Nasal polyps are non-cancerous, soft, and painless growths of inflamed tissue that develop on the lining of the nasal passages or sinuses. These growths often resemble small, peeled grapes and can cause significant symptoms when they obstruct the airways. Common signs include persistent nasal congestion, a reduced or complete loss of the sense of smell, and a feeling of postnasal drip. Managing these chronic growths requires specialized knowledge and often involves a coordinated effort between different medical professionals.
Initial Assessment: The Role of Primary Care
Most patients begin by visiting a Primary Care Physician (PCP) or General Practitioner, often mistaking their symptoms for a prolonged cold or seasonal allergies. The PCP performs a preliminary diagnosis, rules out simple acute infections like bacterial sinusitis, and initiates the first line of medical management. They serve as the initial triage point in the care pathway.
The initial course of treatment often involves prescribing a topical intranasal steroid spray, which is the standard first step to reduce the inflammation causing the polyps. If symptoms do not improve after a trial of this medication, or if the patient presents with severe congestion and loss of smell, the PCP determines the appropriate specialist referral. This screening process ensures that patients with simple inflammation are treated first, while those with complex disease are quickly directed to the next level of care.
The Surgical Expert: Otolaryngologists
The Otolaryngologist, commonly known as an Ear, Nose, and Throat (ENT) doctor, is the primary surgical specialist for nasal polyps. Their expertise lies in the medical and surgical management of disorders affecting the head and neck, including the physical removal of these growths. The ENT specialist uses specialized tools for diagnosis, such as a nasal endoscope—a thin, lighted tube with a camera inserted into the nostril to visualize polyps deep within the nasal passages and sinuses.
When medical therapies fail to shrink the polyps, the ENT performs surgery to physically remove them and restore proper sinus drainage. A simple Polypectomy may be performed to remove accessible polyps using small instruments. For more extensive disease, the specialist may perform Functional Endoscopic Sinus Surgery (FESS), which uses the endoscope to open sinus pathways, remove polyps, and correct underlying structural issues. Surgery is reserved for cases where polyps are large, severely obstruct breathing, or are refractory to medication.
The Medical Management Expert: Allergists
An Allergist/Immunologist focuses on identifying and managing the underlying systemic inflammation that often causes nasal polyps, a condition frequently linked to chronic rhinosinusitis. They recognize that polyps are often a manifestation of other conditions, such as asthma, allergies, or Aspirin-Exacerbated Respiratory Disease (AERD). These specialists use allergy testing to pinpoint specific environmental triggers contributing to inflammation.
Their treatment strategy centers on long-term medical control of the immune response rather than physical removal. This includes using targeted treatments like advanced biological medications, or biologics, which are injectable drugs designed to block specific inflammatory pathways (e.g., those involving IL-4, IL-5, or IgE). Biologics like dupilumab, omalizumab, or mepolizumab can significantly reduce polyp size, improve symptoms, and lessen the need for oral steroids or surgery.
Navigating Care: Choosing the Right Specialist Path
The specialist referral after the initial PCP visit depends on the specific characteristics of the patient’s disease. If diagnostic imaging, such as a CT scan, reveals severe blockage, structural issues, or large polyps, the Otolaryngologist is the appropriate first referral for surgical intervention. Conversely, a patient with recurrent polyps, co-existing asthma, or known sensitivities like AERD, benefits from the systemic management provided by an Allergist.
The most effective care often involves a collaborative approach between both specialists, especially in cases of severe or frequently recurring disease. An ENT may perform surgery to clear the airways and reduce the polyp burden. Simultaneously, the Allergist manages the chronic inflammatory triggers with biologics or other advanced medical therapies to prevent regrowth. This combined strategy treats both the physical obstruction and the underlying immune system dysfunction, offering the best chance for long-term relief.