Nasal polyps are teardrop-shaped, soft tissue growths that form in the lining of your nasal cavity and sinuses (the hollow spaces in the bones of your face). Nasal polyps are benign, which means they aren’t cancerous. They don’t hurt, but as they grow, they can sometimes block breathing, make it hard to smell, and cause infection. They typically form after you’ve had inflammation (swelling) in your upper respiratory system.
What Causes Nasal Polyps?
Doctors don’t know why nasal polyps form or why some people get them and others don’t. Some research suggests people who get them may have an abnormal immune response compared to people who don’t get them. But they’re very often tied to chronic rhinosinusitis (also called chronic sinusitis), which is inflammation of your nasal passages and sinuses that lasts for 12 weeks or more.
There are other patterns among people who tend to form nasal polyps. Certain genes that are linked to the immune system and inflammatory responses may be tied to nasal polyps. This puts you at a slightly higher risk of getting them if you have family members with nasal polyps. Other things that raise your chances of having them include:
- Allergic rhinitis (hay fever)
- Asthma
- Aspirin sensitivity (also called aspirin-exacerbated respiratory disease, or AERD)
- Cystic fibrosis
- Dental infections
- Low levels of of vitamin D
You’re most likely to get nasal polyps as an adult in your 30s or 40s.
Symptoms of Nasal Polyps
Nasal polyps themselves don’t hurt, but they often come with certain symptoms. When you have nasal polyps, it’s a lot like having cold symptoms that don’t go away. You’re more likely to have symptoms from nasal polyps once they start to grow and get larger or you get multiple nasal polyps at once.
Symptoms include:
- Blockage in your nose that makes it hard to breathe (mouth breathing is common)
- Dampened sense of smell and taste
- A “full” feeling or pressure in your face around your sinuses (but not pain)
- Runny nose
- Nosebleeds
- Sneezing
- Headache
- Cough
- Itching around the eyes
- Snoring
Because nasal polyps can block nasal drainage, you can have more frequent infections. Infections cause other issues, like fever or yellowish or greenish drainage from your nose.
You can also get other issues from nasal polyps, such as:
- More frequent asthma attacks if you have asthma
- Sleep apnea or other sleep disorders
Very rarely, serious complications can happen such as:
- Bone infection (osteomyelitis) and bone loss
- Pockets of infection called abscesses that can spread to your eye sockets and brain
- Meningitis (infection of the tissues around your brain and spinal cord)
Diagnosing Nasal Polyps
To see if you have nasal polyps, a doctor will start by getting your medical and family history. They’ll ask about your symptoms to find out which ones you’ve been having and how long they’ve been happening.
Then they’ll use several tests and tools to get a closer look at your nasal passages and sinuses, including:
Nasal endoscopy. An endoscope is a long, thin, flexible tube with a light and camera on the end. A doctor puts it into your nose and up into your sinuses to look for nasal polyps.
Computed tomography (CT) scan. A CT scan uses a computer linked to an X-ray machine to look at cross-sectional images of your sinuses. Typically your doctor only uses this if they’re unclear about your diagnosis after endoscopy.
Magnetic resonance imaging (MRI) scan. An MRI scan uses large powerful magnets, radio waves, and a computer to make images of your nasal tissue and sinus tissue.
Other testing can help your doctor get a better picture of what may be going on. These tests include:
Allergy testing. Allergy tests involve skin prick tests or blood tests to see what substances cause an allergic reaction in your body. This can tell your doctor what may be causing inflammation in your nasal passages and sinuses and leading to nasal polyps.
Biopsy. In some cases, your doctor may want to take a small sample of tissue from a nasal polyp once they find one. The doctor will use very small tweezers called forceps through their endoscope to cut off a tiny sample of the polyp. A lab will look at the tissue cells under a microscope to see if they look abnormal. Doctors typically do this if they are concerned a growth might be cancerous (which would mean it wasn’t a nasal polyp).
In addition to diagnosing your polyps, these tests also help your doctor see where they are in your nasal passages and sinuses.
Nasal Polyps Treatment
How your doctor chooses to treat your nasal polyps will depend in part on how severe they are. Medications can shrink nasal polyps and surgery can remove them, but they often grow back.
Medications
The goal of most nasal polyp medications is to reduce inflammation and the size of your polyps, so you can breathe better and have fewer symptoms. Options include:
- Corticosteroid nasal sprays to shrink polyps
- Oral steroids you take as a pill
- Antihistamines to help with allergy reactions
- Antileukotrienes like montelukast (Singulair)
- Antibiotics if you have infection
- Biologic medicines like dupilumab (Dupixent), mepolizumab (Nucala), omalizumab (Xolair) given as a shot every two to four weeks
It’s important to treat any underlying issues that are causing your nasal polyps. These treatments might include:
- Immunotherapy to address allergic reactions
- Aspirin desensitization therapy if nasal polyps are from AERD
Nasal polyps surgery
If medications don’t shrink your polyps, your doctor may suggest surgery. Usually nasal polyp surgery is an outpatient procedure and you don’t have to stay overnight in the hospital. You might have a:
Polypectomy. A surgeon removes nasal polyps with tiny instruments by grabbing onto and looping around them to cut them and pull them out through your nostrils.
Balloon sinuplasty. A surgeon puts a small balloon through your nostrils into your sinuses and then fills it up. This moves blockages aside and opens up your sinus cavities.
Functional endoscopic sinus surgery (FESS). A FESS is like a polypectomy, but it can also address other issues like diseased tissue, damaged bone, and other obstructions at the same time.
Living With Nasal Polyps
Treatment with a doctor can help in many cases to improve your symptoms and even get rid of nasal polyps for a time, but they often come back. In fact, in 60% to 70% of people who have surgery for nasal polyps, the polyps grow back after 18 months.
But there are things you can do to be more comfortable and keep them at bay longer.
Managing polyps at home
Although nasal polyps aren’t fully preventable, you can keep your sinuses as clear as possible and reduce your risk of complications by following these practices:
Keep up with treatment. If your doctor prescribes medications, take them as directed.
Rinse with saline. If your nasal polyps are caused by an allergen, rinsing or spraying your sinuses every day with a saline solution can help wash irritants out and help prevent problems before they happen.
Use a humidifier. Mucus flows more freely in moist sinuses, which reduces your risk of inflammation and blockages.
Steer clear of irritants. Do your best to avoid things like dust, dander, pollen, smoke, and other substances that can inflame your sinuses.
