Nasal Polyps: Symptoms, Causes & Treatment Guide

Nasal polyps are soft, painless, noncancerous growths that develop in the lining of the nasal passages or sinuses. They result from chronic inflammation and can cause persistent nasal congestion, loss of smell, and recurrent sinus infections. While small polyps may cause no symptoms, larger growths can significantly impact breathing and quality of life. Treatment options range from corticosteroid medications to surgical removal, with newer biologic therapies offering hope for difficult cases.

What Are Nasal Polyps and How Do They Form?

Nasal polyps are soft, teardrop-shaped, noncancerous growths that hang from the lining of the nasal passages or sinuses like grapes on a vine. They develop when the mucous membrane becomes chronically inflamed and swollen, eventually forming visible growths that can obstruct the nasal airways and impair breathing, smell, and sinus drainage.

The formation of nasal polyps is a complex process that typically develops over months or years of persistent inflammation. When the nasal and sinus lining (mucosa) experiences ongoing irritation from allergies, infections, asthma, or other inflammatory conditions, it responds by becoming swollen and filled with fluid. Over time, this chronic inflammation causes the mucosa to stretch and eventually form grape-like protrusions that we recognize as nasal polyps.

These growths originate from the ethmoid sinuses, which are located between your eyes and the bridge of your nose. From there, they can grow downward into the nasal cavity where they may become visible during a medical examination. Unlike the normal pink, firm tissue of healthy nasal passages, polyps appear pale, grayish, and translucent, with a soft, gelatinous texture that has been compared to peeled grapes.

Nasal polyps vary significantly in size - from tiny growths that cause no symptoms to large masses that completely block the nasal passages. They typically develop in both nostrils (bilateral), though symptoms may be more pronounced on one side. Single polyps occurring in only one nostril are less common and may warrant additional investigation to rule out other conditions.

The underlying mechanism involves a type 2 inflammatory response, characterized by elevated levels of certain immune cells (eosinophils) and inflammatory proteins (cytokines) in the nasal tissue. This inflammation damages the epithelial barrier of the nasal lining, allowing fluid and immune cells to accumulate and form the characteristic polyp structure. Understanding this mechanism has led to the development of targeted biologic therapies that specifically address the inflammatory pathways involved in polyp formation.

Nasal Polyps vs. Enlarged Turbinates

It's important to distinguish nasal polyps from enlarged turbinates, as both can cause nasal obstruction but require different treatments. Turbinates are normal structures inside the nose - three bony ridges covered with tissue that help warm, humidify, and filter air. When inflamed (due to allergies or infection), turbinates swell and can block airflow, but they remain attached to the nasal wall. Nasal polyps, in contrast, hang freely in the nasal cavity and move when touched during examination. A healthcare provider can easily differentiate between these conditions during a nasal examination.

What Are the Symptoms of Nasal Polyps?

The most common symptoms of nasal polyps include persistent nasal congestion that doesn't respond to typical cold remedies, loss or reduction of smell (anosmia or hyposmia), decreased sense of taste, runny nose, postnasal drip, and facial pressure or headache. Symptoms typically develop gradually over months or years and may worsen progressively as polyps grow larger.

The symptom profile of nasal polyps closely mirrors that of chronic rhinosinusitis, as the two conditions frequently occur together. In fact, nasal polyps are considered a subtype of chronic rhinosinusitis and are formally classified as "chronic rhinosinusitis with nasal polyps" (CRSwNP) in medical literature. The symptoms you experience depend largely on the size and location of the polyps, with larger growths causing more significant obstruction and discomfort.

Small nasal polyps often cause no noticeable symptoms at all and may only be discovered incidentally during examination for other conditions. As polyps grow, however, they progressively obstruct the nasal passages and interfere with normal sinus function. The first symptom many people notice is a gradual decline in their sense of smell, which can be subtle and easy to overlook initially. This olfactory impairment occurs because polyps block odor molecules from reaching the smell receptors high in the nasal cavity.

Nasal congestion from polyps has a characteristic quality that distinguishes it from congestion due to colds or allergies. Unlike temporary congestion that responds to decongestants and clears within a week or two, polyp-related congestion persists for months and doesn't improve with over-the-counter medications. Many patients describe feeling like their nose is "always blocked" regardless of the season or exposure to allergens.

