Nasal Polyps

Nasal polyps are soft, painless, non-cancerous growths that develop on the lining of the nasal passages or sinuses. They hang down like teardrops or grapes and are caused by chronic inflammation of the nasal mucosa — a condition formally known as chronic rhinosinusitis with nasal polyps (CRSwNP).

Small polyps may cause no symptoms at all. Larger polyps, or clusters of polyps, can block the nasal airway, reduce or abolish the sense of smell, cause persistent nasal congestion, and lead to recurrent sinus infections. They are one of the most common reasons patients are referred to an ENT surgeon.

A recent global systematic review of over 237 million people found that CRS affects approximately 8.7% of the population, with CRSwNP specifically affecting around 0.65%.¹⁰ Prevalence is higher in adults over 40, in men (roughly twice as common), and in those with asthma — where up to 40% may develop polyps. Prevalence appears to be increasing over time.

The symptoms of nasal polyps overlap significantly with chronic sinusitis, which is why many patients live with them for years before seeking specialist help. Common symptoms include:

Persistent nasal congestion — a feeling of being permanently blocked, often worse on one side. This is the most common presenting symptom and the one that most affects daily life.

Reduced or lost sense of smell (hyposmia or anosmia) — often the symptom that concerns patients most. Loss of smell also affects taste, since much of what we perceive as flavour is actually smell. Patients describe food becoming bland, being unable to detect gas leaks or smoke, and losing the emotional connection that familiar scents provide.

Postnasal drip — mucus draining down the back of the throat, causing persistent throat clearing, cough, or a feeling of something stuck in the throat.

Facial pressure or pain — a dull ache across the cheeks, forehead, or between the eyes, particularly when bending forward. This results from sinus obstruction and mucosal inflammation.

Recurrent sinus infections — polyps obstruct sinus drainage pathways, creating a warm, moist, stagnant environment where bacteria thrive.

Snoring and sleep disturbance — nasal obstruction forces mouth breathing during sleep, which can cause or worsen snoring and contribute to poor sleep quality and fatigue.

The exact cause of nasal polyps is not fully understood, but research over the past decade has established that the majority of CRSwNP is driven by type 2 inflammation — a specific pattern of immune activation characterised by elevated levels of interleukins (IL-4, IL-5, IL-13), tissue eosinophilia, and elevated IgE.⁷

This understanding has transformed treatment: biologic therapies that target these specific pathways can now treat the underlying disease mechanism rather than just managing symptoms.

Conditions commonly associated with nasal polyps

Chronic rhinosinusitis (CRS): The most common association. The European Position Paper on Rhinosinusitis (EPOS 2020) classifies CRS into primary and secondary types, with polyps typically arising in primary diffuse type 2 CRS.¹

Asthma: There is a strong bidirectional relationship — up to 40% of CRSwNP patients also have asthma, and treating the polyps often improves asthma control. The shared type 2 inflammatory mechanism means biologics can treat both conditions simultaneously.⁸

Aspirin-exacerbated respiratory disease (AERD): Also called Samter's triad — the combination of nasal polyps, asthma, and aspirin/NSAID sensitivity. Patients with AERD have more severe disease, higher recurrence rates after surgery, and a distinct inflammatory profile driven by cysteinyl leukotriene overproduction.⁹ Aspirin desensitisation therapy after surgery can reduce recurrence in this group.

Allergic fungal rhinosinusitis: A specific type of CRS driven by an immune reaction to environmental fungi, with characteristically thick, tenacious polyps and eosinophilic mucin.

Cystic fibrosis: Nasal polyps in children or teenagers should always prompt consideration of cystic fibrosis, particularly if bilateral.

Nasal polyps are benign (non-cancerous) and are not dangerous in themselves. They do not transform into cancer. However, they can significantly impair quality of life through persistent nasal obstruction, loss of smell, recurrent infections, and disrupted sleep.

There is one important caveat: a unilateral (one-sided) nasal mass — particularly if it is associated with bleeding, pain, or rapid growth — should always be assessed promptly by an ENT specialist. While the vast majority of nasal masses are benign polyps, a one-sided mass occasionally represents something different, such as an inverted papilloma or, rarely, a sinonasal malignancy. Bilateral (both sides) polyps in the context of chronic sinusitis are almost always benign CRSwNP.

This is why any new or persistent nasal mass warrants an ENT assessment — not because polyps are dangerous, but because confirming the diagnosis is straightforward and provides reassurance.

When you attend for a consultation, I follow a structured, evidence-based assessment aligned with the EPOS 2020 guidelines:¹

History and symptom scoring

I begin with a detailed history: duration and severity of symptoms, which side is more affected, whether you've lost your sense of smell, any history of asthma or aspirin sensitivity, previous nasal surgery, and how the condition affects your daily life. You'll complete a SNOT-22 questionnaire — a validated patient-reported outcome measure that scores 22 symptoms on a 0–5 scale. This gives a baseline score that we use to track treatment response.

