Nasal polyps: an overview and more

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Nasal polyps are neoplasms that result from inflammation of the mucous membranes of the sinuses and nasal passages. They can spread to the nasal passages or even the throat and can block the nasal passages, causing nasal congestion , headache and loss of smell, among other things.

Nasal polyps are often associated with other chronic conditions and tend to persist for a long time. They can even grow back after treatment or surgical removal.

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Symptoms of nasal polyps

Most people with nasal polyps will experience nasal congestion, which can be serious and cannot be treated with standard allergy medications.

Other common symptoms include:

  • Runny nose with clear or colored mucus
  • Loss or decrease of the sense of smell and taste.
  • After nasal drops
  • Headache
  • Pressure in the breasts
  • Facial pain

Nasal polyps vary in size, and small polyps may not cause any symptoms. Larger polyps can cause symptoms and block the nasal passages. If polyps block your nasal passages, a sinus infection can develop.

A person with severe nasal polyps can see polyps in the nasal passages. They are of a glossy translucent gray color, reminiscent of clumps of transparent jelly.

Long-lasting polyps in the nose can cause the bridge of the nose to widen, making the eyes appear farther apart.

Causes

Nasal polyps can occur along with many other respiratory conditions, such as:

  • Allergic rhinitis (hay fever)
  • Chronic sinusitis (due to bacterial and fungal infections)
  • Asthma
  • Aspirin aggravates respiratory disease (AERD)
  • Cystic fibrosis

Nasal polyps can also be a sign of immunodeficiency disorders. For example, nasal polyps can be a sign of cystic fibrosis . Other immunodeficiencies , such as primary ciliary dyskinesia and eosinophilic granulomatosis with polyangiitis (EGPA), can also be associated with nasal polyps.

Diagnostics

In some situations, a doctor can diagnose a nasal polyp by examining the nasal passages with an otoscope (a simple lighted instrument commonly used to examine the ears). The diagnosis can be made with a nasal endoscopy, in which a small camera is placed in the nose to better see the nasal passages. In most patients, the diagnosis can be made by nasal endoscopy or by visual examination.

Sometimes a cat scan of the sinuses is required to make a diagnosis. Sinus computed tomography can better characterize the extent of sinus involvement that is not available with endoscopy.

Because people often have other conditions with nasal polyps, additional diagnostic tests may be required.

Watch out

Nasal polyps can be treated with medical and surgical treatments.

In severe cases, or in cases where medications are not effective, sinus surgery is often required to remove large nasal polyps and remove any concomitant sinus infections . For an endoscopic procedure, in which a long, lighted tube is inserted into the nostril, it can usually be sent home the same day.

It is important to note that even after successful surgery, polyps can reappear .

The best therapy for nasal polyps usually involves surgical treatments followed by drug treatments, as this approach helps reduce the chance that the polyps will grow back.

Nasal steroid sprays and drops

Topical nasal steroid sprays such as Flonase (fluticasone propionate) and Nasonex (mometasone furoate) can help shrink nasal polyps and prevent them from developing again after surgery.

Some health professionals use nasal steroid drops instead of sprays to better penetrate the nasal passages and reach nasal polyps.

The FDA recently approved XHANCE , a spray that enters the nasal passages through the oral mechanism.

Corticosteroids

Oral corticosteroids like prednisone can quickly shrink nasal polyps and are helpful in people with severe symptoms.

However, after a short course of corticosteroids (about one to two weeks), topical steroid nasal sprays can generally better control symptoms and prevent the growth of polyps.

In some cases, such as when fungal sinusitis is the cause of nasal polyps, low-dose oral corticosteroids may be needed to prevent the polyps from growing back for several weeks or months after surgery.

Anti-leukotriene drugs

Oral antileukotriene drugs such as Singulair (montelukast) are theoretically beneficial for people with nasal polyps, especially those who are allergic to aspirin.

People allergic to aspirin are known to have high levels of leukotrienes, so medications that block these chemicals should help reduce symptoms of chronic sinus disease and the formation of polyps .

Saline nasal irrigation

Nasal saline irrigation can be especially helpful for people with nasal polyps and chronic sinus infections. This is especially true for those who have had sinus surgery because saline can flush out the sinuses, not just the nasal passages.

Allergy shots

Some allergists use allergy shots to treat or prevent nasal polyps from developing again after surgery.

Some evidence supports the use of allergy shots for allergic fungal sinusitis.

Antibiotics

They can be prescribed for sinus infections.

Biological

In 2019, the Food and Drug Administration (FDA) approved Dupixent (dupilumab) for the treatment of rhinosinusitis with nasal polyps.

Dupilumab is a monoclonal antibody originally approved for the treatment of dermatitis and asthma, but the drug also targets inflammation that can cause polyps.

Studies have shown that patients with polyps who received dupilumab had reduced polyp size and severity of symptoms, and the drug is well tolerated. Your healthcare provider will know if dupilumab is right for you.

Additional therapies are being evaluated for their safety and efficacy in treating nasal polyposis and may become available in the future.

Keep in mind that even if polyps are successfully treated, loss of smell or taste does not always improve with medicine or surgery .

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