Nasal polyps look like small peeled grapes. Pale, greyish, slightly translucent, smooth and glistening, hanging in clusters from the sinus openings high inside your nose. Polyps are soft, painless growths with almost no blood supply of their own, which is why they are pale rather than red.
"Have I got polyps?" is one of the questions ENT surgeons hear most often in clinic. Nearly everyone who asks has already tried to check with a torch and a mirror, and nearly everyone has been looking at the wrong thing. That pale-grape description is worth holding on to, because it answers several of the questions people ask most often.
But the appearance is not the most important thing about them. This is: polyps on both sides are usually benign inflammatory disease. A polyp on one side only is a different problem until proven otherwise. If you take one thing from this article, take that.
Why you cannot see them yourself
Polyps grow from the sinus openings in the middle and upper part of the nose, well behind and above what you can see by tilting your head back at a mirror. By the time a polyp is visible at the nostril it is very large indeed.
What you see when you look up your own nostril is the front of the septum and the front end of the inferior turbinate. That turbinate is frequently mistaken for a polyp. It is pink or red, firm, and attached along the whole side wall. A polyp is pale, mobile, and hangs.
Can you feel nasal polyps with your finger?
No, and please do not try.
Your finger reaches perhaps a centimetre and a half into the nostril. Polyps grow above and behind that. What you can feel is the front of the septum and the turbinate, both of which are normal structures.
There is also a real downside to prodding. The lining is thin and rich in vessels at the front of the septum, and this is the commonest site of nosebleeds. You are far more likely to cause one than to learn anything.
What else gets mistaken for a nasal polyp?
Three things account for most of the worried self-diagnoses I see.
The inferior turbinate. By far the commonest. It is a normal structure, present in everyone, and it swells and shrinks through the day as part of the normal nasal cycle. Pink or red, firm, attached along its length. If what you can see looks fleshy and red rather than pale and grape-like, it is almost certainly turbinate.
A painful lump just inside the nostril. A red, tender lump at the nostril opening is usually an infected hair follicle or a small boil of the nasal vestibule, not a polyp. Polyps are painless and sit far deeper. Vestibular infections hurt, come up over days, and settle with treatment.
The septum. A deviated septum can produce a firm bulge into one side of the nose that people find with a finger and assume is a growth. It is cartilage and bone under normal lining, it has been there for years, and it does not hang or move. If a one-sided blockage turns out to be septal rather than polyp, the treatment conversation is a different one, which I cover on my septoplasty page.
The honest summary: if you can see it or feel it easily, it is probably not a polyp. And if something at the front of the nose is growing, crusting or bleeding, that needs examining in its own right rather than a polyp label.
Do nasal polyps bleed?
Typically not. They have a poor blood supply and are made largely of oedematous, fluid-swollen tissue. That is exactly why they look pale.
So bleeding deserves attention rather than reassurance. A "polyp" that bleeds readily, especially on one side, raises the possibility of something else entirely: an inverted papilloma, a benign but locally aggressive growth, or less commonly a tumour. Vascular lesions in the nose also bleed and can look superficially polyp-like.
Recurrent nosebleeds alongside known polyps are usually coming from the septum rather than the polyps, particularly in anyone using a steroid spray aimed incorrectly at the septum. That is worth checking before assuming the worst.
Can nasal polyps be cancerous?
Ordinary bilateral inflammatory polyps are benign. They are not pre-cancerous and they do not turn into cancer. People with polyps on both sides, a long history of blocked nose and reduced smell, and asthma or aspirin sensitivity have a very recognisable and benign condition.
The caution is entirely about the one-sided case.
A single polyp-like mass on one side, particularly with bleeding, facial pain, numbness of the cheek or teeth, a blocked ear on that side, or any change in vision or eye position, needs urgent examination and imaging. Most such cases still turn out to be benign, including antrochoanal polyps, which are single, benign, and commonest in younger people. But the possibility of an inverted papilloma or a sinonasal malignancy is precisely why nobody should assume a unilateral mass is just a polyp.
This is not a reason to panic. It is a reason to get it looked at with a camera rather than treated with a spray for two years.
When should you worry about a nasal polyp?
Most polyp disease is slow. Polyps enlarge gradually, over months to years, and the symptoms creep up so quietly that people recalibrate around them without noticing. That slowness is itself useful information, because it makes the exceptions stand out.
