Nasal polyps are soft, non-cancerous, teardrop-shaped growths that develop on the lining of the nasal passages or sinuses. They result from prolonged swelling and irritation of the mucous membrane, a condition known as chronic rhinosinusitis. While the exact cause is not fully understood, polyp development is strongly linked to an abnormal immune response and chronic inflammation. Polyps form most often in the areas where the sinuses drain into the nose, growing slowly over time.
The Direct Answer: Do Nasal Polyps Resolve Naturally?
Nasal polyps rarely disappear completely without some form of medical intervention. Since these are physical growths resulting from chronic inflammation, the underlying cause does not typically resolve on its own. Small or newly developed polyps may occasionally shrink if the inflammatory trigger is identified and eliminated. However, larger, established polyps or those causing significant symptoms almost always require treatment to reduce their size or removal. Relying on spontaneous resolution can lead to worsening symptoms and potential complications.
Identifying and Diagnosing Nasal Polyps
The presence of nasal polyps often mimics the symptoms of a persistent head cold or severe allergies. Common indicators include a persistent sensation of stuffiness or nasal blockage that does not clear up with standard remedies. Patients frequently experience a significant reduction or complete loss of their sense of smell, which subsequently affects their ability to taste. Other symptoms include a chronic runny nose, postnasal drip, and a feeling of pressure or facial pain around the eyes and forehead.
A diagnosis usually begins with a physical examination of the nasal passages. To confirm the presence and size of the polyps, a doctor will often perform a nasal endoscopy. This procedure involves inserting a thin, flexible tube with a camera and light into the nose to provide a clear view of the nasal and sinus cavities. For a more detailed assessment, a computed tomography (CT) scan may be ordered to visualize polyps located deep within the sinuses and to rule out other structural issues.
Medical Management and Non-Surgical Treatment
The primary goal of non-surgical management is to reduce the inflammation responsible for the polyps and cause them to shrink. Topical corticosteroid nasal sprays are the first-line treatment, as they deliver anti-inflammatory medication directly to the affected nasal lining. Consistent daily use of these sprays, which include options like fluticasone or mometasone, can effectively decrease the size of smaller polyps and prevent new ones from forming. This local application minimizes the potential for systemic side effects compared to oral steroids.
For patients with large polyps that severely block the nasal passage, a short course of oral corticosteroids, such as prednisone, may be prescribed. These systemic medications quickly reduce swelling and inflammation, often shrinking the polyps enough for the topical sprays to become more effective. Oral steroids are typically limited to a short duration, such as one or two weeks, to avoid potential long-term side effects like high blood pressure or bone density issues. Managing co-existing conditions, like asthma or allergies, is also incorporated to reduce inflammatory triggers. Newer treatment options include biologic medications, such as dupilumab, which are injectable therapies approved for severe cases to target the specific inflammatory pathways that drive polyp growth.
Surgical Intervention and the Risk of Recurrence
When polyps do not respond adequately to medical management or are large enough to cause severe breathing difficulty, surgery may become necessary. The two main surgical options are a simple polypectomy, which removes the visible polyps, or a more comprehensive endoscopic sinus surgery. Endoscopic surgery uses a thin, lighted tube to navigate the sinuses, removing polyps and potentially widening the drainage pathways to improve sinus ventilation. This approach is often performed as an outpatient procedure.
Surgery removes the physical obstruction, but the risk of recurrence is significant and remains a major challenge in long-term management. Studies show that a substantial percentage of patients, sometimes over 50% in long-term follow-up, experience polyp regrowth requiring further intervention. Factors like co-existing asthma, aspirin sensitivity, or high tissue inflammation levels increase this likelihood. Therefore, post-operative medical management, particularly the continuous use of topical corticosteroid sprays, is necessary to slow or prevent the return of the growths.