Nasal polyps are soft, non-cancerous growths that develop from the lining of the nasal passages or sinuses. Shaped like teardrops or grapes, polyps form when the mucosal lining becomes swollen and fluid-filled due to prolonged irritation. They are generally benign, but their presence can significantly disrupt normal nasal function and airflow.
Recognizing the Signs of Nasal Polyps
The symptoms associated with nasal polyps often start subtly and can be mistaken for a persistent common cold or allergies. The most frequent complaint is chronic nasal congestion or stuffiness that does not resolve with typical over-the-counter medications. This obstruction occurs as the polyps grow large enough to physically block the nasal passages and sinus drainage pathways.
Many individuals experience a noticeable reduction in their sense of smell (hyposmia) or the complete loss of smell (anosmia). Polyps physically prevent odor molecules from reaching the specialized olfactory receptors located high in the nasal cavity. A constant feeling of mucus draining down the back of the throat, known as postnasal drip, is also common.
As the growths increase in size, they can contribute to pressure or fullness across the face, particularly around the eyes and forehead. This feeling is generally described as fullness rather than sharp pain, though it can be accompanied by frequent sinus infections. Snoring or breathing through the mouth, especially at night, often results from restricted airflow.
Underlying Causes and Risk Factors
Nasal polyps are not a disease but a symptom of an underlying, long-standing inflammatory process. The formation of these growths is linked to chronic rhinosinusitis (CRS), defined as inflammation of the nasal and sinus lining lasting 12 weeks or more. This persistent inflammation causes the tissue to swell, leading to the fluid-filled sacs that eventually become polyps.
Several systemic conditions are associated with an increased risk of developing these growths. These include asthma, particularly when severe or difficult to control. Another risk factor is aspirin-exacerbated respiratory disease (AERD), which involves a sensitivity reaction to aspirin and other nonsteroidal anti-inflammatory drugs.
Cystic fibrosis, a genetic disorder affecting mucus production, also predisposes individuals to severe polyp formation, particularly in younger patients. A genetic component influences susceptibility, with polyps more likely to occur in individuals who have a family history. The presence of inflammatory cells called eosinophils in the polyp tissue indicates a specific immune response driving the formation of these abnormal growths.
Understanding Growth Progression
The rate at which nasal polyps grow is highly variable and depends on the severity and persistence of the underlying inflammatory triggers. Unlike cancerous tumors that may grow rapidly, nasal polyps typically develop slowly over months or even years. Symptoms only become noticeable once the polyps reach a size that causes physical obstruction or blocks the sinus drainage openings.
Polyps can range in size, from microscopic to several centimeters long, resembling a peeled grape. The growth process is frequently cyclical, with flare-ups of the underlying inflammatory condition, such as chronic rhinosinusitis, causing the polyps to enlarge or new ones to form. Controlling this inflammation is the only way to slow or halt their development.
The chronic nature of the condition is highlighted by the high rate of recurrence, even after surgical removal. Studies show that polyps commonly grow back, with recurrence rates often reaching 35 to 40 percent within 18 months of surgery in some patient groups. Polyps may require revision surgery or medical management again within a few years, underscoring that the inflammatory mechanism driving the growth remains active.
Diagnosis and Management Options
A healthcare provider typically diagnoses nasal polyps through a physical examination, often using a standard light source to view the front of the nasal cavity. For a more detailed assessment, a nasal endoscopy is performed, involving inserting a thin, flexible tube with a camera into the nose to visualize the deeper passages and sinuses. This procedure allows the provider to determine the size, location, and extent of the growths.
A computed tomography (CT) scan may be ordered to assess the condition of the sinuses and to map polyps too far back to be seen with an endoscope. The CT scan also rules out other causes of nasal obstruction and helps plan for surgical intervention. Management strategies are centered on reducing the inflammation and shrinking the polyps.
The first line of medical treatment involves topical corticosteroids, delivered via a nasal spray, to decrease swelling in the lining of the nose. For larger polyps, a short course of oral corticosteroids may be prescribed to achieve a rapid reduction in size. If symptoms persist despite maximal medical therapy, endoscopic sinus surgery may be recommended to remove the polyps and widen the sinus openings.
For patients with severe, recurrent disease, particularly those with associated asthma or AERD, newer biologic therapies may be used. These injectable medications (such as dupilumab, mepolizumab, and omalizumab) target specific inflammatory pathways to shrink the polyps and reduce recurrence. Even after surgery, long-term medical treatment is necessary to maintain clear airways and prevent the regrowth of polyps.