Nasal polyps are painless, teardrop-shaped growths that form in your nose or sinuses. They’re most common where the sinuses near your eyes and cheekbones drain into your nose. Nasal polyps are not cancer and may never cause symptoms or need treatment. But sometimes they can lead to congestion, loss of taste and smell, trouble breathing, or repeat sinus infections.
Some people with nasal polyps become sensitive to common pain relievers like aspirin or ibuprofen. To relieve these symptoms, doctors first try medications such as nasal or oral steroids or biologic drugs like dupilumab (Dupixent), mepolizumab (Nucala) or omalizumab (Xolair), which are given as a shot every two to four weeks. These medicines often can shrink polyps, but they can have drawbacks, including side effects and cost.
Surgery to remove polyps is usually only an option when medicines don’t help. Surgery might not be right for you if you have a bleeding disorder or a serious heart or lung problem.
Types of Nasal Polyp Surgery
There are a few ways to remove nasal polyps:
- Polypectomy. Your doctor may suggest this if you have large polyps that are easy to reach. The polyps are usually removed with very small surgical scissors or snares. A surgical snare is a wire loop that wraps around and cuts the polyp.
- Balloon dilation or balloon sinuplasty. Doctors thread a small balloon into your sinuses and then slowly inflate it. This helps open the sinuses and make breathing easier. Polyps may or may not be removed at the same time.
- Endoscopic nasal polyp surgery. This is the most common way to remove polyps and the one many doctors recommend.
Preparing for Endoscopic Nasal Polyp Surgery
- If you smoke, you should stop at least three weeks before surgery and for four weeks afterward. Smoking makes it harder to heal and may even cause the surgery to fail. Ask your doctor about the best ways to quit.
- Stop taking fish oil, ginkgo, garlic, and common pain relievers like aspirin two weeks before the procedure. They increase bleeding during and after surgery.
- If you take blood thinners like warfarin (Coumadin), heparin, or aspirin, ask your doctor if you should stop them.
- The surgery is usually done while you’re asleep under general anesthesia. If you don’t want this type of anesthesia, ask your doctor about other options.
- Nasal polyp surgery is an outpatient procedure, which means you’ll go home the same day. Be sure you have someone to drive you.
During Nasal Polyp Surgery
The surgery is done inside your nose, so you won’t have cuts or bruises on your face.
- Your surgeon will place an endoscope, a thin tube with a light and camera on the end, into your nostril. This allows them to see the inside of your nose and sinuses on a monitor screen.
- The polyps are removed using small tools. One of the most common is called a microdebrider. It removes and suctions away tissue and blood at the same time.
- Your surgeon may also remove the nasal and sinus lining. This widens and improves drainage to your sinus cavities.
- Depending on the number and location of your polyps, surgery may last from 30 minutes to a few hours.
- You may or may not have packing in your nose to help with bleeding. Packing usually dissolves on its own.
After Nasal Polyp Surgery
It’s normal to feel tired and have some pain for the first week after surgery. You may also have a little bleeding and discharge from your nose. For these reasons, many people take the week off. Tylenol may be all you need for pain. Your doctor can prescribe something stronger if needed.
Your doctor will give you specific at-home instructions. They may include these guidelines to prevent nosebleeds and aid healing:
- Avoid lifting more than 20 pounds or returning to your usual exercise routine for two weeks. Walking is fine, and you can start to ease back into 50% exercise after about seven days.
- Avoid blowing your nose until your doctor says it’s OK.
- Use a saline (sterile saltwater) mist every three to four hours or as your doctor suggests. This soothes tissues in your nose and keeps them moist.
- Your doctor will likely tell you to start sinus rinses the day after surgery. It may seem strange at first, but your doctor or nurse will show you how.
- Keep all your doctor appointments. Your doctor may want to see you every week or two for the first six weeks after surgery. These visits are important to keep track of how you’re healing and to remove any blood or crusts inside your nose.
Nasal Polyp Surgery Complications
Nasal polyp surgery usually goes smoothly, and complications are rare. But like any surgery, there are risks, especially if you smoked in the past or have other health problems. Be sure you understand the risks and other options before you choose surgery.
Infection. This is one of the most common complications of any surgery. Your doctor may prescribe antibiotics to help reduce the risk.
Steady bleeding. It’s normal to lose some blood during surgery and to have light bleeding the first day or two at home. If you have constant bleeding, try tilting your head back slightly or use Afrin nasal spray every 20 minutes for one hour. You can buy it over the counter at most drugstores. If this doesn’t help, call your doctor.
Vision loss or other eye problems. These may happen because your sinuses are very close to your eyes. Sometimes vision loss, double vision or watery eyes can be permanent, but this is very rare.
Cerebral spinal fluid leak. Cerebral spinal fluid or CSF is a clear liquid that surrounds and protects your brain and spinal cord. Very rarely, the bone between the nose and brain is damaged during surgery, causing a CSF leak. This is usually fixed right away. If not, you’ll need another procedure to repair it.
Other complications may include loss of sense of smell, changes in voice, worsening of sinus symptoms, and bruising or swelling around the eyes.
Nasal Polyp Surgery and Insurance
Medicare and many private insurers will pick up at least some of the cost of nasal polyp surgery as long as your doctor can show you need it.
Your out-of-pocket costs depend on your insurance. With Medicare, you may pay about $550 if your surgery’s done in a surgery center. Hospital surgery can cost nearly three times as much.
Nasal Polyp Reruns
One of the biggest downsides of nasal polyp surgery is that polyps almost always come back. One small study found that nearly 80% of people who had surgery saw their polyps return within 12 years. More than one-third needed another operation. Here are some tips to help prevent this:
- Work with your doctor to control asthma and allergies. These are two main causes of nasal polyps.
- As much as possible, avoid breathing tobacco smoke, chemical fumes, allergens, and dust. They can irritate your nose and sinuses.
- Wash your hands often to help prevent infections.
- Use saline spray daily to keep your nose moist and flush out germs.
