Nasal Polyps

Nasal polyps are soft, painless, non-cancerous growths that develop on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes and are caused by chronic inflammation of the nasal mucosa.

Small polyps may cause no symptoms at all. Larger polyps, or clusters of polyps, can block the nasal airway, reduce your 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.

Polyps affect roughly 1–4% of the general population, but the prevalence is much higher in people with asthma (up to 40%), aspirin sensitivity, or chronic sinusitis. They are more common in adults over 40 and affect men roughly twice as often as women.

The exact cause isn't fully understood, but nasal polyps are fundamentally a disease of chronic inflammation. The nasal lining becomes inflamed over a prolonged period, and polyps develop as an abnormal response to this ongoing inflammation.

Conditions associated with nasal polyps

Chronic rhinosinusitis: The most common association. Persistent inflammation of the sinuses creates the environment in which polyps develop. Most patients with significant nasal polyps also have chronic sinusitis.

Asthma: There is a strong bidirectional relationship between asthma and nasal polyps. Up to 40% of patients with nasal polyps also have asthma, and treating the polyps often improves asthma control.

Aspirin-exacerbated respiratory disease (AERD): Also called Samter's triad — the combination of nasal polyps, asthma, and aspirin/NSAID sensitivity. This is a particularly aggressive form of polyp disease with high recurrence rates.

Allergic fungal rhinosinusitis: A specific type of chronic sinusitis driven by an immune reaction to environmental fungi. The polyps in this condition tend to be particularly thick and tenacious.

Cystic fibrosis: Nasal polyps in children or teenagers should always raise the question of cystic fibrosis, particularly if bilateral.

The symptoms of nasal polyps overlap significantly with chronic sinusitis, which is why many patients don't realise they have polyps until they're examined by an ENT specialist. Common symptoms include:

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

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 taste is actually smell.

Postnasal drip — mucus draining down the back of the throat, causing 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.

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

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

I diagnose nasal polyps using nasendoscopy — a thin, flexible endoscope passed through the nostril to directly visualise the nasal passages and sinus openings. This is performed in the clinic, takes about 30 seconds per side, and is mildly uncomfortable but not painful. It gives me a definitive view of whether polyps are present, their size, their location, and which sinuses are affected.

In some cases, a CT scan of the sinuses is also needed — particularly if surgery is being considered. The CT scan shows the extent of sinus disease, the anatomy of your sinuses (which varies significantly between individuals), and helps me plan the surgical approach if intervention is required.

If you have nasal polyps, I also assess for associated conditions — asthma, aspirin sensitivity, and allergies — because managing these conditions is essential for controlling polyp recurrence after treatment.

Medical treatment is always the first line for nasal polyps. Many patients can be managed effectively without surgery, particularly if the polyps are small to moderate in size.

Steroid nasal sprays

Topical corticosteroid sprays (such as mometasone or fluticasone) are the mainstay of treatment. They reduce inflammation in the nasal lining, shrink polyps, and improve symptoms. They need to be used consistently — daily, for months — to be effective. Many patients use them long-term to prevent polyp recurrence.

Steroid nasal drops

For larger polyps, steroid drops (such as betamethasone) delivered in the head-down position can reach areas that sprays cannot. These are typically used in short courses of 6–8 weeks.

Short courses of oral steroids

A short course of prednisolone (typically 1–2 weeks) can dramatically shrink polyps and restore the sense of 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), so this is used judiciously.

Biologic therapies

For severe, recurrent polyps that don't respond to conventional treatment, biologic medications (such as dupilumab, mepolizumab, or omalizumab) are now available. These target specific inflammatory pathways and can be transformative for patients with refractory disease. They are typically prescribed by a specialist in secondary care and given as regular injections.

Surgery is considered when medical treatment has failed to adequately control symptoms, when polyps are large enough to cause significant obstruction, or when there are complications such as mucocoele formation or orbital involvement.

Functional endoscopic sinus surgery (FESS)

The standard surgical approach is FESS — performed entirely through the nostrils using an endoscope and specialised instruments. There are no external incisions. The goal is to remove the polyps, open the sinus drainage pathways, and create an anatomy that allows topical medications (steroid sprays and rinses) to reach the sinus lining effectively.

FESS is performed under general anaesthesia as a day case. Most patients go home the same day. Recovery involves nasal congestion and blood-stained discharge for 1–2 weeks, with a return to normal activities within 1–2 weeks.

Recurrence

Nasal polyps have a significant recurrence rate — up to 40–60% of patients will develop recurrent polyps within 5 years of surgery. This is why ongoing medical management after surgery is critical. Surgery is not a cure; it's a reset that creates the best conditions for long-term medical control.

Patients with Samter's triad (polyps + asthma + aspirin sensitivity) have the highest recurrence rates and may benefit from aspirin desensitisation therapy after surgery, or biologic therapy to prevent regrowth.

Loss of smell is often the most distressing symptom of nasal polyps. Smell is intimately linked to taste, memory, and quality of life — patients describe food becoming bland, being unable to detect gas leaks or smoke, and losing the emotional connection that familiar scents provide.

The mechanism is usually obstructive — polyps physically block odour molecules from reaching the olfactory receptors at the top of the nasal cavity. In most cases, treating the polyps (medically or surgically) restores the sense of smell, often dramatically. Some patients report their smell returning within days of starting oral steroids.

In long-standing cases, there can also be an inflammatory component where the olfactory nerve fibres themselves are damaged. Recovery may be partial in these cases, and olfactory training (structured smell exercises) can help.