What are nasal polyps?
Nasal polyps are soft, benign (non-cancerous) swellings of the lining of the nose and paranasal sinuses. They are shaped like small grapes and are usually painless. When there are many polyps on both sides, the condition is called nasal polyposis.
In most cases polyps develop from chronic inflammation of the paranasal sinuses, the air-filled spaces in the bones of the face. Doctors call this chronic rhinosinusitis with nasal polyps. That is why treating polyps goes hand in hand with treating sinusitis.
What are the symptoms of nasal polyps?
Polyps grow slowly, so symptoms get worse gradually. Small polyps may cause no symptoms. Larger ones block the nose and stop mucus draining from the sinuses.
A polyp on one side only, or one that bleeds, should always be checked carefully, as it may have other causes. Anyone who has had these symptoms for weeks should see a specialist. The most common symptoms are:
- A blocked nose, often on both sides
- A reduced or lost sense of smell, sometimes with less taste
- Mucus running from the nose or down the back of the throat
- Pressure in the face or forehead
- Snoring and mouth breathing
Nasal polyps, asthma and aspirin: what is the link?
Nasal polyps are more common in people with asthma. The nose and the airways of the lungs are part of the same respiratory system and often share the same type of inflammation.
Some people cannot tolerate aspirin and other anti-inflammatory drugs (NSAIDs), such as ibuprofen. After taking them, the nose becomes more blocked and breathing can get worse. Polyps, asthma and aspirin intolerance together are known as Samter's triad.
That is why it is useful to tell the specialist if you have asthma or have reacted to these medicines. However, do not stop or change any treatment without medical advice.
Can nasal polyps be treated without surgery?
Yes, at least initially: medical treatment comes before surgery. The mainstay is a steroid nasal spray, used regularly and long term. It reduces inflammation and can shrink the polyps. Saline nasal rinses are often added.
In some cases the doctor prescribes short courses of oral steroids. They give relief for a limited time and are not used long term because of possible side effects.
For severe forms that keep coming back despite treatment and surgery, newer biologic medicines are now available. They block certain steps of the inflammation. They are prescribed by specialists, according to specific criteria.
Nasal polyp surgery in Bari: how is it done?
If medical treatment is not enough, surgery is considered. A consultation with nasal endoscopy and a CT scan of the sinuses are needed first. Endoscopy shows the inside of the nose with a thin camera. The CT scan shows how far the polyps extend and guides planning.
The operation is called endoscopic polypectomy. The surgeon works through the nostrils with an endoscope, with no cuts on the face. The polyps are removed with a microdebrider, a thin instrument that cuts and suctions tissue. Alternatively, a laser can be used.
It is often combined with FESS, which opens the sinuses where the polyps arise. This helps reduce the risk of them coming back and allows sprays to reach where they are needed. General anaesthesia is usually used and patients go home the same day or after one night. The removed tissue is normally examined under the microscope (histology).
Dr Nicola De Candia trained in endoscopic surgery of the nose and sinuses on courses in Italy and abroad. He also teaches “Endoscopic sinonasal techniques” on the Otolaryngology specialty training programme at the University of Bari.
What happens after surgery?
For the first few days the nose stays blocked, as with a heavy cold. Slight bleeding, crusts and mucus are normal. Discomfort is usually mild to moderate and is controlled with common painkillers.
Saline nasal rinses help the lining heal. A few endoscopic check-ups in the clinic follow, to clean the nasal passages and monitor healing. Dr De Candia gives personalised advice after the consultation. In general, it is advisable to:
- Avoid blowing your nose hard
- Sneeze with your mouth open
- Avoid strain, sport, hot baths and saunas, usually for one to two weeks
- Use the prescribed medicines regularly
Can nasal polyps come back after surgery?
Yes, polyps can grow back, even months or years later. Nasal polyposis is a chronic condition: surgery removes the polyps but does not fully switch off the inflammation that causes them. The risk varies from person to person and is generally higher in people who also have asthma or aspirin sensitivity.
That is why, after surgery, the steroid spray and nasal rinses are usually continued long term. Regular check-ups with the specialist allow any regrowth to be spotted early and treatment to be adjusted. If polyps come back, a new operation is not always needed.
What are the risks of surgery?
Like any operation, this one carries some risks. The most common are generally mild and temporary: nosebleeds, crusting, infection and a blocked nose for a while. Adhesions, small scars joining the walls of the nose, can also form.
More rarely, the eye or the base of the skull, which lie close to the sinuses, can be affected. This applies especially when the sinuses are also operated on. In addition, polyps can come back. Risks, benefits and alternatives are explained at the consultation before surgery.
The information on this page is for general education and does not replace a specialist consultation: indications, recovery times and risks are assessed case by case.