Nasal polyps are soft, non-cancerous, teardrop-shaped growths that form in the lining of the nasal passages or sinuses. The answer to whether they can be removed or reduced without surgery is often yes, particularly in the initial stages. Treatment usually starts with medications designed to shrink the growths. Surgery is typically reserved only if medical management proves ineffective, as the goal is to eliminate obstruction and manage inflammation to prevent recurrence.
Understanding Nasal Polyps
Nasal polyps develop from prolonged inflammation of the mucous membranes lining the nose and sinuses, known as chronic rhinosinusitis. Chronic irritation causes the lining tissue to swell, becoming waterlogged and eventually forming a polyp, which looks like a small, pale grape. The precise cause is not fully understood, but it often involves an abnormal immune response.
These growths are frequently associated with underlying conditions that drive chronic inflammation, such as asthma, allergies, aspirin sensitivity, and cystic fibrosis. Symptoms appear when the polyps grow large enough to block the nasal passages. This blockage can lead to difficulty breathing, a reduced or complete loss of the sense of smell, postnasal drip, and a persistent feeling of sinus pressure.
Non-Surgical Removal Methods
Medical management is the first approach and is often successful in shrinking or eliminating smaller polyps. The primary non-surgical intervention involves anti-inflammatory medications to reduce the swelling that causes the polyps to form. These treatments work by targeting the inflammatory pathways that drive polyp growth.
Topical nasal corticosteroids are typically the first line of defense, delivered via a prescribed nasal spray directly into the nasal passages. Regular use of these sprays can significantly reduce the size of the polyps and alleviate symptoms like congestion and runny nose. For polyps located deeper in the sinuses, specialized delivery systems using the patient’s exhaled breath can help push the medication to hard-to-reach areas.
If polyps are large or symptoms are severe, a short course of oral corticosteroids, such as prednisone, may be prescribed for rapid size reduction. These pills offer a powerful, systemic anti-inflammatory effect but are only used briefly due to the risk of side effects with long-term use. Saline irrigation, using a neti pot or similar device, also provides therapeutic benefits by rinsing away irritants and mucus while promoting better sinus drainage.
Surgical Removal Procedures
Surgery becomes necessary when medical therapies fail or if the growths cause severe obstruction and persistent infection. The choice of procedure depends on the size and location of the polyps, but both types are performed through the nostrils without external incisions.
Polypectomy
A simple polypectomy involves removing isolated, accessible polyps using a small surgical instrument or a microdebrider.
Endoscopic Sinus Surgery (ESS)
For more extensive polyps, ESS is the standard procedure. ESS uses an endoscope to visualize the nasal and sinus cavities, allowing the surgeon to remove polyps and widen sinus openings to improve ventilation and drainage. This widening also allows topical medications to reach the entire sinus lining more effectively. While surgery removes the obstruction, it does not cure the underlying inflammatory condition.
Managing Recurrence and Long-Term Care
Despite successful removal, nasal polyps have a high rate of recurrence because the underlying inflammatory tendency remains. Long-term management focuses on controlling this inflammation to maintain a clear airway. The continuous use of topical nasal corticosteroids, even after surgery, is a foundational strategy to prevent regrowth.
For patients with severe, recurring polyps who do not respond to standard treatment, a newer class of medications called biologics may be used. These injectable drugs, such as dupilumab, target specific immune pathways, like Type 2 inflammation, which drive polyp formation. Biologics have shown promise in reducing polyp size, improving symptoms, and delaying the need for repeat surgery.
Managing associated conditions like asthma or aspirin sensitivity is a crucial part of long-term care, as these factors contribute to the inflammatory environment in the sinuses. Adherence to a consistent post-treatment regimen, including anti-inflammatory medications and regular saline rinses, is paramount to sustain the benefits of initial removal.