If you often use nasal sprays or decongestants or suffer from reoccurring sinus infections, you may wonder if you have something else going on. Could your discomfort be caused by nasal polyps? And if so, do they need to be removed?

Nasal polyps are thought to affect 1 to 4 percent of the population. While they are not uncommon, only an ENT (ear, nose and throat) specialist can see nasal polyps with a scope to distinguish them from typical nasal structures. A CT scan can also help identify them.

What are nasal polyps?

Nasal polyps are soft, fleshy, swollen tissue growths within the nose. A problem of the sinus lining, they can block the nasal cavity passages and affect the sinuses’ ability to drain correctly. 

Nasal polyps are the body’s response to inflammation, but the underlying immune process that causes them is not fully understood.

“The main symptom differentiating nasal polyps is their effect on the ability to smell and taste food. They also can worsen chronic sinus infections, which causes nasal drainage, facial pressure and congestion," says Shannon Wheeler, MD, chief resident of otolaryngology – head and neck surgery. “Why some people get polyps and others don't is not clearly understood, so ongoing research is needed.”

Some people, such as those with asthma, allergies or aspirin sensitivity, may be more at risk from underlying medical conditions.

How do I know if I may have a nasal polyp?

A person will have a combination of symptoms rather than just one and usually be experiencing them for over 12 weeks. Symptoms may include:

• Ongoing stuffy nose and congestion.
• Difficulty with or loss of taste or smell.
• Chronic sinusitis (with or without polyps). 
• Post nasal drip, runny nose or dripping from the front of the nose.
• Headaches or facial pain. 

Polyps are diagnosed through a physical exam using a tiny camera. An imaging test like a CT scan may also be performed if necessary. 

“It's not uncommon for patients to say they take antibiotics, get better, and then a week or two after finishing a course, everything starts returning," adds Dr. Wheeler. “This is a recurrence cycle that people deal with for a few months. At that point, patients will usually get some imaging, which eventually leads them to us to take a closer look.”

Can nasal polyps be cancerous?

While nasal polyps are by definition benign, meaning they are not cancerous, it's understandable that you may have concerns. Polyps generally affect both sides of the nose. Obstruction symptoms that only affect one side of the nose and are combined with other symptoms such as nose bleeds, facial numbness or same-sided vision changes warrant further investigation. Removed polyps will always be sent to the lab for further testing if surgery is warranted.

How are nasal polyps treated?

Nasal polyps will not burst and may or may not require surgery. The first line of treatment is attempting to reduce inflammation over time with topical corticosteroids and nasal saline rinses. These take a few weeks to begin working and continue to be used for several months to reduce inflammation. Oral steroids can help reduce polyps as well, but due to side effects, they are not used repeatedly or long-term.

If polyps persist after trying medical management, surgery may be recommended. “Surgery removes the polyps and opens up the sinuses to help them drain on their own and help the topical medicines get to where they need to go –the sinus lining,” says Dr. Wheeler. “This is where we reduce inflammation more effectively.”

Surgical removal is performed entirely through the nose and is an outpatient procedure. 

Can nasal polyps come back?

Nasal polyps are considered a chronic condition with a high rate of recurrence, which is why follow-up appointments and checkups are essential. Ongoing treatment is often required to prevent future tissue swelling.

Surgery does not permanently cure polyps but helps medications better reach the sinus lining to prevent regrowth. 

People with underlying conditions like allergies, asthma, or aspirin sensitivity are often encouraged to see an allergist if they have persistent issues despite medical management or surgery to help minimize the risk of regrowth. For people who experience rapid regrowth after surgery, new medications (biologics) may help reduce the risk of recurrence.

When to see a doctor if you have symptoms

If you’re experiencing general sinus symptoms, talk with your primary care doctor about treatment. If you need antibiotics several times a year, have several persistent symptoms that keep returning, or have lost your ability to taste and smell, consider setting up an appointment with an ENT specialist.