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Nasal Polyps – An Overview
Introduction
Nasal polyps are soft, painless, noncancerous growths that develop on the lining of the nasal passages or paranasal sinuses. They result from chronic inflammation of the mucous membrane, which causes tissue swelling and leads to the formation of these grape-like masses. While small nasal polyps may go unnoticed, larger ones or clusters can obstruct airflow, impair smell, and lead to frequent sinus infections. They are more common in adults but can occur at any age.
Causes and Risk Factors
The exact cause of nasal polyps is not entirely understood, but they are closely linked to chronic inflammation of the nasal and sinus lining. This inflammation can be triggered by various factors:
- Chronic rhinosinusitis – Long-standing sinus inflammation is the most common cause.
- Allergic conditions – Allergic rhinitis (hay fever) can contribute to polyp development.
- Asthma – A strong association exists between asthma and nasal polyps.
- Aspirin-exacerbated respiratory disease (AERD) – Some people develop polyps along with asthma and aspirin sensitivity.
- Recurrent infections – Frequent upper respiratory tract infections may increase the risk.
- Immune system responses – Overactive immune reactions to environmental triggers.
- Genetics – Family history of nasal polyps or chronic sinus disease can predispose individuals.
Pathophysiology
The formation of nasal polyps is linked to chronic mucosal inflammation, which causes persistent swelling of the nasal or sinus lining. Over time, this inflammation leads to the accumulation of fluid within the mucosa, and gravity causes it to protrude into the nasal cavity. Polyps are typically composed of edematous connective tissue, inflammatory cells (especially eosinophils), and a covering of respiratory epithelium.
Signs and Symptoms
Small nasal polyps may be asymptomatic. However, larger ones or multiple growths can cause:
- Nasal congestion – Persistent blockage or stuffiness.
- Runny nose (rhinorrhea) – Continuous clear or mucous discharge.
- Postnasal drip – Mucus running down the back of the throat.
- Reduced or lost sense of smell (hyposmia/anosmia) – Due to obstruction of olfactory receptors.
- Loss of taste – Secondary to smell loss.
- Headache or facial pain – From sinus pressure.
- Snoring – Due to nasal blockage.
- Frequent sinus infections – Caused by impaired drainage.
Diagnosis
Diagnosis is typically based on history, symptoms, and clinical examination. Common diagnostic methods include:
- Nasal endoscopy – A thin, flexible camera is inserted into the nasal passages to directly visualize polyps.
- CT scan – Provides detailed images of nasal cavities and sinuses, useful for surgical planning.
- Allergy testing – Helps identify triggers for inflammation.
- Nasal cytology or biopsy – Rarely needed unless malignancy is suspected.
Complications
If untreated, nasal polyps can lead to:
- Chronic or recurrent sinusitis
- Sleep apnea due to airway obstruction
- Asthma flare-ups
- Decreased quality of life from impaired smell and breathing
Treatment Options
Management depends on the size, picture, and underlying cause.
Medications
- Nasal corticosteroid sprays – Reduce inflammation and shrink polyps.
- Oral corticosteroids – For severe or resistant cases (short-term use due to side effects).
- Antihistamines – Useful in allergic individuals.
- Antibiotics – For associated bacterial infections.
- Biologic therapies – Such as dupilumab for chronic rhinosinusitis with nasal polyps unresponsive to other treatments.
Surgical Management
If medications fail, endoscopic sinus surgery may be performed to remove polyps and improve sinus drainage. However, surgery does not cure the underlying inflammation, so recurrence is possible.
Prevention and Lifestyle Measures
- Manage allergies and asthma effectively.
- Avoid nasal irritants such as smoke, strong fumes, and dust.
- Use saline nasal sprays or rinses to keep nasal passages moist.
- Treat sinus infections promptly.
- Regular follow-up after treatment to monitor recurrence.
Prognosis
With proper medical management and lifestyle adjustments, many patients experience symptom relief and improved breathing. However, recurrence is common, especially in those with persistent inflammatory conditions like asthma or chronic rhinosinusitis.
Conclusion
Nasal polyps are a common but often underestimated cause of chronic nasal blockage and sinus discomfort. Understanding their causes, symptoms, and treatment options is essential for early intervention and improved quality of life. Although they can be persistent and prone to recurrence, advancements in medical therapy and minimally invasive surgery have significantly enhanced management outcomes.
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