Asthma

Nasal Polyps

What Are Nasal Polyps?

Nasal polyps are small growths on the inner lining of the nose or sinus cavities. They are not cancer. Their shape is like hanging grapes or teardrops. Nasal polyps are usually soft and painless. They can be in both sides of the nasal cavity. Typically, they can be distinguished from normal nasal tissue. 

You may develop nasal polyps from chronic (long-term) inflammation and swelling in your sinuses. People with respiratory diseases, such as asthma, chronic rhinosinusitis, or aspirin-exacerbated respiratory disease (AERD), have a greater chance of having nasal polyps. If you do not get treatment for nasal polyps, they can cause long-term problems in your nose and sinuses. This can have a major impact on your quality of life and mental health. 

What Are the Symptoms of Nasal Polyps?

Symptoms may be different for each person and may vary depending on your age. Common symptoms of nasal polyps may include: 

  • Runny nose
  • Stuffy nose (congestion), fullness, blockage within the nose (most common symptom)
  • Postnasal drip (sometimes associated with cough and throat irritation)
  • Loss of or decreased smell
  • Headaches
  • Pressure or pain on your face or in your sinuses
  • Pain in your upper teeth
  • Snoring and difficulty sleeping

Who Is At Risk of Getting Nasal Polyps?

As many as 13 million people in the United States have nasal polyps. Most people who have them are between 40 and 60 years old. Nasal polyps are more common in males, but females who develop nasal polyps usually have more severe cases.1 

A man with text that says: As many as 13 million people in the U.S. have nasal polyps. Most cases occur in males and people between 40 and 60 years old.

Experts don’t fully understand what causes nasal polyps. But they have found that certain conditions may play a part in developing nasal polyps. They include: 

  • An increase in a type of immune cell called an eosinophil
  • Certain types of infections, especially a staph infection
  • Damaged nasal and sinus thin tissue: this may increase your exposure to airborne viruses, allergens, and particles in the environment and can lead to long-term inflammation (swelling)
  • Antithyroid drugs and certain medicines to treat high blood pressure

Risk factors for the development of nasal polyps include:

  • History of allergies
  • Recurrent sinus infections
  • Nasal trauma (nose injuries)
  • Past nasal surgery
  • Long-term exposure to poor air quality or allergens such as pets
  • Family history of polyps

How Do Doctors Diagnose Nasal Polyps?

Your doctor can make a diagnosis by asking questions about your health and symptoms and doing a physical exam. This may include an exam of your nose with the help of a lighted instrument. Your doctor may also run other tests, such as:

  • Nasal endoscopy (a scope up your nose)
  • Imaging scans (CT or MRI scans – plain X-rays of the sinuses are not recommended)
  • Allergy tests
  • Blood tests
  • Rarely, assessment of airflow and biopsies of the sinuses
     

If you have nasal polyps, you may see a team of doctors. They can include:

  • Primary care physician (PCP)
  • Ear, nose, and throat (ENT) specialist
  • Allergist
  • Sinus surgeon (if you need surgery)

What Treatments Are Available For Nasal Polyps?

There are several treatments to help you manage nasal polyps. Talk with your doctor to decide which treatments are best for you. 

Use a saline (salt water) nose rinse to remove irritants and allergens from your nose. This is a safe and inexpensive option that can improve nasal congestion. The water should be high volume but low pressure. Doing a nasal rinse before using a medicine spray can help the medicine reach the tissue. 

Nasal corticosteroids are often one of the first medicines used to treat nasal polyps. They reduce swelling and irritation to shrink the polyps. But they may not reach deep enough into the nasal cavity to be as effective as they need to be. Common nasal corticosteroid sprays include: 

  • Fluticasone (brand example: FLONASE)
  • Budesonide (brand example: RHINOCORT®)
  • Mometasone (brand example: Nasonex)
  • Triamcinolone (brand example: Nasacort®)
  • Beclomethasone (brand example: BECONASE AQ®)
  • Ciclesonide (brand example: OMNARIS®)
     

If a nasal corticosteroid doesn’t work, your doctor may suggest a short-term oral corticosteroid, such as prednisone. They may prescribe them alone or in combination with a nasal spray. If your nasal polyps are severe, they may recommend an injectable corticosteroid. Repeated or long-term use of oral or systemic corticosteroids can cause major side effects. Talk with your doctor about the benefits and risks. 

Biologics are treatments that target a cell or protein to prevent swelling inside the airways. They are not steroids. They are given by injection or infusion. 

Your doctor may prescribe a biologic if other medicines aren’t working. As of June 2022, there are two biologics (approved by the FDA) to treat nasal polyps: 

  • Omalizumab (XOLAIR®)
  • Dupilumab (DUPIXENT®)
     

Both treatments also treat moderate-to-severe asthma. Dupilumab is also a treatment for chronic eczema or atopic dermatitis. People with asthma are more likely to have chronic rhinosinusitis and nasal polyps. 

For more severe cases, surgery may be the best choice. This may happen when polyps do not respond to medical treatments. Surgery to remove nasal polyps is most often done on an outpatient basis. This means you don’t have to stay in the hospital to recover. During the surgery, the surgeon inserts a small tube with a lighted magnifying lens (called a tiny camera endoscope) into your sinuses. The surgeon then removes the polyps with small instruments. The surgeon may also make the openings from your nasal cavities to your sinuses bigger. 

How Can I Manage Nasal Polyps and Stop Them From Coming Back?

If you have surgery to remove nasal polyps, take proper care of your sinuses to stop them from coming back. Take these steps to prevent nasal polyps from returning:

  • Keep using a nasal corticosteroid spray to reduce swelling.
  • Use a saline nasal spray or rinse to keep your nasal passage moist and prevent swelling. If you have nasal allergies, it can also flush allergens, such as pollen, from your nose.
  • Keep your asthma and allergies well-controlled. People with asthma and allergies have a higher chance of developing nasal polyps.
  • Reduce your exposure to irritants and your allergy triggers as much as possible. These can include dust, smoke, pollen, mold, chemicals, and air pollutants. Use CERTIFIED asthma & allergy friendly® products to help you have a healthier home.
  • If the air in your home is dry, use a humidifier. Dry air can dry out your nose. Moist air can help improve the flow of mucus and prevent swelling. But don’t let the humidity in your home get above 50%. This can cause dust mites and molds (both common allergens and irritants) to thrive.
  • Wash your hands often with warm water for at least 20 seconds. This can reduce your chance of getting an infection from bacteria or a virus that could cause swelling in your nose and sinuses.

 

Medical Review: June 2022 by John James, MD

 

References

1. Stevens, W. W., Schleimer, R. P., & Kern, R. C. (2016). Chronic Rhinosinusitis with Nasal Polyps. The Journal of Allergy and Clinical Immunology. In Practice4(4), 565–572. https://doi.org/10.1016/j.jaip.2016.04.012