Nasal Polyps Treatment

Most polyps in the nose and sinuses are the byproduct of an inflammatory process. It is unclear what drives this inflammatory process—viruses, allergies, bacteria, and environmental irritants have all been proposed. For some reason, however, it appears that an inflammatory cascade is triggered that leads to swelling of the nasal and sinus lining and, ultimately, to the development of polyps.

Polyps can form in the nose, or in the sinuses themselves. When they are present in the nose, they may alone lead to nasal obstruction. If they become large enough, polyps can block the drainage pathways of the sinuses. When the sinus drainage pathways are obstructed, the normal sinus function will be affected, and patients may develop the signs and symptoms of chronic sinusitis.

In most cases, nasal and sinus polyps are benign growths. On occasion, however, the presence of polyps may be a manifestation of a tumor or a cancer. Any patient with sinus or nasal polyps should be seen by a trained otolaryngologist who can perform a nasal endoscopy in the clinic. This procedure is very well tolerated and takes only a few minutes. This will allow your doctor to examine the polyps closely. If the polyps are concerning for a tumor, your doctor may decide to obtain imaging (CT scan, MRI) to help define the extent of the polyp. Your physician may also perform a biopsy for a definitive diagnosis. A biopsy may be performed in the clinic or in the operating room depending on the case. If a biopsy is recommended, your physician will discuss these options with you.

Again, in most cases, polyps are benign growths. However, a trained otolaryngologist should examine patients with polyps to make sure that the polyp does not represent another type of mass. Encephalocoeles (herniated brain tissue) can present as a nasal or sinus polyp. An inverted papilloma is a benign tumor with a small incidence of malignant degeneration that also may present as a simple polyp. Some other lesions that may present with polyps include juvenile nasopharyngeal angiofibroma, pleomorphic adenoma, sarcoidosis, Wegener’s disease, adenocarcinoma, and squamous cell carcinoma. 

Some studies have found polyps to be present in as many as 1-4 percent of people in the general population.

There is an increased prevalence of polyps in some patient groups. Patients with asthma and aspirin intolerance are more likely to have polyps than those without these conditions. Patients with cystic fibrosis and other conditions (Churg-Strauss syndrome, ciliary dysfunction syndrome) also have an increased prevalence of sinonasal polyps.

Many patients do not know that they have sinus polyps. Other patients who have complete nasal obstruction from massive polyposis that blocks all nasal airflow and impedes sinus function are well aware of their condition. Common symptoms include nasal obstruction, diminished sense of smell (hyposmia), and sinusitis. Any patient with a concern for the presence of polyps should be evaluated by an otolaryngologist who can look into the nasal cavity with a small endoscope and evaluate for the presence of polyps.

An antrochoanal polyp is a benign polyp that most commonly has its stalk in the maxillary sinus area (the “cheek” sinus located below the eye). The polyp enlarges until it passes out of the sinus and into the nasal cavity. These masses can grow to be quite large and may distort the surrounding anatomy. Once they grow into the choana (the pathway through which air passes from the nose into the throat), patients’ symptoms may worsen as nasal breathing becomes increasingly difficult. Sometimes the polyp may actually extend all the way to the opposite choana and block nasal breathing from both sides.

Medicines for the treatment of nose and sinus polyps mostly rely on an anti-inflammatory effect. Oral steroids (i.e., prednisone) are often quite effective in shrinking polyps. However, the risks of long-term treatment with oral steroids is often thought to outweigh the benefits of treatment. Most physicians, therefore, use oral steroids in bursts to help patients with polyps who are having a bad episode of swelling. Topical steroids (nasal steroid sprays) can be used on a more long-term basis to help patients decrease the inflammation associated with nasal and sinus polyps. Other novel preparations are available, but the relative risks and benefits should be discussed with your physician.

In some patients with a significant bulk of polyps, it may be necessary to surgically remove the polyps so that topical medications can be effective. In many patients with polyps, the sinuses have also developed a chronic inflammatory state and may need to be opened as well, so that they may return to normal function.

In many patients with hyposmia (decreased sense of smell), decreasing the polyp burden (either with medicines and/or nasal/sinus surgery) may lead to improvement in the sense of smell. Patients should be aware, however, that not all patients will have their sense of smell return or improve, and it can be difficult to predict which patients will benefit from treatment.

Most patients who have their polyps treated effectively with medicines and/or nasal surgery will improve their nasal airflow and function.

Polyps are the byproduct of a chronic inflammatory process. The key word here is chronic. No medicine or nasal surgery can cure you of your polyps (much like no medicine or nasal surgery can cure you of high cholesterol or hypertension), but they can be managed and brought under control so that you can significantly improve your quality of life. Once removed, polyps will have a tendency to regrow. Fortunately, with a combination of topical sprays and drops, and occasional oral medications, most patients can keep their polyps under control.