What Are Nasal Polyps and How Are They Diagnosed?
Nasal polyps are growths that can form in the sinuses, which are hollow spaces in the facial bones near the eyes and brain. They’re not cancerous and usually occur when the lining of a sinus gets inflamed and swells up, forming a grape-like structure that blocks the sinus. People with nasal polyps often have symptoms like stuffy nose, runny nose, trouble smelling, and pain or pressure in the face. Sometimes, they might also have a cough, trouble sleeping, or feel like their quality of life is affected.
To diagnose nasal polyps, doctors will look inside the nose using a small camera. They might also order a special type of X-ray called a CT scan to get a better view of the sinuses.
How Are Nasal Polyps Treated?
Doctors usually start by giving patients medication to treat nasal polyps. This might include oral antibiotics, nasal sprays with steroids, or taking steroid pills by mouth. If these medicines don’t work, doctors might try different kinds of steroids.
First Medicines for Nasal Polyps:
- Rinsing with saline (saltwater)
- Using a nasal spray with steroids
- Taking a short burst of steroid pills by mouth
- Taking antibiotics by mouth
If these medicines don’t help, doctors might suggest trying other treatments like:
- Using steroid rinses
- Trying a special device that helps deliver medicine into the nose
If medicine doesn’t work, doctors might consider endoscopic sinus surgery. This type of surgery is done if patients still have nasal symptoms even after trying medication, and a CT scan shows serious sinus problems.
What Is Sinus Surgery?
Sinus surgery usually involves making the small natural openings in the sinuses bigger. This is done with a method called endoscopic sinus surgery, which uses small cameras and tools. Sometimes, computers help guide the surgery, making it safer and more thorough. Opening the sinuses fully allows more medicine to reach them after surgery.
Most sinus surgeries are done as outpatient procedures, so patients can go home the same day. Only a few patients might need to stay in the hospital overnight, depending on their age and health. The good news is that most patients don’t need sinus surgery more than once. In fact, 95% of patients say they would have the surgery again.
Goals of Sinus Surgery:
- Remove polyps
- Open sinuses widely so that medicine can reach them
Results of Sinus Surgery:
- About 80% of patients feel better after surgery
- Less than one-third of patients need another surgery
- 95% of patients would choose to have the surgery again.
Are All Sinus Operations the Same?
No, not all sinus surgeries are alike. It’s important to know that certain types of surgery, such as limited surgery or balloon sinus dilation, might not make big enough openings for medicines to reach the nose and stop nasal polyps from returning. Things like past surgeries, having nasal polyps, severe allergies (like being allergic to aspirin), and other medical problems can make sinus surgery harder. Everyone is different, so doctors choose surgical methods based on what each patient needs.
Endoscopic view of recurrent polyps in a patient who had previous sinus surgery
Endoscopic view of the same patient 3 years after undergoing complete sinus surgery and utilizing steroid rinses
How Long Will It Take To Recover From Sinus Surgery?
It can vary. After surgery, most folks plan to take about 5-7 days off from work. If your job requires a lot of physical activity, you might need more time off. But if you have a desk job or can work from home, you might be back to work in just a few days. Usually, over-the-counte
r pain meds are good enough for managing any discomfort after surgery, but your doctor might give you something stronger if you need it.
Long Term Management
There’s no cure for nasal polyps right now. The main aim of treatment is to control the ongoing inflammation and symptoms. Usually, doctors use nasal steroids after surgery. These are safe and cost less than other treatments. After surgery, your doctor will need to check your nose regularly with a tool called an endoscope to make sure the polyps aren’t coming back.
Recently, a new kind of medicine designed for severe eczema and asthma has been approved for the toughest cases of nasal polyps. These medicines, called biologics, work by changing how the immune system handles inflammation. They’re given as shots into the skin regularly and can help when other treatments haven’t worked.
But these drugs can cause side effects like allergic reactions, cold sores, and eye inflammation. If you stop taking the shots after seeing improvements, the polyps might return within a few months. Because of these side eff
ects and the need for regular shots, these new drugs are usually only offered to patients with the hardest cases. Your doctor might talk to you about these new medications if they’re needed for your treatment.
Flowchart of treatment for chronic rhinosinusitis with polyps