Nasal polyps are soft, non-cancerous growths resulting from chronic inflammation on the lining of the nasal passages or sinuses. They vary in size and number. Large or numerous polyps act as mechanical obstructions, causing persistent nasal blockage, difficulty breathing, and loss of smell. When standard treatments fail and quality of life is severely affected, surgical removal is often necessary.
Deciding on Surgical Intervention
Surgery to remove nasal polyps is reserved for specific patient profiles, generally after the failure of maximal medical therapy. This therapy typically involves a prolonged course of topical nasal steroids and sometimes oral steroids to reduce inflammation. If these medications do not sufficiently shrink the polyps or alleviate the symptoms, surgical intervention becomes a necessary consideration.
Surgery is also indicated when polyps cause complications beyond simple congestion. This includes severe nasal obstruction leading to persistent sleep apnea, or rarely, changes in vision due to pressure near eye structures. Before the procedure, a high-resolution Computed Tomography (CT) scan is performed to map the extent of the disease and the underlying sinus anatomy. This detailed imaging is crucial for planning the operation.
The Endoscopic Polypectomy Procedure
The standard surgical method is Functional Endoscopic Sinus Surgery (FESS), often performed under general anesthesia. This minimally invasive technique uses a rigid endoscope—a thin tube with a light and camera—inserted directly into the nasal passages. The endoscope provides the surgeon with a magnified view of the nasal cavity and the deeper sinus drainage pathways.
Working through the nostrils eliminates the need for external incisions, leaving no visible scarring. Specialized micro-instruments are introduced alongside the endoscope once the polyps are visualized. These tools often include a microdebrider, a motorized instrument that simultaneously shaves the polyp tissue and suctions it away for precise removal.
FESS is a functional procedure designed to restore the natural workings of the sinuses, extending beyond merely removing visible polyps. This involves widening the narrow openings, or ostia, that connect the sinuses to the nasal cavity. By removing diseased tissue and sometimes small amounts of bone, the surgeon creates patent drainage pathways, allowing air to circulate and topical medications to reach the inflamed sinus linings effectively.
Post-Surgical Care and Immediate Recovery
Immediately following the procedure, the surgeon often places temporary, absorbable packing material into the nasal cavity to control minor bleeding and support healing. The initial recovery involves expected symptoms like congestion, similar to a severe cold, and bloody drainage. Patients manage discomfort with over-the-counter pain relievers, but must strictly avoid aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) for two weeks, as these can increase the risk of bleeding.
A fundamental part of immediate post-operative care is the use of saline irrigation, which often begins the day after surgery. These sinus rinses are performed multiple times daily to flush out dried blood, mucus, and crusting debris. Activity restrictions are put in place to prevent complications, advising against forcefully blowing the nose for at least 10 days, and avoiding strenuous activities or heavy lifting for up to two weeks. Most patients can return to light work within one to two weeks, though full nasal clearance may take several weeks as the swelling fully resolves.
Long-Term Management to Prevent Regrowth
Despite successful surgical removal, nasal polyps have a high propensity for recurrence because the underlying chronic inflammation is not cured by surgery alone. Therefore, long-term medical management is essential and begins shortly after the initial healing phase. The mainstay of this continuous treatment involves the dedicated use of topical nasal steroids, often delivered via a specialized rinse or spray.
These anti-inflammatory medications suppress inflammation in the sinus lining, reducing the chance of new polyp formation. Regular follow-up appointments with the specialist include endoscopic examinations to monitor for early signs of recurrence. For individuals with severe or repeatedly recurring disease, injectable medications known as biologics may be utilized. These advanced therapies target specific inflammatory pathways, helping shrink polyps and reducing the need for repeat surgery.