See someone promptly if any of these apply:
- Symptoms on one side only, or a mass visible in one nostril
- Bleeding from the nose beyond the odd minor nosebleed
- Facial pain, or numbness of the cheek, teeth or lip
- A blocked or full ear on the same side
- Any change in vision, double vision, or a change in the position of the eye
- Something that is changing quickly, over weeks rather than months
None of these proves anything sinister, and most turn out to have benign explanations. But each one is a reason for an examination with a camera rather than another repeat prescription. The two-sided, slowly progressive, smell-fading picture can be assessed on a routine basis. The one-sided picture should not wait.
The symptom that points to polyps before anything else
Loss of smell.
Polyps grow in the olfactory region, the roof of the nose where the smell nerves are. People with polyps usually notice their sense of smell fading, and often their taste with it, before the blockage becomes severe. It is the single most useful distinguishing symptom, because a deviated septum or enlarged turbinates rarely take your smell away.
The rest of the picture
What polyps actually do to you depends on their size and location. A small one tucked up in the drainage channel between the turbinates can sit there for years and cause almost nothing. A large one blocks the nose completely.
- Nasal congestion on both sides that never fully clears, so you end up breathing through your mouth, particularly at night.
- Thick mucus, a runny nose, and a constant post-nasal drip down the back of the throat.
- Bad breath or an unpleasant taste, from infected mucus that sits and drips rather than clearing.
- Sinus pressure across the cheeks, the bridge of the nose or behind the eyes. Dull pressure rather than sharp pain.
- Repeated sinus infections. Blocked drainage channels lead to infected mucus that cannot clear.
- Snoring and broken sleep. A nose that has been blocked for a long time disturbs sleep far more than most people expect, which is why a blocked nose is worse at night.
Polyps rarely cause obstructive sleep apnoea on their own, but they make an existing problem harder to manage.
Plenty of people put all of this down to a cold that never quite went away. If a cold has lasted twelve weeks, it is not a cold.
Asthma sits in this picture too. The combination of nasal polyps, asthma and sensitivity to aspirin or other anti-inflammatory drugs is a well-recognised pattern, and it matters because those patients tend to have more aggressive disease and recur more readily after surgery.
Who gets nasal polyps?
Mostly adults, and mostly in middle age onwards. Polyps become more common with age and are commonest in adults over forty. They are more common in men than in women.
They are distinctly uncommon in children, which is why a child with apparent polyps is investigated for an underlying cause, cystic fibrosis in particular, rather than simply treated for the polyps. A polyp-like mass in a child's nose always deserves specialist review.
The other group worth naming is the asthma and aspirin-sensitivity group described above. If you have asthma, polyps, and reactions to aspirin or ibuprofen, say so to whoever treats you, because that combination changes both the outlook and the treatment plan.
What causes nasal polyps?
Polyps are the end result of long-running inflammation in the lining of the nasal passages and sinuses. The proper name for the underlying condition is chronic rhinosinusitis with nasal polyps, and the distinction matters: the polyps are the visible consequence, not the disease itself, which is why removing them without treating the lining underneath rarely holds for long.
Several things drive it, usually in combination:
Chronic sinusitis. Inflammation that has grumbled on for months rather than days. Repeated sinus infections both arise from polyps and make them worse, and people often describe years of antibiotic courses that helped for a fortnight each time.
Allergies. Allergic rhinitis, whether seasonal hay fever or a year-round house dust mite allergy, keeps the lining swollen and irritable. Allergy is not the whole story, and plenty of people with florid polyps test negative, but it is worth identifying because it is treatable. I have written separately on telling hay fever apart from a structural problem.
Asthma and aspirin sensitivity. The strongest association of the lot, and worth mentioning to whoever treats you even if your asthma is mild.
Cystic fibrosis. The main reason polyps in children are investigated rather than assumed.
What does not cause them: picking your nose, one bad cold, or anything you did wrong.
How are nasal polyps diagnosed properly?
The examination that settles it is a nasal endoscopy, done in clinic by an ear, nose and throat surgeon. A flexible camera goes along the floor of the nose after a local anaesthetic spray and takes about a minute per side. It shows the polyps directly, how extensive they are, whether both sides are involved, and where they are arising from. Most people ask to watch on the screen.
