoor air moist, aiding mucus drainage from the sinuses and preventing blockages and inflammation. Clean the humidifier daily to prevent bacterial growth.
• Use nasal sprays. Saline sprays or rinses can wash nasal passages, facilitating mucus drainage and removing allergens and irritants. Ensure the nasal irrigation kit is cleaned with sterile water and dried thoroughly after each use.

When to see a doctor? 

Consult a doctor if symptoms persist for more than 10 days, as chronic sinusitis and nasal polyps can mimic other conditions like the common cold. Seek immediate medical attention or call the emergency hotline if you experience:

• Severe difficulty breathing
• Sudden worsening of symptoms
• Double vision, reduced vision, or difficulty in moving the eyes
• Severe swelling around the eyes
• Headache accompanied by high fever or difficulty lifting the head

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