Nasal polyps

What are nasal polyps?

Nasal polyps are soft, painless growths that develop inside your nose or sinuses, usually appearing on both sides. They're not cancerous and aren't usually serious, but they can keep growing and block your nose if they're left untreated.

Symptoms of nasal polyps

Small polyps might not cause any symptoms at all. As they grow, though, you may notice:

• a blocked or stuffy nose
• a runny nose
• a feeling of mucus dripping down the back of your throat (postnasal drip)
• a reduced or lost sense of smell or taste
• snoring
• headaches or sinus pressure
• occasional nosebleeds

Nasal polyps can feel similar to a cold at first, but colds usually clear up within a few days, whereas polyps will not improve without treatment. If polyps grow large enough to block your sinuses, you might also develop repeated sinus infections, more frequent asthma attacks if you have asthma, breathing difficulties, or sleep problems such as snoring or sleep apnoea.

Causes and risk factors

Nasal polyps are linked to inflammation, though doctors don't fully understand why inflammation leads to polyps in some people but not others. The most common trigger is chronic sinusitis, ongoing inflammation of your nose and sinuses lasting three months or more, often caused by allergies, infection or asthma.

You may be more likely to develop nasal polyps if you have asthma, hay fever, chronic sinus infections, cystic fibrosis, or a sensitivity to aspirin or other anti-inflammatory painkillers. Genetics may also play a part, since certain inherited gene changes can affect how your nasal tissue responds to inflammation.

Nasal polyps are common, affecting a large proportion of the population, and are around twice as common in men as in women. Many people develop them in their 30s or 40s, though your risk increases with age. They're rare in children.

Types of nasal polyps

Polyps usually appear on both sides of your nose, and you may have just one or several growing together like a bunch of grapes. Small polyps are shaped like teardrops, while larger ones tend to look like peeled grapes and can be pink, yellow or grey.

It's unusual to have a polyp on only one side of your nose. If this happens, your doctor will want to check it more closely, since a growth on just one side is occasionally a different kind of nasal growth rather than a true polyp, and this needs its own assessment.

How are nasal polyps diagnosed?

A GP can often tell if you have nasal polyps just by looking inside your nose. If more detail is needed, they may examine you with a thin, lighted scope, ask about your medical history, particularly allergies, asthma or sinus infections, and find out how long you've had symptoms.

Occasionally, a CT or MRI scan is used to check the exact size and location of your polyps, and allergy testing may help identify what's triggering the inflammation in your nose.

How are nasal polyps treated?

Non-surgical treatment

Steroid nasal drops or a spray are usually tried first, to shrink the polyps and ease your symptoms. Sometimes, a short course of steroid tablets, usually for up to two weeks, is added to help relieve things more quickly. It's important to follow your GP's instructions on how to use these and for how long.

If steroids alone have not worked well enough, your doctor might suggest a biologic medicine, given by injection, which calms an overactive immune response and can shrink stubborn polyps. Antibiotics may also be prescribed if there's a sinus infection alongside your polyps.

A pharmacist can also recommend steroid nasal sprays that don't need a prescription, along with salt water washes (a saline rinse) to help unblock your nose. To make your own salt water wash at home:

1. Mix 1 level teaspoon of salt and 1 level teaspoon of bicarbonate of soda into about a pint of cooled, boiled water.
2. Wash your hands, then stand over a sink.
3. Cup your palm and pour a small amount of the mixture into it.
4. Sniff the mixture up one nostril and let it run back out.
5. Repeat at least three times in each nostril, or until your nose feels clearer.

Check the mixture isn't too hot before you use it, and don't swallow it, as it may make you feel sick. This wash isn't suitable for children.

Surgical treatment

If your symptoms haven't improved after around 10 to 12 weeks of medical treatment, your doctor may suggest surgery to remove the polyps. All the surgical options are minimally invasive and carried out through your nostrils, so you won't have any visible cuts.

A polypectomy uses small instruments, sometimes a tiny lasso-like snare, to grab and remove the polyps directly. Balloon sinuplasty gently inflates a small balloon inside your sinus to open up the blocked passage, sometimes removing polyps at the same time. For more widespread polyps, functional endoscopic sinus surgery (FESS) clears polyps, damaged tissue and any bone that's blocking your nasal passages.

Most people notice an improvement after surgery, but it's common for polyps to grow back, often within a few years. You'll usually need to keep using a steroid nasal spray afterwards to help stop them returning too quickly.

When should I see a doctor?

See a GP if you think you might have nasal polyps, you're having difficulty breathing, your symptoms are getting worse, or you notice changes to your sense of smell.

It's also worth getting checked if your symptoms last longer than about 10 days, since this is longer than a typical cold. Tell your doctor promptly if you notice a growth on only one side of your nose, so they can check whether it's a straightforward polyp or something that needs a closer look.