Nasendoscopy

I examine your nose using a thin, flexible endoscope passed through each nostril. This takes about 30 seconds per side and is mildly uncomfortable but not painful. It gives a definitive view of whether polyps are present, their size and grade, their location, and which sinus openings are affected.

Investigations

Depending on the clinical picture, I may arrange:

Blood tests: Full blood count (looking at the eosinophil count — a marker of type 2 inflammation), total IgE (elevated in allergic disease), specific IgE/RAST panels (to identify allergic triggers), and aspergillus-specific IgE/IgG (to exclude allergic fungal rhinosinusitis).

CT sinuses: A non-contrast CT scan of the sinuses is essential if surgery is being considered. It shows the extent of sinus disease, your individual sinus anatomy (which varies significantly between people), and helps me plan the surgical approach. The CT also provides a Lund-Mackay score — a standardised measure of sinus opacification.

Smell testing: If anosmia is a significant concern, formal olfactory testing can quantify the degree of loss and track recovery with treatment.

Peak flow or spirometry: If asthma is suspected or known, baseline lung function helps guide the overall management plan — particularly if biologic therapy is being considered for both upper and lower airway disease.

Treatment follows an integrated care pathway as recommended by EPOS 2020,¹ with escalating interventions based on disease severity and treatment response. The goal is long-term disease control — not just symptom relief.

Step 1: Topical corticosteroids and saline irrigation

The first-line treatment for all patients with CRSwNP is a topical corticosteroid nasal spray (such as mometasone or fluticasone) combined with regular saline nasal irrigation. These need to be used consistently — daily, for months — to be effective. Many patients use them long-term to maintain control.

Step 2: Steroid drops and short courses of oral steroids

For larger polyps, steroid drops (such as betamethasone) delivered in the head-down-and-forward position can reach areas that sprays cannot. A short course of oral prednisolone (typically 1–2 weeks) can dramatically shrink polyps and restore smell. However, the effects are temporary — polyps tend to regrow when the oral steroid is stopped. Repeated courses carry significant side effects (weight gain, blood sugar changes, bone thinning, cataracts), so EPOS 2020 recommends limiting to two courses per year at most.¹

Step 3: Functional endoscopic sinus surgery (FESS)

If medical treatment fails to adequately control symptoms, endoscopic sinus surgery is the next step. Surgery creates a “reset” — removing polyps, opening sinus drainage pathways, and creating an anatomy that allows topical medications to reach the sinus lining effectively. See the surgery section below for details.

Step 4: Biologic therapy

For patients with severe, recurrent type 2 CRSwNP who have already had surgery or are not suitable candidates for surgery, biologic therapy represents the most significant advance in treatment in decades. See the biologics section below.

Biologic medications target specific inflammatory pathways rather than suppressing the immune system broadly. For CRSwNP, three biologics have been studied:

Dupilumab (Dupixent): A monoclonal antibody that blocks IL-4 and IL-13 — key drivers of type 2 inflammation. The landmark SINUS-24 and SINUS-52 trials published in The Lancet demonstrated that dupilumab significantly reduced polyp size, improved nasal congestion, and restored sense of smell compared to placebo.⁴ In February 2026, NICE approved dupilumab for severe CRSwNP in England and Wales (TA1134), making it the first biologic available through the NHS for this condition.²

NICE recommends dupilumab for adults with severe CRSwNP not controlled by systemic corticosteroids or previous sinus surgery, with a SNOT-22 score of at least 50 and at least one prior sinus surgery.² It is given as a subcutaneous injection every two weeks.

Mepolizumab and omalizumab: Both have evidence of efficacy from clinical trials,⁵ but neither currently has a positive NICE recommendation for CRSwNP in England — their technology appraisals were terminated due to the manufacturers not submitting evidence.³ A new appraisal for omalizumab is in development at NICE.

A Cochrane systematic review of 10 randomised trials confirmed high-certainty evidence that dupilumab improves quality of life (SNOT-22) scores in CRSwNP, with moderate-certainty evidence for omalizumab and low-certainty for mepolizumab.⁵

Functional endoscopic sinus surgery (FESS) is the standard surgical approach for nasal polyps that have not responded adequately to medical treatment. It is performed entirely through the nostrils using an endoscope and specialised instruments — there are no external incisions or visible scars.

What happens during surgery

Under general anaesthesia, I use an endoscope to visualise the nasal passages and sinuses in high definition. Polyps are removed, and the natural sinus drainage pathways (ostia) are widened to restore ventilation and drainage. The extent of surgery depends on the severity and distribution of disease — it may range from a targeted polypectomy to a comprehensive clearance of all sinuses.

Recovery

FESS is typically performed as a day case — most patients go home the same day. Recovery involves nasal congestion and blood-stained discharge for 1–2 weeks. I advise 1–2 weeks off work for desk jobs, longer for physically demanding roles. Saline irrigation begins within a few days, and topical steroid sprays restart once healing allows.