Primary Symptoms

• Nasal congestion: Persistent stuffiness that doesn't respond to decongestants, often described as breathing through a straw
• Loss of smell (anosmia): Partial or complete inability to detect odors, affecting 75-95% of patients with nasal polyps
• Reduced taste: Because smell contributes significantly to taste perception, food may seem bland or flavorless
• Postnasal drip: Mucus draining down the back of the throat, causing throat clearing and coughing
• Runny nose: Persistent clear or thick nasal discharge that doesn't improve with time
• Facial pressure: Dull ache or pressure around the cheeks, forehead, or between the eyes

Secondary Symptoms

Beyond the primary nasal symptoms, nasal polyps can cause several secondary issues that significantly impact daily life. Sleep disturbances are common, as nasal obstruction leads to mouth breathing, snoring, and in some cases, obstructive sleep apnea. Poor sleep quality can result in daytime fatigue, difficulty concentrating, and reduced productivity.

• Snoring and sleep apnea: Nasal obstruction forces mouth breathing during sleep
• Headaches: Particularly around the forehead and behind the eyes
• Ear fullness: Sensation of blocked ears due to eustachian tube dysfunction
• Double vision (rare): In cases where large polyps extend toward the eye socket
• Recurrent sinus infections: Blocked sinus drainage promotes bacterial growth
• Nosebleeds: Irritation of the nasal lining can cause occasional bleeding

When Should You See a Doctor for Nasal Polyps?

You should see a doctor if you have nasal congestion that persists for more than a month without improvement, notice a significant decrease in your sense of smell, or experience recurrent sinus infections. Seek immediate medical attention if you develop sudden severe headache with high fever, visual changes, or swelling around the eyes, as these may indicate serious complications.

Many people tolerate nasal congestion for extended periods before seeking medical attention, often attributing their symptoms to allergies or recurring colds. However, persistent nasal symptoms deserve evaluation, as early diagnosis and treatment can prevent polyps from growing larger and causing more significant problems. The sooner treatment begins, the more likely it is to be effective with medications alone, potentially avoiding the need for surgery.

A general practitioner or family doctor can perform an initial evaluation and may be able to diagnose nasal polyps during a routine examination. They can look into your nose using a lighted instrument (otoscope or nasal speculum) to check for visible polyps. If polyps are suspected or confirmed, you may be referred to an otolaryngologist (ENT specialist) for comprehensive evaluation and treatment planning.

The ENT specialist has access to more sophisticated diagnostic tools, including nasal endoscopy, which allows detailed visualization of the nasal passages and sinuses. They can assess polyp size, determine whether surgery might be necessary, and develop a personalized treatment plan based on your specific situation. For complex cases involving asthma, aspirin sensitivity, or recurrent polyps, a multidisciplinary approach involving allergists and pulmonologists may be beneficial.

Signs That Warrant Medical Evaluation

• Nasal congestion lasting more than 4 weeks without improvement
• Noticeable decrease in sense of smell or taste
• Thick, discolored nasal discharge (yellow or green)
• Facial pain or pressure that doesn't resolve
• Frequent sinus infections (3 or more per year)
• Symptoms that interfere with sleep or daily activities

What Causes Nasal Polyps to Develop?

Nasal polyps develop from chronic inflammation in the nasal and sinus lining, though the exact trigger is often unclear. Known risk factors include asthma, allergies, aspirin sensitivity (AERD), chronic sinus infections, cystic fibrosis, and immune system dysfunction. Genetics also play a role, as nasal polyps sometimes run in families, though no specific gene has been identified.

The development of nasal polyps represents the end result of a complex interplay between genetic predisposition, environmental factors, and immune system dysfunction. While we understand that chronic inflammation drives polyp formation, the precise factors that initiate this inflammation and determine why some people develop polyps while others don't remain areas of active research.

At the cellular level, nasal polyps are characterized by infiltration of eosinophils - a type of white blood cell typically involved in allergic responses and fighting parasites. These cells release inflammatory mediators that perpetuate tissue swelling and contribute to polyp growth. The inflammation also involves an overproduction of certain proteins called cytokines, particularly interleukin-4 (IL-4), interleukin-5 (IL-5), and interleukin-13 (IL-13), which maintain the inflammatory environment and promote eosinophil survival.

This type 2 inflammatory pattern explains why nasal polyps frequently coexist with asthma and allergies, which share similar underlying immune mechanisms. However, not all patients with nasal polyps have identifiable allergies, suggesting that multiple pathways can lead to polyp formation. Some researchers believe that bacterial colonization, particularly by Staphylococcus aureus, may trigger or amplify the inflammatory response in certain individuals.

