Nasal polyps

What nasal polyps are

Inflammatory nasal polyps are soft growths of swollen lining inside the nose and sinuses. They can crowd the nasal passages, obstruct drainage and reduce the sense of smell. Persistent mouth breathing, drainage and a nose that never feels clear may be part of the experience.

Polyps often occur with chronic rhinosinusitis. Some patients also have asthma or sensitivity to aspirin and related medications. Those details affect the overall treatment discussion.

A new one-sided growth, bleeding or progressive one-sided obstruction needs examination. It should not simply be assumed to be a routine inflammatory polyp.

Understanding your pattern

Dr. Fewins asks about nasal breathing, drainage, smell, sleep and previous treatment. Nasal endoscopy lets him examine the polyps and the surrounding lining. CT helps show the extent of sinus involvement when it is needed for diagnosis or surgical planning. Selected findings may require tissue assessment.

Bring a list of sprays, rinses, oral steroids and other treatments you have used, including what helped and how long the benefit lasted. If you have had surgery, the operative report and prior images help explain the current anatomy.

Tell him about asthma, reactions to aspirin or anti-inflammatory pain medicines, and how much the symptoms affect daily life. A plan for a first episode may differ from care for polyps that have returned despite surgery and ongoing medication.

Medication and everyday care

Topical nasal corticosteroids and saline care are common parts of treatment. The delivery method matters: medication needs to reach the affected lining. Large polyps or narrow pathways can limit where a spray reaches.

Use distilled, sterile, or previously boiled and cooled water for nasal irrigation. Follow your prescribed preparation and schedule. If a rinse is uncomfortable or difficult to use, tell the team rather than repeatedly stopping and restarting without a plan.

Medication is reassessed according to your symptoms and examination. The aim is a workable long-term routine with a clear reason for each part of treatment.

When surgery helps

Endoscopic sinus surgery can remove obstructing polyps and open affected sinus pathways. It also improves access for topical medication. Balloon dilation alone does not remove polyp tissue.

The decision depends on the disease seen on examination and CT, the response to treatment, and how much symptoms interfere with your life. Surgery is not necessary simply because a polyp is present. Dr. Fewins explains what an operation could improve and what treatment would continue afterward.

For significant polyp disease, he uses image guidance when it helps him carry out more complete, thorough surgery. Postoperative visits assess healing, remove crusting when needed and adjust treatment to the lining's response.

Biologics, including Dupixent

Biologics target parts of the inflammatory response involved in polyp disease. Dr. Fewins prescribes biologics for indicated cases, mainly dupilumab (Dupixent).

This discussion is particularly relevant when polyp disease remains difficult to control. He considers the treatments already tried, prior surgery, associated asthma, current findings and your goals. Surgery and medication are considered together as parts of disease management.

A biologic involves ongoing treatment and follow-up. Benefits, potential side effects, eligibility, insurance requirements and personal cost need to be discussed before starting. It is not an automatic prescription for everyone with polyps.

Smell and recurrence

Smell may improve as airflow and inflammation improve, but the amount and timing vary. Long-standing inflammation may limit recovery. Tell the team whether smell loss is recent, longstanding, intermittent or changing during treatment.

Polyps can return after successful removal because surgery does not remove the underlying inflammatory tendency. Continued topical treatment and follow-up help maintain the benefit. Returning symptoms are a reason to reassess the plan; they do not automatically mean another operation.

When further surgery is being considered, revision planning takes the previous treatment, current anatomy and medical options into account.

Common questions