Nasal polyps symptoms include a stuffy nose, especially when lying down, and a reduced sense of smell. Removing nasal polyps is done via sinus surgery. Nasal polyps or polyps in the nose are stalked, drop-shaped, benign swellings of the nasal mucosa. These abnormalities often arise in the ethmoid cavity, one of the four paranasal sinuses. The ethmoid cavity is located between your nose and eyes. Nasal polyps mainly occur in adults. It is not (yet) known what causes them, but nasal polyps are more common in patients with asthma or rhinosinusitis. Rhinosinusitis is a chronic inflammation of the sinuses or sinuses. Small polyps can be treated with corticosteroid nasal spray or drops. As a result, they will shrink within a few weeks and the complaints will decrease significantly. Larger polyps can be surgically removed.

• What are nasal polyps?
• Who suffers from polyps in the nose?
• Nasal polyps cause
• Risk factors
• Nasal polyps symptoms
• Complications
• Examination and diagnosis

• General investigation
• Viewing research
• Visual art investigation
• Allergy testing

• Removing and treating nasal polyps

• Treating small polyps
• Removal of larger polyps

• Prognosis
• Prevention

• Humidity
• Hygiene
• Irritants
• Treatment of asthma and allergies
• Nasal rinse

 Nasal polyps / Source: Michael Hawke MD, Wikimedia Commons (CC BY-4.0)

What are nasal polyps?

Nasal polyps are pedunculated, drop-shaped benign abnormalities or swellings of the nasal mucosa, which usually arise in the ethmoid cavity. The ethmoid sinus is located between your nose and eyes and is one of the four paranasal sinuses. The polyps drop from the ethmoid cavity into the nose and as a result complaints arise. Malignant nasal polyps occur only rarely.

Who suffers from polyps in the nose?

Polyps are rare in children. However, children with cystic fibrosis or cystic fibrosis are at greater risk of developing nasal polyps. In this hereditary condition, the nose, paranasal sinuses and lungs are constantly (chronically) inflamed. Adults with asthma or rhinosinusitis are especially likely to develop nasal polyps. It is usually seen in people between the ages of 30 and 40. Nasal polyps often arise on both sides of the nose. One-sided nasal polyps can be a manifestation of a one-sided maxillary sinus infection, for example as a result of problems with the upper teeth.Nasal polyps / Source: Alila Medical Media/Shutterstock.com

Nasal polyps cause

In recent years, much research has been conducted into the possible cause of nasal polyps. There are two hypotheses in 2023. One hypothesis suggests that the bacterium Staphylococcus aureus activates the immune system, which could then lead to polyp formation through a number of steps. The other hypothesis suggests that the fungus Alternaria alternata is responsible for the development of nasal polyps. A severe reaction to fungal components could cause damage to the upper layer of the skin and mucous membranes, resulting in an inflammatory reaction. Ultimately, this could lead to polyp formation.

Risk factors

The cause of the development of nasal polyps is (still) unknown, but factors can be distinguished that increase the risk of nasal polyps:

• Allergic predisposition;
• Rhinosinusitis: chronic inflammation of the nasal and paranasal sinus mucosa;
• Nasal mucosa that responds overactively to stimuli (e.g. dust, heat and cold);
• Aspirin sensitivity may make some people more likely to develop nasal polyps;
• Allergic fungal sinusitis, an allergy to airborne mold;
• Cystic fibrosis or cystic fibrosis, a hereditary condition in which something goes wrong with the production of mucus;
• Churg-Strauss syndrome, a rare disease that causes inflammation of the blood vessels;
• Asthma and especially when asthma worsens.

