Condition: Nasal Polyps

A nasal polyp is a swelling of the lining of the nose, usually due to inflammation. They often originate from the ethmoid sinuses, which drain into the sidewall of the nasal cavity.

Conditions associated with polyps include:

• Late onset asthma in adults (rather than childhood asthma). 20-40% of patients presenting with polyps also have coexisting asthma.
• Aspirin hypersensitivity (not caused by an allergic reaction but an alteration on prostaglandin production) – in 8% of polyp patients, aspirin sensitivity occurs alongside asthma and polyps. These polyps tend to recur more than in other conditions.
• Cystic fibrosis
• Nasal allergy is present in some cases, but over two thirds of patients with polyps show no evidence of systemic allergic disease.

Nasal polyps are more common in adults and are rare in children between the ages of 2-10 years. If polyps appear in children, they should be examined to exclude cystic fibrosis.

The chance of developing nasal polyps is between 1 and 20 for every 1,000 people and the chance declines after the age of 60. They are more common in men but, in those with late onset asthma, it can also occur in women.

The exact reason why some people get nasal polyps is not known. However, 90% of nasal polyps include inflammatory cells (known as eosinophilia) that are associated with allergies, so polyps can be associated with allergy and infection.

Polyps look like small grapes and can appear in isolation or in clusters in the nose. They can cause:

• Blocked nose
• Runny nose and/or sneezing (in about half of patients)
• A poor sense of smell and taste which may not always return after treating the polyps
• Catarrh

An endoscopy (using a small tube with a camera on the end) is used to see up the nose and will exclude any infection or any unusual feature.

There are no specific treatments for nasal polyps.

However, they are known to shrink with the use of nasal sprays or drops containing nasal steroids in up to 80% of people. Many can take up to six weeks before they fully take effect. Stronger steroid drops can be used carefully in short courses. Steroid tablets can also work to relieve symptoms, but the effects are temporary and they should be used in moderation because of potential side effects.

Surgery can be performed to remove nasal polyps that block the nose. However, polyps come back after an average of about four years in 3 out of 4 patients.

If they do continue to return, cleaning out and opening up the sinuses is thought to increase the amount of time before they return. Local medical treatment using anti-inflammatory sprays or drops may still be needed.