Nasal polyps, medically known as polyposis nasi, are a chronic condition, specifically classified as chronic rhinosinusitis with nasal polyps (CRSwNP). This condition significantly reduces the quality of life for those affected, and symptoms often remain difficult to fully control. So, what should patients know? Here is essential information on the causes, symptoms, diagnosis, and latest treatment options.
What Are Nasal Polyps?
Nasal polyps are growths that develop on the mucous membrane inside the nose and paranasal sinuses. These abnormal tissue formations can be broad and extensive or narrow and stalk-like.
It’s important to note that they are different from the “polyps” found in children, which are enlarged lymphatic tissues in the nasopharyngeal area and are commonly removed surgically.
How Common Are They?
In Germany and across Europe, approximately 2–4% of the population is affected by nasal polyps. However, chronic sinusitis, often linked to nasal polyps, occurs in 7–19% of Europeans. The risk of developing the condition tends to increase with age.
Where Do They Develop?
They mainly appear at the entrances to the paranasal sinuses and within the sinuses themselves. The key sinuses include:
- Frontal sinuses
- Maxillary sinuses
- Sphenoid sinuses
- Ethmoid cells (located between the eye sockets)
These polyps can vary in size and typically develop at the openings of the sinuses, which are positioned high in the nasal cavity. This means they are not usually visible externally, although in rare cases, extremely large polyps may extend downward and become visible through the nostrils.
Polyps generally affect both sides of the nose and tend to appear in multiple clusters.
Causes
They result from chronic inflammation of the nasal and sinus mucosa, a condition known as chronic rhinosinusitis. Around 25% of patients with chronic sinus inflammation also develop nasal polyps, though the exact reason remains unclear. Due to the overlap of symptoms with other conditions, nasal polyps are often misdiagnosed or overlooked.
Nasal Polyps & Aspirin (ASA) Intolerance: A Connection?
Some patients with ASA intolerance experience adverse reactions to certain medications, including aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs).
Aspirin intolerance can be linked to nasal polyps and asthma, a condition known as:
- ASA Intolerance Syndrome
- Samter’s Disease
- Widal’s Disease
- Aspirin-Exacerbated Respiratory Disease (AERD)
This condition is characterized by symptoms such as:
- Runny nose after taking specific medications
- Recurring sinus infections
- Asthma attacks
- Skin rashes (urticaria)
- Swelling of mucous membranes (angioedema)
- Intestinal cramps and diarrhea
Symptoms
Nasal polyps often arise from chronic rhinosinusitis (CRS). If an acute sinus infection does not resolve within six weeks, it may become chronic.
Common symptoms persisting for more than three months include:
- Nasal congestion
- Difficulty breathing
- Loss of smell
- Nasal discharge
- Facial pain or pressure
- Headaches (often worsening when bending forward)
These symptoms are similar to those of acute sinusitis, making it difficult to distinguish between the conditions.
Symptoms in Children
In children, may cause:
- Chronic nasal congestion
- Mouth breathing due to blocked nasal passages
- Frequent colds
- Snoring
- Hearing impairment or delayed speech development
It is important to differentiate between nasal polyps and enlarged adenoids (nasopharyngeal tonsils), commonly referred to as “polyps” in children. While adenoids are normal tissue that can enlarge, nasal polyps are abnormal growths that do not belong in the nasal passages.
Can Nasal Polyps Lead to Other Health Issues?
Chronic nasal polyps may increase the risk of other conditions, including:
- High blood pressure (hypertension)
- Diabetes mellitus
- Lipid metabolism disorders (hyperlipidemia)
- Coronary artery disease
- Cerebrovascular diseases
- Chronic kidney disease
- Allergic rhinitis
- Asthma and COPD
- Chronic liver diseases
- Depression
Can Nasal Polyps Become Cancerous?
While they have the potential to become cancerous, this is extremely rare.
Can Nasal Polyps Disappear on Their Own?
Spontaneous resolution of nasal polyps is theoretically possible but occurs very rarely. Most cases require treatment.
Diagnosis
To diagnose , doctors typically:
- Take a detailed medical history
- Conduct a physical examination (checking for facial pain and tenderness)
- Use imaging techniques such as:
- Nasal endoscopy
- X-rays
- CT scans of the sinuses
Treatment Options
There are various treatment methods available, though symptoms may not always be fully eliminated.
1. Corticosteroid Therapy
- Nasal sprays with corticosteroids are commonly prescribed but have limited effectiveness, as the medication may not reach the deeper polyps.
- Oral corticosteroids are an option but are associated with potential side effects.
2. Other Medications
- Antibiotics are generally not recommended.
- Antifungal treatments have not been proven effective.
3. Home Remedies
- Nasal rinses may provide some relief, but alternative remedies such as Schuessler salts or homeopathic globules are not effective.
4. Surgical Removal
If medical treatments fail and they severely impact breathing and daily life, surgery may be necessary. Endoscopic sinus surgery can remove polyps, often providing temporary relief. However, They frequently return, sometimes shortly after surgery. The reason for recurrence remains unclear.
5. Biologic Therapy (New Treatments)
Recent research has identified biologic drugs that target the inflammatory processes involved , particularly type 2 inflammation. These biologics include:
- Omalizumab
- Dupilumab
- Mepolizumab
- Benralizumab
These therapies have shown promising results but require regular monitoring.
Who Can Receive Biologic Therapy?
According to EUFOREA guidelines, biologic therapy is considered if a patient has:
- Severe, persistent CRSwNP affecting both nasal passages
- No improvement with corticosteroids or surgery
- At least 3 or 4 additional criteria, such as asthma, reduced sense of smell, or a need for systemic corticosteroids
Nasal Polyps & COVID-19
Patients with nasal polyps or chronic sinusitis may take longer to recover from COVID-19 and may experience worsening symptoms. However, having nasal polyps is not a contraindication for COVID-19 vaccination. If undergoing biologic therapy, it is advised to leave a gap of at least one week between the biologic injection and vaccination.
Important Disclaimer
This article provides general information only and is not a substitute for medical advice. Always consult a healthcare professional for diagnosis and treatment.