Your family history can also play a role. There is some evidence that certain genetic variations related to immune system function increase the chance of developing nasal polyps.Headache with a full feeling in the head due to nasal polyps / Source: Istock.com/JackF

Nasal polyps symptoms

Nasal polyps develop gradually. Depending on the severity of the complaints and the number of polyps, you may experience the following complaints:

• a stuffy nose, especially in a lying position;
• a reduced sense of smell;
• regularly feeling like you have a ‘cold’;
• sometimes a sore nose;
• sometimes a runny nose due to increased mucus secretion;
• catarrh (a mild inflammation of the mucous membranes associated with the secretion of mucus);
• often headache with a feeling of fullness in the head.

Complications

With nasal polyps, complications can arise because the airflow and fluid drainage become blocked, and because of the underlying chronic inflammation. Possible complications include:

• Obstructive Sleep Apnea Syndrome (OSAS), caused by an obstruction of the airway. This is a sleep-related breathing disorder in which your body stops breathing during sleep.
• Asthma flare-ups. Chronic rhinosinusitis can make asthma worse.
• Sinusitis. Nasal polyps can make you more susceptible to sinus or sinus infections that often recur or become chronic.

Examination and diagnosis

General investigation

If you suspect nasal polyps, your GP or ear, nose and throat doctor will first perform a general examination, including looking into your nose. In many cases, nasal polyps are clearly visible.

Viewing research

Sometimes, however, the nasal polyps are so small or located deep in the nose that the doctor cannot directly observe them. In that case, a nasal endoscopy can offer a solution. This is a short-term, outpatient examination in which the doctor looks higher and deeper into the nose with a thin viewing tube, also called an optic, endoscope or scope. This visual examination can be performed with or without anesthesia of the nasal mucosa.CT scan / Source: IStock.com/Pavel Losevsky

Visual art investigation

Images obtained with computed tomography (CT) can help the doctor to localize the size and location of polyps in deeper areas of the sinuses and determine the degree of inflammation. Such examination can also help to rule out the presence of other possible obstructions in the nasal cavity, such as structural abnormalities.

Allergy testing

The doctor can use skin tests to determine whether allergies contribute to chronic inflammation. With a skin test, small drops of allergy-causing substances (allergens) are pricked into the skin of your forearm or upper back. After 15 minutes, the doctor or nurse will examine your skin for signs of allergic reactions.If a skin test cannot be performed, the doctor can do a blood test for specific antibodies against various allergens.

Removing and treating nasal polyps

Treating small polyps

Smaller nasal polyps can be treated with nasal spray or nasal drops containing corticosteroids, a powerfulanti-inflammatory. This allows the polyps to shrink significantly and the symptoms will diminish.

Removal of larger polyps

Larger polyps can be surgically removed. This can be done by polyp extraction, in which the part of the polyp that is visible in the nose is removed. Another option is endoscopic paranasal sinus surgery, which removes polyps from both the nose and the paranasal sinuses.

Prognosis

Removing polyps through surgery ensures that you can breathe easily through your nose again. However, over time, nasal polyps often return. The reduced sense of smell does not always recover after treatment with medications or surgery.Wash your hands thoroughly regularly / Source: Pezibear, Pixabay

Prevention

The following measures may be able to prevent the formation of nasal polyps:

Humidity

If the air in your home is dry, consider purchasing a humidifier.

Hygiene

Regular and thorough hand washing reduces the risk of a bacterial or viral infection, resulting in fewer cases of inflammation of the sinuses and nasal passages.

Irritants

Avoiding irritants such as some allergens, chemicals and air pollutants (which cause inflammation) can help reduce the risk of developing polyps.

Treatment of asthma and allergies

People who follow their doctor’s recommendations regarding treatment of their asthma and/or allergies may be less likely to develop nasal polyps.

Nasal rinse

Rinsing your nose with a saline solution can help keep your sinuses clear and prevent scabs and infections. Do this if you suffer from a (chronic) cold, chronic or acute sinus infection or nasal allergy. You can buy a special nasal douche for this purpose at a drugstore or pharmacy. A nasal douche is a soft squeeze bottle, especially for cleaning the nose and paranasal sinuses.

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