Nasal polyps are the most common types of mass lesion found in the nose. They are benign outgrowths of the nasal mucosa, appearing like a grape hanging from a stalk. The surface is smooth, gelatinous and pale. Most polyps arise from the ethmoid sinuses (found on both sides of the nasal bridge) with some coming from the maxillary (under cheekbones) or sphenoid (directly behind nose) sinuses.

Who gets nasal polyps?

Men outnumber women 2:1 with the onset typically after age 40. They are extremely rare under 10 years old and in this group one should consider the diagnosis of cystic fibrosis.

What causes polyps?

The short answer is, we don’t know. Various theories have been discussed, including allergy, infection, nerve pathway imbalance, enzyme abnormality, drug sensitivity and mechanical obstruction. Fortunately, most people with hay fever (allergic rhinitis) do not have polyps (< 2%).

Association with other diseases:

Asthma has long been known to be associated with nasal polyps. Studies show that anywhere from 15%-30% of patients with polyps will also have asthma. An even greater association with asthma is found in those individuals who also are allergic to aspirin (hives or asthma following aspirin or ibuprofen-like drug). These patients with asthma and aspirin sensitivity have a 50% chance of having nasal polyps.

Symptoms of nasal polyps:

Nearly everyone with polyps will complain of nasal congestion. Diminished or loss of smell is also very common occurring in 75% of patients. Less frequent symptoms include runny nose, sneezing, post-nasal drainage, facial pain and itchy eyes. The major complication seen in patients with polyps is the development of sinus infections. The polyp "closes the door" on the sinuses allowing bacteria to accumulate in the sinus.

Treatment:

The goal of treating polyps is to reduce their size so they will no longer obstruct the drainage pathways of the sinuses. This can be done medically or surgically, but due to the high recurrence rate after surgery only those patients that fail medical treatment should be considered for surgery. Steroids are the mainstay of medical treatment. Steroids taken by mouth are the most potent treatment, however their long-term use is limited by side effects. A 1-2 week course of oral steroids is safe and can be used a few times a year if needed. The preferred way of taking steroids is by inhalation into the nose. The side effects of steroids taken by mouth do not occur when a nose spray is used.