What are nasal polyps?
Polyps are soft, teardrop- or grape-shaped swellings of inflamed lining that hang from the sinuses or the inside of the nose. They are not painful by themselves and are not cancerous. They occur in roughly 2–4% of adults, are more common in men and after age 40, and are strongly linked with chronic rhinosinusitis, asthma, allergic fungal sinusitis and aspirin-exacerbated respiratory disease. Children with polyps should be evaluated for cystic fibrosis.
Symptoms
- Persistent nasal blockage or stuffiness on both sides.
- Runny nose and postnasal drip.
- Reduced or lost sense of smell and taste.
- Facial pressure or fullness, mild headache.
- Snoring and mouth breathing; sleep problems.
- Frequent sinus infections.
- A sensation of something in the nose; sometimes the polyps are visible.
Causes and associations
- Chronic inflammation of the nose and sinuses, often with a type 2 (allergic-type) immune response.
- Asthma, particularly adult-onset asthma.
- Aspirin and NSAID sensitivity with asthma and polyps (Samter’s triad or AERD).
- Allergic fungal rhinosinusitis.
- Cystic fibrosis (in children).
- Churg–Strauss syndrome (rare).
- Genetic predisposition and family history.
How polyps are diagnosed
An ENT specialist examines the nose with a small camera (nasal endoscopy) to see polyps and assess the sinuses. A CT scan shows the extent of sinus disease and helps plan surgery. Allergy testing, a smell test, blood tests and lung assessment may also be performed. One-sided polyps, bleeding or unusual features may need a biopsy to exclude other growths. See stuffy nose and loss of smell.
Medical treatment
- Nasal corticosteroid sprays (mometasone, fluticasone, budesonide) used daily are the mainstay; they shrink polyps and improve symptoms in many people over weeks.
- Steroid rinses (budesonide in saline) may be more effective for some after surgery.
- Short courses of oral steroids can shrink polyps quickly, but are limited by side effects.
- Saline irrigation to wash out mucus and allergens. See neti pot and sinus rinse.
- Antibiotics only for bacterial infection.
- Antihistamines and allergy treatment if allergic.
- Manage asthma and avoid triggers such as aspirin if you are sensitive.
Biologic medicines
For severe polyps that return after surgery or do not respond to sprays, injectable biologic drugs that block parts of the allergic inflammatory pathway (dupilumab, omalizumab, mepolizumab, tezepelumab in some countries) can shrink polyps, restore smell and reduce the need for surgery and oral steroids. They are prescribed by specialists, are expensive and are subject to local approval criteria.
Surgery
Functional endoscopic sinus surgery (FESS) removes polyps and opens the sinus drainage pathways through the nostrils, without external cuts. It is considered when medical treatment fails to give adequate relief. It usually relieves blockage and improves smell in most people, but polyps recur in many, often within a few years, so continued steroid sprays and rinses are essential. Complications are uncommon but include bleeding, scarring and, rarely, injury to the eye or skull base.
Recovering your sense of smell
Smell loss is one of the most bothersome symptoms. It often improves with steroids, surgery or biologics, provided the nerve is not permanently damaged. Smell training (sniffing four strong scents twice daily for months) may help recovery. Safety precautions, such as smoke and gas alarms and checking food dates, are advisable while smell is reduced.
When to see a doctor
- Blocked nose lasting more than 10 days without improvement, or recurrent for 12 weeks.
- Loss of smell.
- One-sided blockage, bleeding or facial numbness.
- Eye swelling, double vision or vision changes (urgent).
- Asthma that worsens with nasal symptoms.
- Recurrent sinus infections.
Three common situations
A 50-year-old with years of blocked nose, lost smell and adult-onset asthma: typical profile; arrange an ENT assessment with endoscopy.
Polyps that return after surgery: daily steroid rinses and spray, and ask about biologics.
One-sided blockage with bleeding: needs prompt specialist evaluation.
Daily life with nasal polyps
A simple routine helps control symptoms: rinse with saline once or twice a day, use your steroid spray correctly (point it away from the septum towards the outer wall of the nose), keep up with follow-up visits and manage asthma and allergy. Avoid smoke and irritants, stay hydrated and ask your doctor before taking aspirin or other anti-inflammatories if you have asthma. A smoke detector is a sensible precaution when smell is reduced.
Key points to remember
Nasal polyps are benign but troublesome. Daily steroid spray and saline rinses control them in many people, with surgery or biologics for resistant cases. Long-term maintenance reduces recurrence. Our ENT team can examine your nose and plan treatment.
This guide is for general information and does not replace an assessment by your own doctor or ENT specialist.
Questions about nasal polyps
These answers are general information and do not replace an examination or individual medical advice.
Are nasal polyps cancerous?
No. They are benign, but one-sided or unusual growths need examination to exclude other conditions.
Can nasal polyps go away on their own?
Rarely. Treatment with steroid sprays usually shrinks them but they tend to return if treatment stops.
What causes nasal polyps?
Chronic inflammation of the nasal and sinus lining, often with asthma, allergy or aspirin sensitivity.
Will I lose my sense of smell?
It is common, and often improves with treatment.
Do polyps come back after surgery?
Often, within a few years, which is why ongoing medical treatment is recommended.
Are biologic drugs worth it?
For severe, recurrent polyps they can reduce polyps and restore smell, but they are specialist treatments subject to local availability.
Sources
- NHS · Nasal polyps
- AAO-HNSF · Clinical practice guideline: Adult sinusitis (Rosenfeld et al., 2015)
- NHS · Sinusitis (sinus infection)
- AAO-HNSF · Clinical practice guideline: Allergic rhinitis (update), 2015
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.