Nasal Polyps: Causes, Symptoms and Treatment
Nasal polyps are benign growths of the mucous membrane inside the nose or sinuses that can cause breathing difficulties and loss of smell.
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Nasal polyps are benign growths of the mucous membrane inside the nose or sinuses that can cause breathing difficulties and loss of smell.
What Are Nasal Polyps?
Nasal polyps (medical term: polyposis nasi) are soft, non-cancerous growths that develop on the lining of the nasal passages or sinuses. They hang like small teardrops or grapes from the mucous membrane and are made up of inflamed tissue. Although nasal polyps are benign, they can significantly reduce quality of life by obstructing nasal breathing and impairing the sense of smell.
Causes
The exact cause of nasal polyps is not fully understood. Chronic inflammation of the nasal lining is thought to play a central role. The following factors increase the risk of developing nasal polyps:
- Chronic rhinosinusitis: Ongoing inflammation of the sinuses is the most common contributing factor.
- Allergies: Allergic rhinitis (hay fever) can promote inflammation of the nasal mucosa.
- Asthma: People with asthma have a higher risk of developing nasal polyps.
- Aspirin intolerance (Samter triad): Sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) is frequently associated with nasal polyps.
- Cystic fibrosis: Nasal polyps occur particularly often in individuals with this inherited condition.
- Genetic predisposition: Nasal polyps can run in families.
Symptoms
Small polyps often cause no noticeable symptoms. Larger or multiple polyps may lead to:
- Persistent nasal congestion (blocked nose)
- Reduced or absent sense of smell (hyposmia or anosmia)
- Diminished sense of taste
- Runny nose or increased mucus production
- Facial pressure or headaches
- Snoring and disrupted sleep
- Frequent sinus infections (sinusitis)
Diagnosis
Nasal polyps are diagnosed by an ear, nose, and throat (ENT) specialist using the following methods:
- Nasal examination (rhinoscopy): The doctor examines the nasal cavity with a speculum or endoscope.
- Nasal endoscopy: A thin, flexible camera is used to inspect the nasal cavity and sinuses in detail.
- Imaging: A CT scan of the sinuses can accurately show the extent and location of the polyps.
- Allergy testing: To identify any underlying allergic triggers.
Treatment
Medical Treatment
The first line of treatment typically involves medications to reduce inflammation:
- Corticosteroid nasal sprays: These are the standard treatment. They shrink the polyps and relieve symptoms such as nasal congestion and loss of smell.
- Oral corticosteroids: Short-term cortisone tablets may be prescribed for severe cases to rapidly reduce polyp size.
- Nasal rinses: Saline rinses help cleanse the nasal mucosa and reduce inflammation.
- Biologics (monoclonal antibodies): Advanced medications such as dupilumab or mepolizumab are used in severe, treatment-resistant cases and target specific inflammatory pathways.
Surgical Treatment
If medications are not sufficiently effective, surgery may be necessary:
- Functional endoscopic sinus surgery (FESS): Polyps are removed minimally invasively using an endoscope. This procedure is performed under general anesthesia on an outpatient or inpatient basis.
- After surgery, continued use of corticosteroid nasal sprays is essential to prevent recurrence.
Outlook and Prognosis
Nasal polyps tend to recur after treatment, especially if the underlying inflammation is not adequately controlled. Long-term management and regular ENT check-ups are therefore important. With appropriate treatment, most patients experience a significant improvement in their symptoms.
References
- Fokkens WJ et al. - European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020). Rhinology. 2020;58(Suppl S29):1-464.
- Bachert C et al. - Dupilumab for the Treatment of Adult Patients with Uncontrolled Chronic Rhinosinusitis with Nasal Polyps. NEJM. 2019;380(18):1707-1716.
- National Institute of Allergy and Infectious Diseases (NIAID) - Chronic Rhinosinusitis and Nasal Polyps: Overview and Management. NIH Publication, 2022.
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