Nasal polyps

In this article:

• What Is nasal polyps?
• How do nasal polyps look?
• How fast nasal polyps grow?
• Symptoms
• When to see a doctor
• Causes
• Risk Factors
• Complication
• Prevention
• Diagnosis
• References

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What Is nasal polyps?

Nasal polyps are not as scary as they sound. As a matter of fact, they have nothing to do with other polyps of the body, like colon polyps, which have a tendency to become cancerous. Nasal polyps are benign growth of the inflamed nasal mucosa. They usually originate from the sinuses up in the nose and hang down like grapes inside a nasal cavity. Most of the time they grow slowly, but can reach a pretty big size and then become a problem because they block the breathing. 

Nasal polyps are common for people who have allergies. Actually, polyps are the most common complication of the untreated environmental allergy and allergy to NSAIDS (anti-inflammatory over-the-counter pain killers). Some people who take aspirin as clot prevention develop nasal polyps.

How do nasal polyps look?

Sometimes you can actually see a polyp inside a nostril – it looks as bluish gel-filled grape. It does not hurt if you touch it, but if you can see it in a mirror, it is time to call an ENT doctor or an allergist.

How fast nasal polyps grow?

Forming and growth of a polyp usually takes a long time – like months and years. They can also shrink if the cause is no longer present, and regrow. While some people may get only one polyp on one side of the nasal cavity, others may develop grape like abundance of 10-15 polyps of different sizes.

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Symptoms

Nasal polyps also can be responsible for very annoying symptoms such as:

• Foul mouth smell
• Loss of taste and smell
• Throat irritation
• Snoring
• Congestion
• Sinus infection

When untreated polyps become large, they will either hang in the back of the throat or fill up the nostril. As a result, a person may experience inability to breathe in one side or a complete absence of the nasal breathing.

When to see a doctor

Nasal polyps can be asymptomatic or silent for a long time. But if left without treatment, you may encounter serious complications. Here are reasons to schedule an appointment:

• Sudden increase in symptoms
• New symptoms such as headaches, sinus pain and fever. This may indicate that you have a secondary sinus infection due to large polyps that blocked your sinuses
• Congestion or inability to breathe through your nose that does not go away longer than two weeks
• If you can see the polyp inside the nostrils in a mirror

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Causes

Anything that irritates nasal mucosa may cause it to grow in size. As the nose is a bony structure, there is no room for the nasal mucus layer to expand, so it starts hanging down forming a bubble filled up with liquid. There are several causes of the nasal polyps:

1. Allergies to environment, such as allergic rhinitis due to cat or dust mites
2. Systemic diseases causing inflammation
3. Genetic syndromes
4. Chronic sinus infections
5. An allergic reaction to aspirin and NSAIDS
6. Allergic fungal rhinosinusitis (due to mold Aspergillus)

Cystic fibrosis should be in the differential of the young patient (pre-teen, teen, and young adults) with refractory nasal polyposis, particularly in patients of European ancestry.

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, and cystic fibrosis (CF) is a rare genetic disease that may start with nasal polyps.

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Risk Factors

One of the most common risk factors for the development of the polyps is untreated rhinosinusitis, commonly known as congested nose. While you might think that congestion is benign, this is a sign of significant chronic inflammation inside the nasal cavity. As a result, mucus membrane swells and may transform into polyps.

What can cause chronic congestion? Surprisingly, it is allergy! There are few common symptoms how to recognize that your polyps may be a result of allergic rhinosinusitis:

• Itchy nose and eyes
• Excessive sneezing
• Runny of congested nose
• Other allergic diseases (asthma, allergic conjunctivitis, eczema or atopic dermatitis etc.)

Does use of decongestants cause polyps? Decongestants are common over the counter (OTC) medications that can be administered in spray or tablet.

Here are some common names of decongestants:

• Nasal sprays can be made as brands or generic (Afrin, Dristan, Sinex)
• Oral tablets (Sudafed, Walgreens Wal-Phed, Nasal decongestant PE)
• Many tablets contain antihistamine and decongestant and are sold as allergy or cold medications (Allegra-D, Benadryl Allergy Plus Sinus, Claritin-D, and Zyrtec-D).

While it is OK to use a decongestant for 2-3 days, it is not recommended to use them longer because they cause many health problems. Indeed, congestion will become worse with time and you can end up with a completely blocked nose as any decongestant has a “rebound” effect helping just for a few hours and causing a mucus membrane to swell more right after. Rebound congestion happens when blood vessel constriction (the way a decongestant works) goes away. 

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Complication

There are many problems that may start with time if you leave nasal polyps untreated. Here are some:

• Snoring due to polyps may lead to sleep apnea
• Sinusitis is a common complication, as the normal flow of the mucus from a sinus is blocked
• Sinus headaches are a result of increased inflammation and sinus pressure
• Blocked nasal breathing will affect an ability of exercise and overall quality of life
• Loss of smell and taste
• Social interaction problems due to foul smell from the breath and the nose
• Chronic fatigue due to lack of sleep and normal breathing

If the polyps are a result of systemic and genetic disease, then chronic progression of inflammation may lead to other organ involvement (but this is not because polyps are growing – they are merely a part of systemic disease).

