What are nasal polyps?

Nasal polyps are a type of chronic sinusitis in which the mucous membranes lining the nose and sinuses have become so swollen that they begin to dangle into the nose, causing obstruction.  In some cases, the polyps can be so large that they dangle out the nostril or down the back of the nose into the throat.  Polyps often shrink in response to steroid medications, but they can easily recur if the underlying disease is not corrected.  Polyps are typically caused by chronic infections with obstruction of the sinuses.  The infection may be bacterial or fungal.  If the infection does not resolve with antibiotics and steroids, then sinus surgery may be necessary.

How are nasal polyps diagnosed?

A nasal endoscopic examination and a CT scan are recommended for the evaluation of nasal polyps.  The endoscopic examination is performed in the office by the ENT specialist to assess the airway and to look for evidence of tumors or infection.  Richmond ENT is fortunate to have a low dose sinus CT scanner right in our office – the first of its kind in Richmond.  Your physician will personally examine the CT scan with you to assess the extent of the polyps and to look for evidence of bone destruction that might threaten vision or indicate a tumor.

Read more about sinus CT scans

A biopsy of nasal polyps is generally recommended following the CT scan.  In many cases, surgical removal of the polyps is recommended in the operating room and the tissue can easily be sent for pathologic evaluation.  Polyps generally do not have a strong sensory nerve supply, so a biopsy can be comfortably performed in the office if surgery is not immediately necessary.

Read more about endoscopy with biopsy

Do allergies cause nasal polyps?

Allergies do not appear to be a major cause of nasal polyps.  Indeed, some studies have shown that patients with allergies are less likely to have nasal polyps than patients without allergies.  However, patients who have both nasal polyps and allergies are more likely to improve if the allergies are treated aggressively at the same time that the polyps are removed.  For this reason, allergy testing is often recommended prior to surgery for nasal polyps.

Read more about allergy testing

How do we treat nasal polyps?

Steroids are the primary medications used to treat nasal polyps.  Nasal steroid sprays are the safest way to shrink polyps, but they often need to be used two times daily – twice the usual dose for allergies. When the nose is too congested to use topical nose sprays, oral prednisone or methylprednisolone may be prescribed for 1-2 weeks. After surgery, there are additional options, including steroid rinses and implantable stents that release steroids slowly over several weeks.

Read more about steroids, including the risks of prolonged use

Is surgery necessary?

Surgery is recommended for polyps that do not respond to medical management. While some patients are satisfied with simply debulking the polyps at the time of biopsy, failure to correct the underlying disease usually results in persistence or recurrence. Surgery for nasal polyps tends to be thorough and aggressive. Endoscopic sinus surgery for polyps is most commonly performed under general anesthesia on an outpatient basis. Powered endoscopic shavers are commonly used to remove the polyps while leaving a portion of the mucous membrane lining the sinuses. The sinuses are usually opened widely to remove the sinus secretions, which are often as thick and sticky as denture adhesive. Wads of fungal debris are sometimes encountered. The surgery is often tedious and bloody and usually requires the placement of nasal tampons for 2-3 days after surgery. As with the biopsy, surgery for nasal polyps is less painful than might be expected.  Most patients return to work less than a week after surgery, but continue nasal steroid sprays daily.

Read more about endoscopic sinus surgery