The evidence on surgery

A Cochrane systematic review found insufficient high-quality trial evidence to determine whether extensive sinus clearance provides better outcomes than simple polypectomy alone,⁶ highlighting the need for individualised surgical planning based on CT findings and disease pattern rather than a one-size-fits-all approach.

What is well established is that surgery is not a cure in isolation. It creates the best conditions for long-term medical control — opening the sinuses so that topical medications can reach the sinus lining where they are needed. Ongoing medical management after surgery is critical.

Nasal polyps have a significant recurrence rate. Studies suggest that 40–60% of patients will develop recurrent polyps within 5 years of surgery. This is why EPOS 2020 emphasises that CRSwNP should be managed as a chronic disease requiring long-term treatment, not a one-off surgical problem.¹

Factors that increase recurrence risk:

High tissue eosinophilia — research by Gevaert and colleagues demonstrated that elevated tissue eosinophil counts and IL-5 levels are associated with higher rates of polyp recurrence after surgery.⁷ This is also the biological rationale for biologic therapy in recurrent disease.

Samter's triad (AERD) — patients with the combination of polyps, asthma, and aspirin sensitivity have the highest recurrence rates.⁹ Aspirin desensitisation therapy after surgery, or biologic therapy, may help prevent regrowth in this group.

Poor compliance with post-operative medical treatment — patients who stop their steroid sprays and saline irrigation after surgery are more likely to experience recurrence.

The combination of appropriate surgery followed by consistent long-term medical therapy offers the best chance of sustained control.

No — and attempting to do so is dangerous. Despite what some online sources suggest, you should never try to remove nasal polyps at home. The nasal passages sit between the eyes and beneath the brain, surrounded by delicate structures including blood vessels, nerves, and the thin bone separating the nose from the brain cavity.

Attempting self-removal risks severe bleeding, infection, damage to the eye or its surrounding structures, and cerebrospinal fluid leak. Additionally, not every mass in the nose is a polyp — what appears to be a polyp could be an inverted papilloma, a meningoencephalocele, or another lesion that requires specialist assessment before any intervention.

If your polyps are causing symptoms, the correct approach is to see an ENT specialist. Medical treatment with steroid sprays can shrink many polyps without any procedure at all. When surgery is needed, it is performed under direct endoscopic vision by a trained surgeon using specialised instruments — safely and effectively.

Nasal polyps are treated on the NHS, and the medical pathway (steroid sprays, short courses of oral steroids) is the same whether you are seen privately or through the NHS.

The main differences with private treatment are speed of access and continuity of care. NHS waiting times for ENT appointments can be several months, and further waits for CT scans and surgery can add significantly to the timeline. Privately, I can typically see you within days, arrange a CT scan within the week, and schedule surgery within 2–4 weeks if needed.

For biologic therapy (dupilumab), NICE TA1134 applies to both NHS and private patients in England.² The eligibility criteria are the same: severe CRSwNP, SNOT-22 score of at least 50, and at least one prior sinus surgery.

1. Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464. doi:10.4193/Rhin20.600
2. National Institute for Health and Care Excellence. Dupilumab for treating severe chronic rhinosinusitis with nasal polyps. NICE Technology Appraisal TA1134. February 2026. nice.org.uk/guidance/ta1134
3. NICE Technology Appraisals: Mepolizumab for CRSwNP (TA847, terminated); Omalizumab for CRSwNP (TA678, terminated). TA847 / TA678
4. Bachert C, Han JK, Desrosiers M, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52). Lancet. 2019;394(10209):1638-1650. doi:10.1016/S0140-6736(19)31881-1
5. Chong L-Y, Piromchai P, Sharp S, et al. Biologics for chronic rhinosinusitis. Cochrane Database Syst Rev. 2021;3(3):CD013513. doi:10.1002/14651858.CD013513.pub3
6. Sharma R, Lakhani R, Rimmer J, Hopkins C. Surgical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database Syst Rev. 2014;2014(11):CD006990. doi:10.1002/14651858.CD006990.pub2
7. Gevaert P, Han JK, Smith SG, et al. The roles of eosinophils and interleukin-5 in the pathophysiology of chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2022;12(11):1413-1423. doi:10.1002/alr.22994
8. Fokkens WJ, Lund V, Bachert C, et al. EUFOREA consensus on biologics for CRSwNP with or without asthma. Allergy. 2019;74(12):2312-2319. doi:10.1111/all.13875
9. Stevens WW, Jerschow E, Baptist AP, et al. Aspirin desensitization in aspirin-exacerbated respiratory disease: a Work Group Report from the AAAAI. J Allergy Clin Immunol. 2021;147(3):827-844. doi:10.1016/j.jaci.2020.10.043
10. Min HK, Lee S, Kim S, et al. Global incidence and prevalence of chronic rhinosinusitis: a systematic review. Clin Exp Allergy. 2024;55(1):52-66. doi:10.1111/cea.14592