Nasal polypectomy at Taunton Hospital

What is a nasal polypectomy?

A nasal polypectomy removes polyps, soft, non-cancerous swellings that grow inside the nose or sinuses. The procedure is done by going up through the nasal passages, so there is no need to cut on the outside of the nose.

What conditions does a nasal polypectomy treat?

Nasal polyps tend to develop alongside a long-term inflammatory condition affecting the nose and sinuses together, known as chronic rhinosinusitis, and are often linked to allergies, asthma, or a sensitivity to aspirin, though the exact reason isn't always clear. Men are affected more often than women, and the odds of developing them drop once you're past 60.

Polyps can cause:

• a blocked or stuffy nose
• a runny nose or sneezing, affecting around half of those with polyps
• a weakened or lost sense of smell, which doesn't always come back even once treated
• a feeling of mucus dripping down the back of your throat
• a reduced sense of taste

Occasionally, polyps affecting only one side of the nose can be linked to other conditions that need further investigation, in both adults and children.

What are the benefits of a nasal polypectomy?

This surgery works best at clearing a blocked nose caused by polyps, and can also improve sinus infections linked to them. It can ease symptoms including nasal discharge, a feeling of fullness in the cheeks, headaches at the front of the head, and a sense of smell that isn't working as it should.

It's worth knowing that surgery doesn't cure the underlying condition. Nasal polyps and chronic rhinosinusitis are long-term conditions, so daily medication is usually still needed afterwards to help control symptoms and lower the chances of polyps coming back.

Are there different types of nasal polypectomy?

• intranasal polypectomy, using small grasping tools, suited to polyps visible and reachable from the front of the nose
• endoscopic nasal polypectomy, using a thin telescope with a camera for a clearer view, suited to smaller polyps or those higher up or within the sinuses; this is often carried out as part of wider endoscopic sinus surgery

Surgery is usually only considered once other treatments, such as steroid nasal sprays, drops or tablets, haven't brought your symptoms sufficiently under control.

What happens before a nasal polypectomy?

• you'll usually hear from the hospital a few weeks beforehand confirming when your operation is booked in, along with instructions on eating, drinking and what to bring
• you may attend a pre-admission clinic, where checks such as bloods or an ECG reading might be done, and your fitness for the anaesthetic is assessed
• you'll be asked about your general health, current medicines and any allergies, and given a chance to discuss the operation and its risks before signing a consent form
• if you smoke, aim to stop for at least 24 hours beforehand
• on the day, you’ll usually need to stop eating at least 6 hours and stop drinking at least 3 hours before your general anaesthetic
• rings, makeup, body piercings and nail varnish are all best left at home

Flag it with your surgeon beforehand if you're on any blood thinning medications such as aspirin or warfarin, or have had bleeding problems in the past.

What happens during a nasal polypectomy?

1. You're given a general anaesthetic, so you're asleep throughout.
2. A thin telescope wired to a camera, an endoscope, travels up through your nostrils, giving your surgeon a live view displayed on a monitor of what's happening inside.
3. Your surgeon removes the polyps, along with some swollen lining and, where needed, small amounts of bone, widening the natural openings of your sinuses. Where this is the first time you've had the surgery, a piece of tissue may be sent off for laboratory analysis.
4. Trapped mucus is drained from the sinuses.
5. Dissolvable packing may be placed in your nose to help control bleeding.

How much tissue needs removing depends on how swollen your nose and sinuses are, plus the number of polyps present and their overall size.

What does recovery look like?

You're taken to a recovery area to wake from the anaesthetic, then either home the same day or to a ward if you're staying overnight. A responsible adult will need to fetch you and remain close for the first day afterwards, and travelling alone, driving, drinking alcohol or making significant decisions should all wait until that time has passed.

Your nose is likely to feel blocked and swollen for a week to ten days, gradually easing as the swelling settles. Some bleeding and blood-stained discharge afterwards is very common. Avoid blowing your nose for the first 2 days at home, then do so gently. Take things easy and hold off anything strenuous over those opening days, since overdoing it can set off a nosebleed.

Your nose may feel crusty as it heals. A gentle saline rinse can help with this, and staff will run through how to make one up and use it properly before you're discharged. A nasal spray is usually prescribed from around 2 weeks after surgery onward and keeping it up long-term helps stop your polyps coming back.

Avoid smoking and smoky or crowded places for at least 2 weeks, avoid strenuous activity, heavy lifting and flying for around 2 weeks, and expect to need up to 2 weeks off work, or longer if your job is physical or involves close contact with others. A follow-up appointment will be arranged to check how your nose is healing.

What are the risks and complications?

Possible risks of a nasal polypectomy include:

• nosebleeds, which are very common; slight blood loss continuing for roughly a month afterwards is normal, though around 1 in 20 people have a heavier nosebleed needing hospital attention
• infection at the operation site, which may need antibiotics
• polyps returning, which happens fairly often and at an unpredictable pace; this is more likely if you have asthma or are sensitive to aspirin or anti-inflammatory painkillers
• scar tissue (adhesions) forming inside the nose as it heals, occasionally needing a further short procedure to correct
• a change to your sense of smell; surgery sometimes improves this, but rarely it can get worse or be lost permanently
• rare but serious risks linked to the thin bone separating the nose from the eye and brain, including a watery eye (under 1 in 100), bleeding around the eye (around 1 in 500), and a leak of the fluid surrounding the brain (around 1 in 1,000); these are treated promptly if they happen, and lasting harm such as loss of vision is extremely rare
• the general risks of a general anaesthetic, including blood clots and chest infection, with more serious complications being very rare