Major Risk Factors

The Asthma Connection

The relationship between nasal polyps and asthma is particularly striking and clinically important. Studies show that 20-50% of people with asthma have nasal polyps, compared to 1-4% in the general population. This connection appears to be bidirectional - not only does asthma increase polyp risk, but treating nasal polyps often improves asthma symptoms and control. The concept of "unified airway disease" recognizes that the upper and lower respiratory tracts are interconnected, and inflammation in one area affects the other.

Patients with both conditions tend to have more severe disease and may require more aggressive treatment. The good news is that newer biologic medications, such as dupilumab, target inflammatory pathways common to both conditions and can effectively treat both asthma and nasal polyps simultaneously.

Aspirin-Exacerbated Respiratory Disease (AERD)

AERD, also known as Samter's triad, is a specific condition characterized by the combination of asthma, nasal polyps, and sensitivity to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). People with AERD often have particularly severe and recurrent nasal polyps that are difficult to control. The condition affects approximately 7% of adults with asthma and up to 14% of those with severe asthma.

In AERD, taking aspirin or NSAIDs triggers acute respiratory reactions including nasal congestion, asthma attacks, and sometimes life-threatening breathing difficulties. The mechanism involves abnormal metabolism of arachidonic acid, leading to overproduction of inflammatory leukotrienes. Management requires avoiding NSAIDs, though aspirin desensitization therapy under medical supervision can be beneficial for some patients.

How Are Nasal Polyps Diagnosed?

Nasal polyps are diagnosed through clinical examination, typically starting with a visual inspection of the nasal passages using a lighted instrument. Nasal endoscopy provides detailed visualization and is the most accurate method for detecting polyps. CT scans of the sinuses may be ordered to assess polyp extent and plan treatment, particularly before surgery. Additional tests may include allergy testing and cystic fibrosis screening in appropriate cases.

The diagnostic process for nasal polyps typically begins with a thorough medical history and physical examination. Your doctor will ask about your symptoms, their duration and severity, any associated conditions like asthma or allergies, medications you take, and your family history. This information helps determine the likelihood of nasal polyps and guides further testing.

During the physical examination, the doctor will examine your nasal passages using an otoscope or nasal speculum with a light source. Large polyps may be visible during this basic examination as pale, grayish masses that move when touched - unlike the fixed pink tissue of normal nasal structures or swollen turbinates. However, smaller polyps or those located deeper in the nasal cavity may not be visible without more specialized equipment.

For definitive diagnosis and thorough evaluation, nasal endoscopy is the gold standard. This procedure involves passing a thin, flexible tube with a camera (endoscope) through the nostril to visualize the entire nasal cavity and the openings to the sinuses. Nasal endoscopy can be performed in the doctor's office, typically after applying a local anesthetic spray to numb the nose. The procedure takes only a few minutes and provides crucial information about polyp size, location, and extent.

Diagnostic Procedures

• Anterior rhinoscopy: Basic examination with a nasal speculum and light; can detect large polyps but limited view of deeper structures
• Nasal endoscopy: Detailed visualization using a flexible or rigid scope; gold standard for diagnosis and monitoring
• CT scan of sinuses: Shows polyp extent, sinus involvement, and anatomical variations; essential for surgical planning
• MRI: Rarely needed; may be used if tumor is suspected or to evaluate unusual presentations
• Allergy testing: Skin prick tests or blood tests to identify allergic triggers contributing to inflammation

Polyp Staging Systems

Doctors use various staging systems to classify polyp severity and guide treatment decisions. These systems help track disease progression and treatment response over time. One common approach grades polyps from 0 to 4 based on their size and extent:

• Grade 0: No visible polyps
• Grade 1: Small polyps confined to the middle meatus (drainage pathway)
• Grade 2: Polyps extending beyond the middle meatus but not completely blocking the nasal passage
• Grade 3: Large polyps causing near-complete nasal obstruction
• Grade 4: Polyps completely blocking the nasal cavity

Ruling Out Other Conditions

Part of the diagnostic process involves excluding conditions that can mimic or coexist with nasal polyps. In children and young adults, nasal polyps should prompt evaluation for cystic fibrosis through a sweat chloride test or genetic testing. Single-sided polyps in adults may require biopsy to rule out tumors, including inverted papilloma or more serious malignancies. Other conditions that can cause similar symptoms include enlarged turbinates, deviated septum, and foreign bodies in children.

How Are Nasal Polyps Treated?

