Nasal Polyps Information
Nasal polyps are fleshy, non-cancerous (benign) swellings that grow inside the nose or sinuses. The most common symptoms they cause are a stuffy, runny nose. Steroid nasal drops are commonly used to shrink the polyps. Surgical removal of polyps is sometimes needed. Nasal polyps often return after treatment, so steroid nasal sprays can be used daily to prevent recurrence.
What are nasal polyps?
Nasal polyps are soft fleshy swellings that grow inside the nose. They may be yellowish, grey or pink in colour. They are common and non-cancerous (benign). Nasal polyps can vary greatly in size. There may be only one but sometimes several grow like a small bunch of grapes on a stem.
What causes nasal polyps?
In most cases the cause is not known. It is thought that ongoing (chronic) inflammation in the nose causes swelling (oedema) of the lining of the nostril. Due to gravity, this swelling hangs down (dependent oedema), forming the polyp. Polyps usually affect both nostrils and can gradually enlarge, blocking the nose.
Polyps can also grow in the sinuses. The sinuses are air-filled spaces in the skull which drain into the nose. The biggest sinuses are called the maxillary sinuses. They are found under the eyes, behind the cheeks. The lining of the sinuses is the same as the lining of the nose, so this is why polyps can also form in the sinuses.
The medical name for the inflammation of the nose and sinuses is rhinosinusitis. Often the cause is unknown but it can be due, in part, to infection. Nasal polyps can be a part of this condition.
Certain conditions make nose inflammation and polyps more likely. These include asthma, an allergy to aspirin, cystic fibrosis and some rare conditions of the nose (such as allergic fungal sinusitis and Churg-Strauss syndrome).
Who gets nasal polyps?
2-4 in 100 people will develop nasal polyps at some stage in their lives. Nasal polyps can affect anyone but most cases occur in people over the age of 40 years. They are twice as common in men as in women. Nasal polyps are uncommon in children. A child with nasal polyps should also be checked for cystic fibrosis, as cystic fibrosis is a risk factor for developing nasal polyps. (About 1 in 2 people with cystic fibrosis have nasal polyps.)
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What are the symptoms of nasal polyps?
Initially you might think you have a cold. This is because a blocked or runny nose is a common symptom in viral infections like colds. Colds usually only last 2-14 days and the symptoms improve on their own. If you have nasal polyps, the symptoms will not get better without treatment.
The main symptom is a blocked feeling in the nose. You may find it difficult to breathe through your nose. You may then have to breathe through your mouth for much of the time. This is especially troublesome at night and your sleep may be affected.
Watering from the nose (rhinorrhoea) is common.A postnasal drip may occur. This is the sensation 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.
- Your sense of smell and taste may be dulled or lost.
- A blocked nose may make your voice sound different.
- Larger polyps may cause headaches and snoring.
- Sometimes polyps block the drainage channel of the sinuses into the nose. This can make you more prone to infection of the sinuses (sinusitis).
Large polyps sometimes interfere with breathing at night and cause obstructive sleep apnoea. (See separate leaflet called Obstructive Sleep Apnoea for more information.)
Very large untreated polyps can make your nose and front of your face enlarge. This is rare. In extremely rare cases, double vision can occur. This is due to huge polyps changing the structure of the face and pressing on the nerves that send vision signals from the eyes to the brain.
Do I need any tests?
Your GP might suspect that you have nasal polyps from your symptoms. A GP can examine the lower part of the nostrils, so might be able to see a large polyp. It is usual for you to be referred to an ear nose and throat (ENT) surgeon the first time you have symptoms of nasal polyps.
An ENT surgeon can usually diagnose nasal polyps based on your symptoms and on examination of your nose (and perhaps your sinuses).
Large polyps may be easily visible through your nostrils. Smaller polyps and polyps in the sinuses are not visible via the nostrils. In such cases, the ENT specialist will pass a small flexible telescope with a camera on it (an endoscope) into your nose. This procedure is called nasendoscopy. It allows the extent and location of the polyps to be assessed.
Occasionally a CT scan or MRI scan may be needed. These scans may show more detail about where the polyps are and what effects they might have had on other parts of the face, sinuses and skull.
Note: nasal polyps in one nostril only (unilateral) are unusual. In some cases they might be a sign of cancer (malignancy). They should be examined by an ENT surgeon to rule this out. Bloody discharge from one nostril is also a potentially worrying symptom. It can happen due to infection, nose picking or incorrect use of nasal sprays, all of which are generally harmless. However, if you have a bloody discharge from one side of the nose, you should see your GP, as in rare cases it can be another sign of tumour.
What are the treatments for nasal polyps?
Everyone with nasal polyps should try treatment with medicines, before considering surgery (unless there is any doubt about whether there is a more serious problem, such as tumour).
Medicines for nasal polyps might be topical (for example, drops and sprays), or tablets.
- Steroid nose drops
- Steroid nose drops are the usual first-line treatment for nasal polyps.
Nose drops that contain steroid medicines reduce inflammation in the nose. Gradually, nasal stuffiness reduces and the polyps shrink. Drops may take a week or two to make any obvious difference to your symptoms. You will probably be advised to use them for at least 4-6 weeks.
It is important to use the drops exactly as prescribed every day for the best chance of success.
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