Nasal polyps

Summary

Nasal polyps are soft, benign swellings caused by inflammation of the lining of the nose and sinuses. They commonly arise around the ethmoid sinuses between the nose and the eyes. They can cause nasal blockage, reduced smell and taste, discharge and facial pressure. Diagnosis is based on examination, often with nasal endoscopy and sometimes a CT scan. Treatment includes corticosteroid medication and, when necessary, surgery. A one-sided or unusual-looking nasal mass needs further investigation because it may not be an ordinary inflammatory polyp.

What are nasal polyps?

Polyps are smooth, sac-like swellings that can extend from the sinus lining into the nasal cavity. Their development is linked to persistent inflammation. They are associated with chronic rhinosinusitis, asthma and sensitivity to aspirin or other NSAIDs in some patients. Allergy may coexist but is not the only cause. Polyps are most common in adults and are unusual in young children; a child with polyps may need assessment for an underlying condition.

Symptoms

Symptoms include persistent blockage, reduced or absent smell, reduced flavour perception, nasal discharge and a feeling of pressure or fullness. Symptoms can be present on both sides and may worsen during other upper-airway inflammation. Asthma and sinus inflammation can influence each other, so good control of both upper and lower airway disease is important.

Diagnosis

The ENT specialist examines the nose and may use a thin endoscope to see deeper areas. A CT scan can show the extent of sinus disease, particularly before surgery or when symptoms and examination do not match. A biopsy is not required for every typical bilateral polyp, but an isolated one-sided, bleeding, painful or irregular mass requires prompt specialist assessment and may need imaging and tissue examination.

Treatment

A corticosteroid nasal spray is commonly used to reduce inflammation and shrink polyps. Correct, regular use is important. A short course of oral corticosteroids may be considered for selected severe symptoms under medical supervision. Saline rinsing can help with mucus and delivery of topical treatment.

If symptoms remain troublesome despite appropriate treatment, endoscopic surgery may remove polyps and open the affected sinuses. Polyps can recur because surgery does not remove the underlying tendency to inflammation, so ongoing nasal treatment and follow-up are often needed. Some patients with severe recurrent disease may be assessed for additional treatments such as biologic medicines.