Treatment for nasal polyps focuses on reducing polyp size and controlling symptoms. First-line therapy consists of intranasal corticosteroid sprays, which can shrink polyps and improve symptoms in most patients. Short courses of oral corticosteroids may be added for larger polyps. When medications don't provide adequate relief, endoscopic sinus surgery can remove polyps and improve sinus drainage. Newer biologic medications offer additional options for severe, recurrent cases.

The treatment approach for nasal polyps follows a stepwise progression, starting with the least invasive options and escalating as needed based on response. The primary goals are to reduce polyp size, relieve symptoms, restore sense of smell when possible, and prevent recurrence. Most patients can achieve good symptom control with medical therapy alone, though surgery may be necessary for those who don't respond adequately to medications.

Intranasal corticosteroid sprays represent the cornerstone of medical treatment and are recommended as first-line therapy by all major guidelines. These medications work by reducing inflammation in the nasal lining, which causes polyps to shrink over time. Common options include fluticasone, mometasone, budesonide, and triamcinolone. These sprays are generally safe for long-term use, with minimal systemic absorption when used as directed.

The effectiveness of intranasal corticosteroids depends on proper technique and consistent use. It typically takes several weeks of daily use before significant improvement is noticed, and treatment must be continued long-term to maintain benefits. Many patients use these sprays indefinitely to prevent polyp regrowth. Your doctor or pharmacist can demonstrate proper spraying technique to ensure the medication reaches the target areas effectively.

Medical Treatment Options

Oral Corticosteroids

When intranasal sprays alone don't provide sufficient relief, short courses of oral corticosteroids (such as prednisone) may be prescribed to rapidly shrink polyps. These medications are highly effective but are reserved for short-term use due to potential side effects with prolonged therapy. A typical course lasts 1-3 weeks and can dramatically reduce polyp size, often restoring breathing and smell temporarily.

Oral steroids are particularly useful for "debulking" large polyps before starting intranasal spray therapy or before surgery. They may also be used periodically when symptoms flare despite maintenance treatment. However, repeated courses should be limited, and alternative treatments should be considered if oral steroids are frequently needed.

Biologic Medications

A significant advancement in nasal polyp treatment has been the approval of biologic medications that target specific inflammatory pathways. Dupilumab, originally developed for atopic dermatitis and asthma, received approval for chronic rhinosinusitis with nasal polyps based on clinical trials showing significant polyp reduction and symptom improvement. Other biologics approved or under investigation include omalizumab and mepolizumab.

Biologic medications are typically reserved for patients with severe nasal polyps who haven't responded adequately to other treatments or who require frequent oral corticosteroids. They are administered by injection every 2-4 weeks. While highly effective, these medications are expensive and require ongoing treatment to maintain benefits. They represent an important option for patients with difficult-to-control disease, particularly those who also have asthma.

Endoscopic Sinus Surgery

Surgery becomes necessary when medical therapy fails to provide adequate symptom relief, typically after 2-3 months of appropriate treatment. Functional endoscopic sinus surgery (FESS) is the standard procedure, performed through the nostrils using a camera and specialized instruments without external incisions. The surgeon removes polyps and opens the sinus passages to improve drainage and allow better access for topical medications.

The procedure is usually performed under general anesthesia as day surgery, meaning most patients go home the same day. Recovery involves nasal congestion and mild discomfort for 1-2 weeks, with progressive improvement over the following weeks. Most patients experience significant symptom improvement after surgery, with better breathing and often restoration of smell.

However, surgery is not a cure - polyps can regrow even after complete removal. Studies show that 40-60% of patients experience some degree of polyp recurrence within 3-5 years after surgery. This is why ongoing maintenance therapy with intranasal corticosteroids is essential after surgery to delay or prevent regrowth. Some patients may need revision surgery if polyps return and cause significant symptoms.

What Can You Do at Home to Manage Nasal Polyps?

While medical treatment is necessary for nasal polyps, several home measures can help manage symptoms and support treatment effectiveness. Regular saline nasal irrigation helps clear mucus and irritants. Using a humidifier adds moisture to indoor air. Avoiding known allergens and irritants reduces inflammation. These self-care strategies work best when combined with prescribed medications rather than as standalone treatments.

Home management strategies for nasal polyps should be viewed as complementary to medical treatment rather than replacements for it. No home remedy can shrink or remove nasal polyps, but certain practices can help relieve symptoms, reduce inflammation, and enhance the effectiveness of prescribed medications. Establishing consistent self-care routines can make a meaningful difference in your overall comfort and quality of life.

