Nasal Polyps: Symptoms, Causes, and Treatment Options

What are nasal polyps and what causes them?

Nasal polyps are teardrop-shaped growths arising from the mucous membranes that line the sinuses. They develop in the setting of chronic inflammation — usually chronic rhinosinusitis with nasal polyps (CRSwNP), a distinct subtype of sinus disease 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Diagnosis, classification, and management of chronic rhinosinusitis including nasal polyps; intranasal corticosteroids as first-line therapy; nasal saline irrigation as adjunct. The inflammation is typically type 2 (eosinophilic) in nature, driven by an immune response rather than infection.

Conditions commonly associated with nasal polyps include: - Chronic allergic rhinitis - Aspirin-exacerbated respiratory disease (AERD) — also called Samter's triad: nasal polyps, asthma, and aspirin/NSAID sensitivity - Asthma - Cystic fibrosis (particularly in children) - Less commonly, certain immune conditions

Polyps are not caused by infection and are not a sign of cancer.

What symptoms do nasal polyps cause?

Symptoms depend on the size and location of the polyps. Large or numerous polyps can cause 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Diagnosis, classification, and management of chronic rhinosinusitis including nasal polyps; intranasal corticosteroids as first-line therapy; nasal saline irrigation as adjunct:

• Persistent nasal congestion or stuffiness that does not respond to typical cold remedies
• Reduced or lost sense of smell — anosmia is one of the most common and distinctive features, because polyps often begin in the olfactory cleft
• Reduced sense of taste (often secondary to smell loss)
• Runny nose — clear or cloudy mucus drainage
• Postnasal drip — mucus draining to the back of the throat
• Facial pressure or headache
• Snoring or difficulty breathing through the nose
• Recurrent sinus infections

Small polyps may cause no symptoms at all and are sometimes found incidentally.

Nasal polyps vs. sinusitis: The two conditions overlap substantially. Chronic rhinosinusitis without polyps can cause similar symptoms, but anosmia is more strongly associated with polyps 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Diagnosis, classification, and management of chronic rhinosinusitis including nasal polyps; intranasal corticosteroids as first-line therapy; nasal saline irrigation as adjunct. The distinction matters because treatment approaches differ.

How are nasal polyps diagnosed?

An ENT specialist can often see polyps during a nasal examination using a flexible endoscope (nasal endoscopy) — a brief in-office procedure. CT scanning of the sinuses provides a clearer picture of polyp extent and any underlying sinus disease 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Diagnosis, classification, and management of chronic rhinosinusitis including nasal polyps; intranasal corticosteroids as first-line therapy; nasal saline irrigation as adjunct.

No blood test diagnoses polyps, though tests for allergy and, when AERD is suspected, aspirin sensitivity may be informative.

What are the treatment options for nasal polyps?

Intranasal corticosteroid sprays are the foundation of non-surgical treatment. Daily use can shrink polyps, improve nasal airflow, and partially restore smell. They are safe for long-term use when used correctly 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Diagnosis, classification, and management of chronic rhinosinusitis including nasal polyps; intranasal corticosteroids as first-line therapy; nasal saline irrigation as adjunct. They work better as maintenance than as rescue treatment, so consistency matters.

Short courses of oral corticosteroids (such as prednisone) may be used to achieve faster, more substantial shrinkage — particularly before surgery or in severe flares. They are not suitable for long-term use due to systemic side effects.

Saline irrigation (nasal rinsing with salt water) is a simple adjunctive measure that helps clear mucus, reduce inflammation, and improve delivery of nasal steroid sprays 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Diagnosis, classification, and management of chronic rhinosinusitis including nasal polyps; intranasal corticosteroids as first-line therapy; nasal saline irrigation as adjunct.

Functional endoscopic sinus surgery (FESS) removes polyps and opens the sinuses to improve drainage. Surgery is considered when medical management has failed, when polyps are large, or when smell loss is severe 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Diagnosis, classification, and management of chronic rhinosinusitis including nasal polyps; intranasal corticosteroids as first-line therapy; nasal saline irrigation as adjunct. Surgery does not prevent polyps from recurring — ongoing medical treatment after surgery is important.

Biologic medications represent a newer approach for people with moderate-to-severe CRSwNP who have not responded adequately to steroids. Dupilumab, targeting IL-4 and IL-13, is the best-studied biologic for this indication and was shown in randomized trials to substantially reduce polyp burden and improve nasal symptoms including smell 2Ref 2Bachert C, Han JK, Desrosiers M, Hellings PW, Amin N, Lee SE, et al. (2019).Efficacy and Safety of Dupilumab in Patients with Severe Chronic Rhinosinusitis with Nasal Polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): Results from Two Multicentre, Randomised, Double-Blind, Placebo-Controlled, Parallel-Group Phase 3 Trials.Phase 3 trial evidence for dupilumab (IL-4/IL-13 biologic) substantially reducing nasal polyp burden and improving nasal congestion and smell in CRSwNP patients who failed corticosteroids. Other biologics targeting the type 2 inflammatory pathway have also received regulatory approval for CRSwNP.

Can nasal polyps cause permanent smell loss?

In most cases, smell loss from nasal polyps is at least partially reversible with effective treatment, because the olfactory nerves themselves are usually intact — the polyps are physically blocking or inflaming the olfactory cleft rather than damaging the nerves 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Diagnosis, classification, and management of chronic rhinosinusitis including nasal polyps; intranasal corticosteroids as first-line therapy; nasal saline irrigation as adjunct. Many people notice meaningful improvement in smell after corticosteroid treatment or surgery. However, smell recovery is not guaranteed, particularly after many years of untreated disease. Early treatment tends to produce better outcomes.