Patient information · ENT
Nasal polyps
treatable, recurrent, and worth treating early for the sense of smell
Nasal polyps are soft, non-cancerous swellings of the lining inside the nose and sinuses. They cause blockage, a runny nose and, most distressingly for many people, loss of smell. They respond well to treatment but tend to return, so management is long-term rather than one-off.
Seek urgent assessment if you have
- a one-sided polyp or blockage, particularly with bleeding — this needs excluding as something else
- swelling or redness around the eye, double vision or reduced vision
- severe headache with a stiff neck, confusion or drowsiness
- clear watery fluid dripping from one nostril, especially after injury or surgery
- polyps in a child, which are uncommon and warrant investigation for cystic fibrosis
Polyps are normally bilateral. A single-sided mass, particularly with bleeding or facial numbness, must be examined and imaged rather than assumed to be a polyp. Infection spreading to the eye socket is an emergency. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Symptoms
- Persistent blocked nose, often both sides, not relieved by decongestants
- Reduced or absent sense of smell, and with it a loss of taste — frequently the symptom people mind most
- runny nose, or mucus dripping down the back of the throat
- facial pressure or fullness, and reduced sleep quality with snoring
- recurrent sinus infections
- symptoms present for more than twelve weeks — which distinguishes this from an ordinary cold
The asthma and aspirin link
Nasal polyps, asthma and sensitivity to aspirin and other anti-inflammatory painkillers occur together often enough to have a name — sometimes called Samter's triad or N-ERD. If you have polyps and asthma, be cautious with ibuprofen, aspirin and naproxen: in this group they can trigger a severe asthma attack. Tell any clinician prescribing for you. Treating the nose properly also improves asthma control, and vice versa.
Treatment
- Steroid nasal spray — the mainstay, used daily and indefinitely rather than in short bursts. It shrinks polyps and prevents regrowth.
- Technique determines whether it works. Look down, aim the nozzle outwards towards the ear on that side, use the opposite hand, and breathe in gently without sniffing. Aiming up the middle causes nosebleeds and delivers nothing to the polyps.
- Steroid drops are more effective than spray for larger polyps, and are usually given in the head-down-and-forward position so they reach the roof of the nose.
- Saline rinsing before the steroid, once or twice daily, using cooled boiled or distilled water.
- A short course of steroid tablets can shrink polyps rapidly and restore smell, but the effect is temporary and courses cannot be repeated often.
- Biologic injections are now available for severe recurrent polyps, particularly with asthma, and have transformed outcomes for people who previously faced repeated surgery.
Surgery
Endoscopic sinus surgery removes polyps and opens the sinuses, and is considered where medical treatment has not controlled symptoms. It improves blockage substantially and often restores smell — but it is not a cure. Polyps recur in a significant proportion within a few years, and the single biggest determinant of how long the benefit lasts is whether you continue the steroid spray and rinsing afterwards. Many people stop once they can breathe, and the polyps return.
Smell
Loss of smell affects appetite, enjoyment of food, and safety — you may not detect gas, smoke or spoiled food. Fit smoke alarms and check food dates rather than relying on smell. Smell training — deliberately sniffing four distinct scents twice daily for several months — has reasonable evidence and is worth doing alongside treatment.
Why come to us. Polyps are frequently treated with a spray that is being used incorrectly, then declared unresponsive. Our ENT team can examine the nose with nasendoscopy in clinic, confirm the diagnosis, check your technique properly, prescribe drops and biologic treatment where indicated, and arrange CT rapidly through our CQC-registered imaging partners. We also test for the allergies that drive the inflammation, on site. No referral needed, seven days a week.
ENT nasendoscopy without a referral
Allergy testing on site, CT through our imaging partners. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.