Have you ever felt like you have a cold that never goes away? Nasal congestion that doesn’t seem to go away, even with over-the-counter cold or allergy medication, may be caused by nasal polyps.
Nasal polyps are benign (noncancerous) growths of the lining of your nose (called mucosa).
Nasal polyps grow in inflamed tissue of the nasal mucosa. The mucosa is a very wet layer that helps protect the inside of your nose and sinuses and humidify the air you breathe. During an infection or allergic reaction, the nasal mucosa becomes swollen and red, and may produce fluid that drips out. With continued irritation, this mucosa may form a polyp. A polyp is a round-shaped growth that can block nasal passages.
Although some people can develop polyps with no previous nasal problems, often there is a trigger for developing polyps. These triggers include:
- chronic sinus infections
- allergic rhinitis (hay fever)
- cystic fibrosis
- Churg-Strauss syndrome
- NSAID sensitivity (an allergy-like response to aspirin, ibuprofen, naproxen, etc.)
There may be a hereditary tendency for some people to develop polyps. This may be due to the way their genes cause their mucosa to react to inflammation.
Nasal polyps are soft, painless growths inside the nasal passage. They often occur in the area where the upper sinuses drain into the nose (where the eyes, nose, and cheekbones meet). You may not even know that you have polyps because they lack sensation.
Polyps can grow large enough to block your nasal passages, resulting in chronic congestion. Symptoms can include:
- nasal obstruction (feeling like your nose is blocked)
- runny nose
- postnasal drip (excess mucus that may run down the back of your throat)
- persistent stuffiness/congestion
- reduced sense of smell
- mouth breathing
- sense of pressure in forehead or face
Pain or headaches may also occur, but only if there is also a sinus infection in addition to the polyp.
A nasal polyp will likely be visible if your doctor looks up into your nasal passages with a lighted instrument called an otoscope. If the polyp is deeper in the sinuses, a nasal endoscopy may be performed (a thin flexible tube with a light and camera at the end is guided up into your nasal passages).
A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may be ordered to determine the size of the polyp. Polyps show up as opaque spots on these scans. Scans can also reveal whether bone in the area has been deformed by the presence of the polyp. This can also rule out other kinds of growths that may be more medically serious, such as structural deformities or cancerous growths.
Allergy tests can help doctors determine the source of persistent nasal inflammation. These tests involve making tiny skin pricks with a liquid form of a variety of allergens to see which your immune system reacts to.
If a very young child is diagnosed with nasal polyps, tests for genetic diseases, such as cystic fibrosis may be performed.
Medications that reduce inflammation may help reduce the size of the polyp and relieve symptoms of congestion.
Nasal steroids that are sprayed into the nose can reduce your runny nose and the sensation of blockage by shrinking the polyp. However, if you stop taking them, symptoms may quickly return. Examples include fluticasone (Flonase, Veramyst), budesonide (Rhinocort), and mometasone (Nasonex).
An oral or injectable steroid, such as prednisone, may be given if the nasal sprays do not work. These cannot be taken for a long-term solution due to serious side effects, including fluid retention, increased blood pressure, and an elevated pressure in the eyes.
Antihistamines or antibiotics may also be prescribed to treat allergies or sinus infections that may be causing inflammation in the nose.
If your symptoms still are not improving, surgery may be required to remove the polyps completely. The type of surgery depends on the size of the polyp. A polypectomy is an outpatient surgery done with a small suction device or a microdebrider that cuts and removes soft tissue including the mucosa.
For larger polyps, endoscopic sinus surgery is performed, in which your doctor uses a thin, flexible endoscope with a tiny camera and small tools on the end. Your doctor will guide the endoscope into your nostrils, find the polyps or other obstructions, and remove them. Your doctor may also enlarge the openings to your sinus cavities. This endoscopic surgery is done as an outpatient procedure most of the time.
After surgery, nasal sprays and saline washes are prescribed to prevent polyps from returning. In general, reducing the inflammation of the nasal passages with nasal sprays, antiallergy medications, and saline washes can help prevent nasal polyps from developing.
With surgical treatment, most symptoms get significantly better. However, if you have lost some sense of smell, it may never return. Even with surgery, nasal polyps may regrow in up to 10 percent of patients with a chronic nasal problem.
Treating nasal polyps, especially with surgery, may result in nosebleeds. Surgery may also result in infection. Continued treatment with nasal steroid sprays or oral corticosteroids may lower your resistance to sinus infections.