What Are Nasal Polyps, and How Do You Treat Them?
DOES YOUR NOSE SEEM TO always be stuffed up? Do you have loss of taste or smell? Do you get frequent sinus infections? If so, you may have nasal polyps.
Which raises the question: What exactly are nasal polyps? Are they the same as polyps in the colon and uterus? The short answer is no. According to the American College of Allergy, Asthma and Immunology, nasal polyps are growths that develop in the lining of the sinus or nose. They can get so large that they bulge out of your nostrils. But they are not cancerous and don’t become cancerous.
As mentioned above, nasal polyps can be associated with severe nasal blockage, loss of taste and smell, and recurrent or chronic sinus infections. Some people even complain of facial pain. Many adults who suffer from asthma and allergies have related nasal polyps, and therefore have all the symptoms seen in those conditions, such as wheezing, sneezing and runny nose.
We don’t know exactly what causes nasal polyps, but it appears they result from long-term inflammation of sinus tissue. If your parents had nasal polyps, you are at a higher risk of developing them. Nasal polyps in children are rare. Any child with a nasal polyp should be checked for cystic fibrosis, as they are commonly seen in patients with this condition. Usually nasal polyps are found in young and middle-aged adults, with a higher rate seen in males than females. Most of these patients also have chronic rhinosinusitis, which is an inflammation of the sinuses and nose that lasts for more than three months. As mentioned, many people have asthma and allergies in conjunction with nasal polyps. Another condition that may be seen in adults with nasal polyps is sensitivity to aspirin and/or non-steroidal anti-inflammatory drugs such as Advil, Aleve and many over-the-counter pain relievers. These medications can cause asthma and sinus symptoms to flare and polyps can worsen, so they should be avoided. If you need to take a pain or fever medication, use acetaminophen.
How do we diagnose nasal polyps? Sometimes they can be seen by looking up your nostril if they are large. Usually an endoscope, a thin tube with a camera on the end, is inserted into your nostril passageway to see if there are any polyps high up in the nose. In some cases, a CT scan of your sinuses is performed to locate nasal polyps, look for other abnormalities and assess the degree of inflammation. Since some people with nasal polyps have allergies and asthma as well, allergy testing may be performed to determine if allergens like dust mite, pollen or pets may be contributing to the problem.
Treatment of nasal polyps usually begins with an intranasal corticosteroid, such as Flonase or Nasonex. These need to be used daily to help shrink the polyp. There is also a prescription nasal steroid in a special breath-activated device (Xhance) that may work better than the routine nasal steroid sprays available without a prescription. In conjunction with the intranasal corticosteroids, saline irrigation can be beneficial. Oral corticosteroid tablets like prednisone may be given for a short period if the polyps worsen. Antibiotics may be prescribed if there is evidence of infection. In some cases, certain antibiotics can be tried for long periods to reduce sinus inflammation.
Unfortunately, nasal polyps may not always be controlled with standard medical management, and other approaches are needed. One option is surgery, in which the polyps are removed. Since surgery doesn’t cure the condition, it is important that intranasal corticosteroids be started after surgery to prevent recurrence. Another option is a biodegradable corticosteroid stent. It is placed in the sinus tissue in an office procedure and slowly releases corticosteroid over a period of three months to reduce the polyps.
Another course of treatment is the use of a biologic that helps control inflammation. One of these treatments, dupilumab (Dupixent), is approved by the Food and Drug Administration for this condition, and others will be approved soon. These treatments are given on a regular basis by shots, and have been shown to decrease polyp size and improve symptoms like loss of sense of smell and taste. They may also be effective in controlling asthma in patients with both conditions. Much like surgery, these biologics don’t cure nasal polyps, and they need to be used indefinitely. Allergy immunotherapy or allergy shots may be beneficial if allergies are contributing to the nasal polyps.
If you think you may have nasal polyps, a board-certified allergist and/or an otolaryngologist will be able to work with you to control this condition and dramatically improve your quality of life
