Category: Nasal & Sinus  

Nasal Polyps

Nasal polyps are soft, jelly-like overgrowths of the lining of the sinuses. They look like grapes on the end of a stalk. They occur in around 1 in 200 people, mostly by the age of 40 years.

Symptoms of nasal polyps

Polyps do not always cause symptoms but as they grow down from the sinuses into the nasal cavity, the result is often a blocked nose. More importantly, they can block the tunnels connecting the nose to the sinus cavities preventing circulation of air and mucous. Like water in a stagnant pond, this can lead to bacterial overgrowth and sinus infections.

Causes of nasal polyps

The cause is unknown, but inflammation in the sinuses (from allergy or infection) may trigger polyps and make them grow faster—and regrow after sinus operations. It is not known whether there is a genetic link.  An allergic response to fungus may be the main cause of nasal polyps in a few patients who respond to a nasal spray containing an antifungal medication.  Unfortunately it is not easy to determine which polyp patients will respond to this treatment.

Nasal polyps are also seen in three unique situations: asthma, cystic fibrosis and aspirin sensitivity. Nasal polyps occur in:

  • 15% of asthma patients
  • 25% of cystic fibrosis patients
  • Most asthma patients with aspirin sensitivity

Treatment

  • Surgical removal, although they will regrow eventually in around 50% of people, especially those with aspirin allergy.
  • Cortisone tablets will shrink them down temporarily, but long-term use is restricted to the most severe cases because of side-effects.
  • Cortisone / steroid nose sprays slow polyp growth. People with recurrent polyps who have had multiple operations are often advised to stay on these sprays forever. In people with recurrent disease, nasal steroid sprays should be considered as “weed killers”, which need to be used continuously. Slower growth means fewer sinus infections, less antibiotics and less frequent surgery.
  • Allergy desensitization injections are sometimes used in allergic people with hay fever as well as polyps. While this often helps hay fever, it is not known for certain whether the injections help shrink the polyps as well as they decrease the severity of the allergy.
  • Diet – there is no evidence that altering the diet will help.
  • Other medications – sometimes antifungal sprays and tablets are effective in resistant cases.
  • People with aspirin allergy, nasal polyps and asthma (a condition known as the aspirin triad) have the option of aspirin desensitization, which can reduce asthma severity, the rate of polyp regrowth and the severity of sinusitis. The decision to undertake aspirin desensitization should be made by an allergy specialist.
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