Nasal saline irrigation is one of the most beneficial self-care practices for people with nasal polyps. Regular rinsing with saline solution helps remove mucus, allergens, and irritants from the nasal passages, reducing inflammation triggers and improving nasal breathing. It also moisturizes the nasal lining and can help medications like corticosteroid sprays penetrate more effectively. Many patients find that irrigating before using their medicated sprays improves symptom control.

Environmental modifications can also help reduce symptoms. Using a humidifier, especially during dry winter months, keeps nasal passages moist and comfortable. Identifying and avoiding personal triggers - whether allergens like dust mites, pet dander, or mold, or irritants like smoke, strong odors, and pollution - can reduce the inflammatory burden on your nasal passages and help prevent symptom flares.

Effective Self-Care Strategies

• Nasal saline irrigation: Use a neti pot, squeeze bottle, or powered irrigator with sterile or distilled water and pre-made saline packets. Irrigate 1-2 times daily.
• Steam inhalation: Breathing warm, moist air from a bowl of hot water or during a shower can provide temporary symptom relief.
• Humidifier use: Maintain indoor humidity between 30-50% to prevent nasal dryness.
• Elevate head while sleeping: Sleeping with your head slightly elevated can reduce nighttime congestion.
• Stay hydrated: Drinking adequate fluids helps keep nasal secretions thin and easier to clear.
• Avoid irritants: Limit exposure to cigarette smoke, strong chemicals, and air pollution.

Proper Nasal Irrigation Technique

To perform nasal irrigation safely and effectively, always use distilled, sterile, or previously boiled (and cooled) water - never tap water directly, as it may contain microorganisms. Prepare the saline solution according to package directions or make your own with 1/4 teaspoon non-iodized salt per 240ml (8 oz) water. Lean over a sink, tilt your head to one side, and gently irrigate one nostril, allowing the solution to drain from the other nostril. Repeat on the opposite side. Clean and dry your irrigation device after each use.

Can Nasal Polyps Be Prevented from Coming Back?

While nasal polyps cannot always be prevented, several strategies can reduce the risk of development or recurrence. Consistent use of intranasal corticosteroid sprays is the most effective preventive measure. Managing underlying conditions like asthma and allergies, avoiding aspirin if sensitive, practicing regular nasal hygiene, and following up with your healthcare provider can all help keep polyps under control.

Prevention and recurrence reduction are key concerns for anyone who has experienced nasal polyps, given the high recurrence rate even after successful treatment. While we cannot completely eliminate the risk of polyp regrowth, understanding the factors that contribute to recurrence and taking proactive steps can significantly extend symptom-free periods and reduce the need for repeated interventions.

The single most important preventive measure is consistent, long-term use of intranasal corticosteroid sprays. Studies consistently show that patients who continue using these sprays after surgery or after polyps have been controlled have lower recurrence rates than those who stop treatment. Even if you feel completely well, continuing your maintenance spray as prescribed is essential for long-term success. Think of it like managing any chronic condition - ongoing treatment maintains the benefits achieved.

Managing underlying conditions that contribute to nasal inflammation is equally important. If you have asthma, working with your healthcare provider to optimize asthma control can help reduce nasal inflammation as well. Similarly, if allergies are identified as triggers, appropriate allergy management - whether through avoidance, medications, or immunotherapy - can reduce the inflammatory burden on your nasal passages.

Prevention Strategies

• Continue maintenance therapy: Use intranasal corticosteroid sprays as directed, even when symptoms are controlled
• Treat underlying asthma: Optimize asthma control with appropriate medications and monitoring
• Manage allergies: Identify and avoid triggers; consider allergy medications or immunotherapy
• Avoid aspirin/NSAIDs: If you have AERD, strictly avoid these medications unless under medical supervision
• Regular nasal hygiene: Continue saline irrigation as part of your daily routine
• Treat infections promptly: Seek treatment for sinus infections to prevent prolonged inflammation
• Regular follow-up: Keep scheduled appointments for monitoring, even when feeling well

Long-Term Monitoring

Regular follow-up with your healthcare provider allows for early detection of polyp regrowth, when it can be addressed with less aggressive treatment. Many ENT specialists recommend periodic nasal endoscopy examinations, particularly in the first few years after surgery or initial treatment. If you notice return of symptoms like declining smell or increasing congestion, schedule an appointment promptly rather than waiting for your next scheduled visit.