Nasal polyps

Key points about nasal polyps

  • Nasal polyps are small swellings or bags of fluid and mucus that occur in the linings of the nose or sinus cavity.
  • They are usually harmless, but may cause discomfort – symptoms include a stuffy runny nose, changes to taste and smell, headaches and snoring.
  • Nasal polyps can vary in size and number. You may have one or sometimes several grow like a small bunch of grapes on a stem. 
  • Polyps usually affect both nostrils and can gradually enlarge, blocking your nose.
  • Treatment options include steroids (nasal sprays or tablets) or surgical removal if they're very large.
Bleary man holding nose and rubbing sinuses
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The exact cause of nasal polyps is unknown, but it is often associated with conditions that cause inflammation of the nose such as hay fever, and rhinosinusitis (inflammation of the nose and sinus). It is also more common in people with asthma, cystic fibrosis and allergy to aspirin. 

At first, the symptoms of nasal polyps are similar to those of having a cold – a blocked or runny nose, but colds usually only last 2 to 14 days and the symptoms improve on their own. If you have nasal polyps, the symptoms will not get better without treatment.

Other symptoms of nasal polyps are:

  • Blocked nose and difficulty breathing through your nose. You may find you have to breathe through your mouth more often. This is especially troublesome at night and your sleep may be affected.
  • Ongoing runny nose.
  • Postnasal drip – this is the feeling of something continually running down the back of your throat. It is due to mucus coming from the back of the nose because of large polyps
  • Changes in your sense of smell and taste. 
  • Fullness or pressure in your face.
  • Headaches and snoring – larger polyps may cause headaches and snoring.
  • Sinus infection – sometimes polyps block the drainage channel of the sinuses into the nose. This can make you more prone to infection of the sinuses (sinusitis).

Medication

The main treatment option for nasal polyps is the use of corticosteroids (steroid) medication. These reduce inflammation in the nose, and over time, shrinks the polyps.

  • For smaller polyps, steroids are given as a nasal spray, for example: Alanase®, Beconase®, Becloclear®, Butacort®, Flixonase®. Read more about steroid nasal sprays.
  • These may take 1 to 2 weeks to make any obvious difference to your symptoms. You will probably be advised to use them for at least 4 to 6 weeks. 
  • For larger polyps, steroids may be given orally, by mouth, as tablets such as prednisone. These are usually taken as a short course, for about 1 to 2 weeks.  

Surgery

An operation may be advised if polyps are large, or if steroid nose drops or tablets have not worked.

  • Polypectomy involves removing the polyps with a surgical instrument. It can be done through the nostrils, either with local anaesthetic (awake) or under general anaesthetic. The type of anaesthetic might depend on the number and size of the polyps, where they are and how fit you are for an operation.
  • Endoscopic sinus surgery is done with a general anaesthetic. It might be done where the polyps are very large and numerous, or where they are seriously blocking your sinuses. The endoscope allows the surgeon to see into the sinuses with a camera and to do the operation in a place that is difficult to reach with normal surgical instruments. 
  • More research is needed to show if medical or surgical treatment gives better outcomes than the other. 

The following links provide further information on nasal polyps. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.
Nasal polyps(external link) The Australasian Society of Clinical Immunology and Allergy, NZ
Nasal polyps(external link) Patient Info, UK
Nasal polyps(external link) NHS Choices, UK
Nasal polyps(external link) Information sheet, Australasian Society of Clinical Immunology and Allergy (ASCIA), Australia, 2019

References

  1. Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012(external link). Rhinol Suppl. 2012 Mar;(23):3 
  2. Rimmer J, Fokkens W, Chong LY, Hopkins C. Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps(external link). Cochrane Database of Systematic Reviews 2014, Issue 12.

Clinical questions: 

1. In people with nasal polyps, how does giving short-course oral steroids alone compare with placebo?
Cochrane Clinical Answer: "Short-course oral steroids may improve outcomes in the short term but may increase risk of adverse effects. Effects at long term are unclear." (Read more at Cochrane Clinical Answers(external link))

2. In people with chronic rhinosinusitis, how do intranasal steroids compare with placebo?
Cochrane Clinical Answer: "In adults with chronic rhinosinusitis (most of them with nasal polyps), low-quality evidence suggests that, compared with placebo, intranasal steroids may reduce disease severity at 12 weeks (on average 758 versus 273 per 1000 people reported improvement on a five-point global rating scale)." (Read more at Cochrane Clinical Answers(external link))

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