What are nasal polyps? (Warning – Graphic Medical Images And Video)

What are nasal polyps?

Nasal polyps (Figures 1) are growths or swellings from the lining (mucosa) of your nose and sinuses. Majority of polyps are due to chronic  sinusitis (long standing inflammation of the sinuses). However, sometimes, nasal polyps can be due to a tumour,  which most of the time is benign (non-cancerous) and rarely malignant (cancerous).

Figure 1 – Nasal polyps in the nose and sinus cavity

What are the symptoms of nasal polyps?

The symptoms of inflammatory nasal polyps are similar to those of chronic sinusitis. Patients may experience a blocked nose, runny nose (which may be clear or coloured), facial pressure or pain, reduced or loss of sense of smell and postnasal drip. Often, patients with reduced or loss of sense of smell will complain of loss of taste.

How are nasal polyps diagnosed?

An ENT Specialist will perform a nasoendoscopy (a scope through the nose done under local anaesthesia in the clinic) in patients with symptoms suggestive of nasal polyps. Nasal polyps can be seen during a nasoendoscopy (Figures 2a-d). If the polyps has a “peeled grapes” appearance and are present in both sides of the nasal cavity, it is likely an inflammatory polyp. If the polyp has suspicious features (e.g. fleshy, bleeds easily or is present only on one side of the nasal cavity) additional tests such as a biopsy (extraction of a small sample of polyp tissue for analysis under the microscope) and a CT scan (special series of X-rays) may be required.

Figure 2a – Right nasal polyp

Figure 2b – Left nasal polyp

Figure 2c – Typical “peeled grape” appearance of a large inflammatory right nasal polyp completely blocking the right nasal cavity

Figure 2d- A large left nasal polyp almost coming out of the nose

What causes nasal polyps?

We do not know exactly why some people have polyps but certain risk factors such as chronic or recurrent sinus infections, allergies, chronic inflammation due to asthma and genetic factors may play a role in the formation of inflammatory polyps.

How are nasal polyps treated?

The symptoms of inflammatory nasal polyps can be reduced with medications (nasal steroid sprays, nasal wash, oral steroids and when acutely infected, oral antibiotics). However, in most patients, medications alone may not be adequate and sinus surgery (aka Functional Endoscopic Sinus Surgery or FESS) may be required. A recent study has shown that patients with chronic sinusitis with nasal polyps are more likely to fail medical treatments and require sinus surgery compared to patients with chronic sinusitis without nasal polyps.

The purpose of sinus surgery is to remove the polyps (to reduce the “inflammatory load”), unblock and drain the sinuses and allow application of medications (e.g. steroid solutions) into the sinuses to keep the polyps under control. If you also have Asthma or Bronchitis, it is important to treat your nasal polyps to prevent or minimize exacerbations of these lung conditions. Patients with chronic rhinosinusitis with nasal polyps have a higher chance of disease recurrence compared to those without nasal polyps. However, with regular follow up  early recurrence can be picked up and controlled with appropriate intervention and medications.

What are the potential complications of untreated nasal polyps?

Most of the time, nasal polyps are benign and do not lead to complications if left untreated. However, the symptoms and recurrent sinus infection from nasal polyps can significantly impair the quality of life of the patient.

Occasionally, untreated severe nasal polyps can lead to the following complications:

1. Recurrent sinus infections
2. Mucocoele formation – This refers to a bag of trapped mucous in a sinus that can potentially expand and erode into nearby critical organs such as the eyes and the brain.
3. Mucopyocoele – This refers to an infected mucocoele (see video below)
4. Severe sinus infection spreading to the eyes or brain
5. Obstructive sleep apnoea (this is a condition in which one stops breathing momentarily during sleep)
6. Worsening of inflammatory lower airway diseases such as Asthma and Bronchitis

Best wishes,

Dr Gan Eng Cern
ENT Specialist Singapore