It is the one thing that separates polyps from the other conditions that block a nose, and it is why I would rather look with a camera than treat blind.
If treatment is being planned, a CT scan of the sinuses maps the extent, shows which sinuses are affected, and gives the surgical roadmap. In a unilateral case, imaging is not optional, and a biopsy is usually taken.
Treatment, honestly
Steroid sprays and drops first. For polyps, drops used in a head-down position often work better than sprays, because they reach higher into the nose where the polyps are. Technique matters enormously here and is rarely explained properly.
Saline rinses, large volume, daily, as a foundation.
A short course of oral steroids can shrink polyps dramatically and quickly. The effect is real but temporary, and repeated courses carry meaningful risks, so this is not a long-term strategy.
Biologic drugs have changed the picture for severe recurrent disease. These are injectable antibody treatments targeting the underlying type 2 inflammation, and they are available on the NHS for selected patients with severe polyps, usually those who have already had surgery and relapsed. If you have had multiple operations and keep recurring, ask specifically whether you are a candidate.
Surgery when medical treatment fails. Modern practice is endoscopic sinus surgery rather than simply plucking out polyps: the polyps are removed and the sinus openings are widened, which improves drainage and lets topical steroids reach the lining afterwards. Day case, general anaesthetic, and generally comfortable afterwards.
What surgery does and does not achieve
It reliably restores the airway and frequently restores smell, sometimes strikingly.
It does not cure the underlying inflammation. Polyps recur, and anyone who tells you otherwise is overselling. Recurrence is commoner in people with asthma and aspirin sensitivity. The single biggest determinant of how long the benefit lasts is whether you keep using topical steroid treatment afterwards, which is exactly what patients stop doing once they feel well. Surgery opens the sinuses so the spray can work; the spray is what keeps them open.
Side effects to know about: bleeding, which is usually minor; temporary crusting and congestion for a few weeks; and rarely, injury to the eye socket or the skull base, both of which sit immediately next to the sinuses. These are uncommon in experienced hands and are the reason the operation is done endoscopically with careful imaging.
I have set out the condition and its management in more depth on my nasal polyps page.
Frequently asked questions
What do nasal polyps look like?
Pale grey, translucent, smooth and grape-like, hanging from the sinus openings. Not red or fleshy, which is what a normal turbinate looks like.
Can you see nasal polyps by looking up your nose?
Rarely. They sit above and behind the visible area. What most people spot is a normal turbinate, and a polyp large enough to be seen at the nostril is an advanced one.
Can you feel nasal polyps with your finger?
No. They are out of reach, and probing risks a nosebleed. A lump you can easily feel at the front of the nose is almost always something else.
Do nasal polyps hurt?
Not usually. They are painless. A painful lump near the nostril opening is more likely an infected hair follicle, and facial pain with polyps suggests infection or another diagnosis. One-sided pain warrants prompt assessment.
Do nasal polyps bleed?
Not typically. A polyp that bleeds, particularly a single one on one side, needs examining rather than assuming.
Can nasal polyps be cancerous?
Ordinary polyps on both sides are benign and do not turn into cancer. A single one-sided mass is the situation that needs excluding properly, with a camera examination and usually a scan.
Will nasal polyps go away on their own?
Not usually. They may shrink with steroid treatment and regrow when it stops. Untreated, they tend to enlarge slowly over months to years.
Do nasal polyps always come back after surgery?
Not always, but recurrence is common, especially with asthma or aspirin sensitivity. Continuing topical steroid treatment afterwards is the main thing that delays it.
Will surgery bring my sense of smell back?
Often, and sometimes dramatically. It is not guaranteed, and longstanding smell loss recovers less reliably than recent loss.
How do I know if it is polyps or a deviated septum?
Smell loss and blockage on both sides suggest polyps. Consistent one-sided blockage with normal smell suggests a septal deviation. Both can coexist, and a nasal endoscopy in clinic distinguishes them in minutes.
If your smell has faded and your nose has been blocked on both sides for months, that combination is worth examining with a camera. You can book a consultation, and if there is anything one-sided about your symptoms, say so when you book, because it changes how quickly you should be seen.
Mr David Whitehead is a Consultant ENT and Facial Plastic Surgeon in London, on the GMC Specialist Register for Otolaryngology and certified by the Royal College of Surgeons Intercollegiate Board in Cosmetic Surgery. More about my training and credentials.