Nasal polyps are soft, painless, non-cancerous growths that originate from the nasal passages or paranasal sinuses. They often look like tiny teardrops or grapes hanging inside the nasal cavity. They are the result of various disease processes that take place in the nasal cavities, including chronic inflammation. Nasal polyps can form at any age, but they’re most common in young and middle-aged adults and more common in men than women. In the United States, the overall incidence of nasal polyps in children is 0.1% and in adults is about 4%.
What causes nasal polyps?
The exact cause is not known. There might be a genetic predisposition. There’s some evidence that different immune system responses and different chemical makers are found in patients who develop nasal polyps versus those who don’t.
There are several underlying conditions that are often associated with nasal polyps:
- Cystic fibrosis, a rare genetic disorder, typically diagnosed in childhood. About 86% of these patients have nasal polyps.
- Chronic rhinosinusitis – about 20% of these patients may have nasal polyps.
- AERD (aspirin exacerbated respiratory disease) is characterized by asthma, nasal polyps, and aspirin sensitivity or allergy. Up to 30-40% of patients with asthma and nasal polyps have AERD.
- Asthma – more than 50% of patients with nasal polyps have underlying asthma.
- Allergic rhinitis – up to 30% of those with nasal polyps have underlying allergies.
Additional risk factors for nasal polyps include allergic fungal rhinosinusitis (AFRS) which is an allergy to airborne fungi, and Churg-Strauss syndrome (eosinophilic granulomatosis with polyangitis) which is a rare disease that causes inflammation of blood vessels.
- Runny nose
- Postnasal drip
- Decreased or complete loss of smell
- Loss of taste
- Face pain or headaches
- Snoring and/or sleep apnea
If the polyps are large enough, it can cause difficulty breathing by blocking the nasal airways, thereby inhibiting the ability to breathe through the nose. It can also lead to frequent nasal/sinus infections.
A thorough history and physical examination are important. Nasal polyps might be visible with the aid of a simple lighted instrument (i.e otoscope). Direct visualization with nasal endoscopy can confirm the presence of nasal polyps. With this procedure, a narrow tube with a small camera or magnifying lens is inserted into the patient’s nose and allows the doctor to examine the inside of the nose and sinuses.
A sinus CT (computerized tomography) scan is helpful because it can document the extent of sinus disease, and the size and location of the nasal polyps. This imaging can also help rule out other structural abnormalities or any other type of cancerous or noncancerous growth.
Allergy skin prick testing and/or blood work can help determine if allergies are triggering the chronic inflammation, potentially contributing to nasal polyp growth. Additional blood work might be helpful to rule-out other underlying conditions.
Medications can help shrink nasal polyps:
- Prescription or over-the-counter nasal corticosteroid sprays. Some common ones include Flonase, Xhance, Rhinocort, Nasonex, Nasacort, Qnasal, and Omaris.
- Oral corticosteroids, such as prednisone, are potent anti-inflammatory agents. Because oral corticosteroids come with some side effects, these are typically used for a limited time only.
- Antihistamine and leukotriene inhibitors, such as Singulair may help as well.
- Dupixent (dupliumab) is a biologic medicine given as a subcutaneous injection every 2 weeks for the treatment of nasal polyps as add-on therapy. In clinical studies, it was shown to reduce the need for surgery and treatment with oral steroids. This medication was initially approved for atopic dermatitis, then for moderate to severe asthma, and now more recently for nasal polyposis.
If there is underlying AERD, aspirin desensitization may help those patients with nasal polyps. If there is underlying allergic rhinitis, allergen immunotherapy is a long-term treatment option that decreases the immunes system’s response to the allergens overtime, which can also help in decreasing chronic inflammation associated with nasal polyps.
If medications fail to shrink or eliminate the nasal polyp, surgical intervention might be an option. An ENT (ears-nose-throat) physician may remove the polyp surgically which is typically preformed as an outpatient procedure depending on the individual patient. Success rate can be as high as 80-90% post-surgery; however, on average, nasal polyps tend to regrow within 3-4 years post-surgery.
Long-term complications and prognosis
Nasal polyps can have a significant impact on patients’ quality of life, increased missed days of work and/or school, all complicated by their recurring nature. Some of the most common complications of untreated nasal polyps include obstructive sleep apnea, increased asthma flare-ups, and recurrent sinus infections.
What’s the next step?
Since we know that underlying allergies and other conditions can trigger chronic inflammation and nasal polyps, it is important to get a complete evaluation. Our physicians are board certified allergists and immunologists that treat both children and adults. We can perform allergy testing in the office setting. We also have an on-site state-of-the-art Xoran MiniCAT CT scanner that allows us to image the sinuses in less than 1 minute. It can help determine if there is an infection, nasal polyps, or any other structural abnormalities. Our facility is accredited by the Intersocietal Accreditation Commission (IAC) and our physicians are certified to perform and review the CT results with you immediately and direct appropriate treatment.
Contact North Texas Allergy & Asthma Center for an appointment – we can help!
SHIKHA MANE, MD
Board Certified Allergist