Nasal Polyps

What are nasal polyps?

Nasal polyps are soft fleshy swellings that grow inside the nose. They may be yellowish, grey or pink in colour. They are common and are not cancerous (that is, they are benign). Nasal polyps can vary greatly in size. There may be only one but sometimes several grow like a 'small bunch of grapes' on a stem.

What causes nasal polyps?

In most cases the cause is not known. It is thought that ongoing (chronic) inflammation in the nose causes overgrowth of the lining of the nostril. This can sometimes lead to small polyps forming. These may then gradually grow larger. Polyps usually affect both nostrils. The cause of the inflammation is unclear in most cases. However, certain conditions make nose inflammation and polyps more likely. These include: asthma, allergy to aspirin, cystic fibrosis, and some rare conditions of the nose.

Who gets nasal polyps?

About 1 in 100 people will develop nasal polyps at some stage in their life. Nasal polyps can affect anyone. However, most cases occur in people over the age of 40 years. They are four times more common in men than in women. Nasal polyps are uncommon in children. A child with nasal polyps should also be checked for cystic fibrosis as cystic fibrosis is a 'risk factor' for developing nasal polyps.

What are the symptoms of nasal polyps?

• The main symptom is a blocked feeling in the nose. You may find it difficult to breathe through your nose. You may then have to breathe through your mouth for much of the time. This is especially troublesome at night and your sleep may be affected.
• Watering from the nose (rhinorrhoea) is common.
• A 'post nasal drip' may occur. This is the sensation of something continually running down the back of your throat due to mucus coming from the back of large polyps.
• Your sense of smell and taste may be dulled or lost.
• A blocked nose may make your voice sound different.
• Larger polyps may cause headaches and snoring.
• Very large untreated polyps can make your nose and front of your face enlarge.
• Sometimes polyps block the drainage channel of the sinuses. This can make you more prone to sinusitis (infection of the sinuses).
• Large polyps sometimes interfere with breathing at night and cause obstructive sleep apnoea. (See separate leaflet called 'Sleep Apnoea'.)

Do I need any tests?

An ear nose and throat specialist can usually diagnose nasal polyps from their appearance. Sometimes a CT scan of the front of your face is ordered. This may be done to find out how large the polyps are, or if they are also in your sinuses. A small flexible telescope may also be used to look inside your nose and assess the extent of the polyps.

What are the treatments for nasal polyps?

Steroid nose drops
Nose drops that contain steroid medicines reduce inflammation in the nose. These sometimes take effect over a few days. However, it may take a week or so to notice an improvement as the polyps gradually shrink. It is important to use the drops exactly as prescribed every day for the best chance of success.

To insert the drops you should kneel, or stand and bend fully down and forward (as if you were about to stand on your head). Stay with the head down for 3-4 minutes after putting in the drops. This will allow the drops to drain fully to the back of the nostrils. If this is difficult, you can put in the drops by lying on a bed with your head falling back off the edge of the bed. (Do not put in nose drops by tilting your head back. The upper surface inside your nose will not be covered by the liquid.)

Steroids tablets
Sometimes a course of steroid tablets is prescribed for a week or so to reduce inflammation in the nose. This is often works very well to shrink the polyps.

Surgery
An operation may be advised if polyps are large, or if steroid nose drops or tablets have not worked. This involves removing the polyps with a surgical instrument. This can be done under a local or general anaesthetic. Some people may have two or more operations in their life to remove recurring nasal polyps. Although the polyps are not in themselves usually serious, you may get a great relief of symptoms when polyps are removed.

Keeping polyps away with steroid nose sprays

Some people are prone to develop recurring nasal polyps. Therefore, some people use a steroid nasal spray each day. This usually prevents inflammation and polyps from developing in the nose. A nasal spray is more convenient to use than nasal drops. Regular use of a steroid nasal spray is thought to be safe. However, steroid nose drops are stronger than sprays and are better at clearing polyps if they do recur.

References

1. Sanford M Archer Nasal Polyps, Nonsurgical Treatment Emedicine Article dated May 27, 2005
2. Lund V. Diagnosis and treatment of nasal polyps. BMJ 1995;311:1411-1414
3. Scadding GK. Comparison of medical and surgical treatment of nasal polyposis. Curr Allergy Asthma Rep. 2002 Nov;2(6):494-9. Review
4. Patiar S, Reece P. Oral steroids for nasal polyps. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD005232

© EMIS and PIP 2007   Updated: February 2007