Understanding Nasal Polyps: Causes, Symptoms, and Treatment

Warning: Graphic medical images

What are Nasal Polyps?

Nasal polyps (Figures 1) are soft, painless, non-cancerous growths or swellings that form from the lining (mucosa) of your nose and sinuses. Compared to normal tissue that is smooth, pink, and firm, they look like small, teardrop-shaped growths or “peeled grapes” in the nose. While most are linked to chronic sinusitis (long-term sinus inflammation), some nasal polyps can actually be tumours—though these are usually benign and rarely cancerous.

Figure 1 – Nasal polyps in the nose and sinus cavity

Symptoms of Nasal Polyps

The symptoms of inflammatory sinus polyps are similar to those of chronic sinusitis. Patients may experience a blocked nose, runny nose (which may be clear or coloured), facial pressure or pain, postnasal drip and reduced or loss of sense of smell and taste.

Diagnosing Nasal Polyps

To diagnose nasal polyps, an ENT specialist will perform a nasoendoscopy, a quick, in-office procedure that uses a thin scope to examine your nasal passages. If the polyps are small and appear on both sides of the nose with a “peeled grapes” appearance, they are likely inflammatory. However, if a polyp has suspicious features (e.g., fleshy, bleeds easily, or is present only on one side of the nasal cavity), additional tests such as a biopsy (extraction of a small sample of polyp tissue for analysis under the microscope) and a CT scan (special series of X-rays) may be required to rule out a tumour.

Figure 2a – Right nasal polyp

Figure 2b – Left nasal polyp

Figure 2c – Typical “peeled grape” appearance of a large inflammatory right nasal polyp completely blocking the right nasal cavity

Figure 2d- A large left nasal polyp almost coming out of the nose

Causes of Nasal Polyps

The exact cause of polyps isn’t fully understood, but risk factors like recurrent sinus infections, allergies, chronic inflammation from asthma, and genetic factors can contribute to their formation.

Treatment of Nasal Polyps

Small inflammatory nasal polyps may be managed with medications like nasal steroid sprays, washes, oral steroids or antibiotics (for acute infections). However, for many patients, medication alone isn’t enough, and sinus surgery, known as Functional Endoscopic Sinus Surgery (FESS), is required. This surgery removes the polyps (to reduce the “inflammatory load”), unblocks the sinuses, and allows medications (e.g. steroid solutions) to be more effective. If you also have asthma or Bronchitis, treating your nasal polyps is crucial to help prevent flare-ups.

It is important to note that patients with chronic rhinosinusitis with nasal polyps have a higher chance of disease recurrence. However, with regular follow-up, early recurrence can be detected and controlled with appropriate interventions and medications.

Complications of Untreated Nasal Polyps

While nasal polyps are typically benign and do not lead to complications if left untreated, their symptoms and recurrent infections can severely impact your quality of life. In rare cases, untreated severe sinus polyps can lead to the following complications:

• Recurrent sinus infections
• Mucocoele formation – This refers to a bag of trapped mucous in a sinus that can potentially expand and erode into nearby critical organs such as the eyes and the brain.
• Mucopyocoele – This refers to an infected mucocoele (see video below)
• Severe sinus infection spreading to the eyes or brain
• Obstructive sleep apnoea (this is a condition in which one stops breathing momentarily during sleep)
• Worsening of inflammatory lower airway diseases such as Asthma and Bronchitis

If you are experiencing persistent symptoms, it’s important to seek professional medical advice. Reaching out to an ENT Specialist subspecialising in the management of nasal polyps is the first step toward effective treatment. As an ENT Specialist in Singapore, Dr. Gan can provide a proper diagnosis and recommend the best course of action for a myriad of conditions, offering sensitive nose remedy and sinusitis cure.