Nasal Polyps and Treatment Options

Causes

Nasal polyps can grow anywhere on the lining of the nose or the sinuses. They often grow where the sinuses open into the nasal cavity. Small polyps may not cause any problems. Large polyps can block your sinuses or nasal airway.

Nasal polyps are not cancer. They seem to grow due to long-term swelling and irritation in the nose from allergies, asthma, or infection.

No one knows exactly why some people get nasal polyps. If you have any of the following conditions, you may be more likely to get nasal polyps:

• Aspirin sensitivity
• Asthma
• Chronic sinus infections
• Cystic fibrosis
• Hay fever

Symptoms

If you have small polyps, you may not have any symptoms. If polyps block nasal passages, a sinus infection can develop.

Symptoms include:

• Runny nose
• Stuffed up nose
• Difficulty breathing through the nose
• Sneezing
• Feeling like your nose is blocked
• Decreased sense of smell
• Decreased sense of taste
• Headache and pain if you also have a sinus infection
• With polyps, you may feel like you always have a head cold
• Fullness, pressure, or pain around the eyes
• Nasal congestion or stuffiness

Diagnosis

Polyps can be seen during your specialist appointment using a small, specialized camera called a nasal endoscope. This procedure utilizes a specialized lighted camera to visualize the interior of the nose and assess for any polyps, inflammation, or infection. A CT scan thoroughly evaluates for inflammation of all of the sinuses located above, below, between, and behind your eyes. Both of these diagnostic tests are quick, painless, and can accurately determine if you have chronic sinusitis with or without nasal polyps.

Exams and Tests

Your health care provider will look in your nose. Polyps look like a grayish grape-shaped growth in the nasal cavity.

You may have a CT scan of your sinuses. Polyps will appear as cloudy spots. Older polyps may have broken down some of the bone inside your sinuses.

Medical Treatment

Treatment can range from medication to minimally invasive procedures with or without anesthesia, however, studies show that patients have lasting relief with procedural treatment of their nasal polyps.

• Steroid nasal sprays: a low dose of nasal steroid is directly applied to the inflamed tissues inside the nose to decrease the inflammatory response of chronic sinusitis. These medications may or may not work as the sole therapy in patients with nasal polyps, but have proven to be beneficial in preventing the recurrence of nasal polyps when diligently used as prescribed.
• Oral steroids: typically used in patients with larger polyps to shrink them temporarily.
• Allergy medications: typically used after polyp removal procedures in conjunction with steroid nasal sprays to prevent recurrence.
• Antibiotics: used only if patients also have an acute bacterial infections along with chronic sinusitis. Antibiotics alone are not beneficial in patients with chronic sinusitis and nasal polyps.

Procedures

• In-Office Balloon Sinuplasty: Using the same specialized camera (nasal endoscopy) for visualization, a minimally invasive balloon dilation device is inserted into the nose and positioned at the opening of each inflamed sinus. When in the appropriate position, the balloon is inflated, creating a wider sinus opening and relieving sinus pressure and restoring natural sinus drainage. Polyps are then removed with similarly minimally invasive instruments. Patients are awake, but locally anesthetized for this quick 5 minute procedure, can expect some mild pressure but no pain, and can go home on the same day.
• SINUVA Sinus Implant: SINUVA is a treatment for nasal polyps and may be an alternative to sinus surgery and other treatment options. SINUVA opens in the sinus and delivers anti-inflammatory medicine to treat nasal polyps.
• Functional Endoscopic Sinus Surgery (FESS): Similar to the in-office balloon sinuplasty, FESS also utilizes the same specialized nasal endoscopy camera and the balloon dilation device, but is performed with the patient asleep under general anesthesia. This procedure is usually recommended for patients with larger or more aggressive polyps. Patients are able to go home on the same day after the procedure.
• Sometimes, polyps come back, even after surgery.