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Prevention

It is important to treat the main problem that led to polyp growth. As we know, allergy is one of the main causes of nasal polyps. It is easy to see an allergist who will determine if you have a hay fever, or an allergic reaction to your pet. The good news – polyps that are caused by an allergic rhinosinusitis often resolve on their own if you eliminate the cause. Don’t worry – you don’t need to get rid of your pet. An allergist can offer you an effective way to get rid of the allergy itself – an immunotherapy is safe and effective!

Allergy test is a fast way to find out what exactly is causing polyps to grow. The skin prick test is done in 30 min! You can also as your Primary Care doctor to order an allergy panel, which is a blood test that can screen you for the presence of the antibodies in blood.

Nasal wash is an excellent natural measure to reduce the allergen and prevent polyps. It consists of a device and saline water. When it is done correctly, it can help you to reduce the symptoms in half! 

Allergic fungal sinusitis can be prevented by eliminating molds from your environment. Aspergillus and Penicillium indoor molds are capable of causing a severe systemic disease in some people. Make sure your house is well-ventilated and does not have water damage. If you can feel the musty smell in your room, it is time to talk to an expert environmental company that will check for the moisture in the house structures and will offer a mold inspection.

Sometimes the nasal polyps are caused by the OTC anti-inflammatory medications (NSAIDS). There is a disease that includes asthma and polyps that is called an Aspirin Triade. If you need to continue taking an aspirin, a trained Allergist will be able to desensitize you. You will be given a regimen of the various doses of aspirin until your immune system stops rejecting it. That is a great treatment that will allow you to get rid of symptoms and continue to take aspirin safely.

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Diagnosis

Nasal polyps can be diagnosed by a Primary care or by specialists of ENT and Allergy. If the condition includes other systemic symptoms suspicious of a genetic disease, an Immunologist and Pulmonologist will help to diagnose it.

Self-diagnosis of nasal polyps. Sometimes when the polyps grow big, you can actually see the grape-like transparent “thing” inside a nostril when you look in the mirror. Don’t try to poke it – just call to make an appointment. If you had polyps before and got them removed, it is possible for them to grow back.

How are polyps diagnosed? There are several methods specialists may use:

• Rhinoscopy. This procedure is done in the office with local anesthesia (such as Lidocaine spray). A doctor will use a rhinoscope – a fiberoptic device that goes in the nose and has a camera that can see if that is a polyp, and where it is coming from.
• Imaging radiologic methods. A face x-Ray or CT scan will help a doctor to see if there are nasal polyps and sinus inflammation
• Blood labs. A doctor will order labs that can show if you have a systemic inflammation, an allergy, or an Aspergillosis
• Sweat test and genetic testing can help determine if polyps are a symptom of a Cystic Fibrosis
• An Immunologist can order specific tests to diagnose an Eosinophilic granulomatosis with polyangiitis (EGPA)

Don’t delay treatment – it is easy to get rid of polyps to avoid all possible complications.

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References

Chronic Rhinosinusitis with Nasal Polyps. Hopkins C. N Engl J Med. 2019 Jul 04;381(1):55-63. [PubMed]

Chronic Rhinosinusitis with Nasal Polyps. Stevens WW, Schleimer RP, Kern RC. J Allergy Clin Immunol Pract. 2016 Jul-Aug;4(4):565-72. [PMC free article] [PubMed]

Will we ever cure nasal polyps? Ta NH. Ann R Coll Surg Engl. 2019 Jan;101(1):35-39. [PMC free article] [PubMed]

EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, Cohen N, Cervin A, Douglas R, Gevaert P, Georgalas C, Goossens H, Harvey R, Hellings P, Hopkins C, Jones N, Joos G, Kalogjera L, Kern B, Kowalski M, Price D, Riechelmann H, Schlosser R, Senior B, Thomas M, Toskala E, Voegels R, Wang de Y, Wormald PJ. Rhinology. 2012 Mar;50(1):1-12.  [PubMed]

Aspirin-exacerbated respiratory disease and current treatment modalities. Sakalar EG, Muluk NB, Kar M, Cingi C. Eur Arch Otorhinolaryngol. 2017 Mar;274(3):1291-1300. doi: 10.1007/s00405-016-4273-1. Epub 2016 Aug 18. PMID: 27538737 Review. https://pubmed.ncbi.nlm.nih.gov/27538737/ 

Nasal Polyps. del Toro E, Portela J. 2021 Aug 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 32809581 Free Books & Documents. Review. https://pubmed.ncbi.nlm.nih.gov/32809581/ 

Immediate Hypersensitivity Reactions. Justiz Vaillant AA, Vashisht R, Zito PM. 2021 Jun 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.PMID: 30020687 Free Books & Documents. Review. https://pubmed.ncbi.nlm.nih.gov/30020687/