Nasal Polyps
Management of soft tissue growths inside the nose that can affect breathing and smell
What is nasal polyps?
Polyps are soft, pale swellings that grow from the lining of the sinuses and hang down into the nasal cavity. They are not tumours and they are not growths of the nose's own surface; they are the lining itself, waterlogged and stretched after long inflammation.
They are almost always on both sides, and they sit in the region high in the nose where the sinuses drain. That location matters twice over: it is why they block the nose so completely once they are large, and why they interfere with the nerve endings for smell, which sit in the roof.
The inflammation behind them is the actual disease. Many people with polyps also have asthma, and a smaller group reacts badly to aspirin and similar drugs, a combination that produces the most stubborn form. Polyps on one side only in an adult are different, and are always investigated instead of assumed to be the usual kind.
What you might notice
- Reduced sense of smell
- A blocked nose for weeks
- Facial pressure and headache
How it is diagnosed
Endoscopy of the nose is what confirms it and grades how far the polyps extend. The doctor notes whether both sides are involved, how much of the airway is filled and how the lining behind them looks.
A CT of the sinuses shows how much of the sinus system is affected and gives the surgeon the anatomy. It also flags a picture confined to one side, or one that is expanding bone, which needs a different line of investigation.
Because the polyps are the visible end of a wider inflammation, testing usually goes further: allergy tests, a blood count looking at the eosinophil level, and lung function or a formal asthma review where breathing is also affected. Where the diagnosis is not certain, tissue is sent for examination.
Recovery
Nasal steroids are the mainstay and they are slow, needing six weeks of correct daily use before their effect can be judged. A short course of oral steroid shrinks polyps quickly and is used to get on top of things, though it cannot be repeated often.
After surgery the nose is blocked and bloodstained for about a week, and saline rinsing starts almost immediately and becomes the main task of the first month. Smell often improves within days, and it is common for it to fluctuate afterwards before settling.
Desk work resumes in about a week and exercise at three. The important part of recovery is what continues: sprays or rinses containing steroid, used indefinitely, are what keep the nose open. Polyps regrow in a substantial proportion of people who stop them, and reviews are arranged with that in mind.
If it is left untreated
Polyps do not turn into cancer and they are not an emergency, so there is time to work through medical treatment properly before considering anything else.
What happens over years is steady, and never sudden. They enlarge, the nose closes completely, and mouth breathing becomes the norm, which disturbs sleep and dries the throat. The loss of smell becomes progressively harder to recover the longer the nerve endings have been buried, and with it goes most of what people call taste. There is a practical safety cost as well, in not being able to detect gas, smoke or spoiled food.
Very large polyps present for a long time can widen the nasal bones and press on the structures around the eye. A polyp on one side only, or one with bleeding, is investigated promptly because that pattern has other causes.
Questions about nasal polyps
Will my sense of smell come back?
Often, at least partly. Smell usually improves once the airway is open and odour molecules can reach the nerve endings in the roof of the nose, and many people notice a change within days of the polyps being reduced or removed. How much returns depends on how long the endings have been buried and how much inflammation remains in that area. It commonly fluctuates for months afterwards, and continuing steroid rinses is what protects it. Where smell has been absent for years, recovery is less predictable.
Do polyps grow back after removal?
A significant proportion do, because the operation removes the polyps and not the inflammation that produced them. The rate is highest in people who also have asthma or aspirin sensitivity. What makes the biggest difference is what happens afterwards: daily steroid nasal treatment, usually as a rinse instead of a spray so it reaches the operated areas, continued long term. Newer biologic drugs are available for severe recurrent disease and are something your specialist would raise if you fall into that group.
Are polyps a form of cancer?
No. Nasal polyps are swollen, waterlogged lining and they do not turn into cancer. The reason your doctor still sends tissue for examination is that a small number of other growths can look similar, particularly when they are on one side only. Polyps on one side in an adult, or any growth that bleeds, is investigated properly for that reason. The usual kind is on both sides and is straightforward to recognise on endoscopy and a CT scan.
Other ENT treatments
Management of recurrent or persistent tonsil problems, including medical treatment and surgery when indicated
Day CareTreatment for enlarged or chronically infected adenoids that may affect breathing, sleep or ear health
Day CareTalk to a care coordinator about nasal polyps
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one