Nasal polyps are swellings of the normal nasal lining that occur inside the nasal passages and sinuses (air-filled spaces behind the nose, eyes and cheeks).
They are typically pearly in colour and can vary in size. Each polyp is teardrop-shaped, and can look like a grape when fully grown.
You may not always know if you have nasal polyps because they can be difficult to see and don't always cause any symptoms.
What problems can they cause?
Nasal polyps usually only cause problems if they are large or grow in clusters.
Symptoms can include:
• a blocked nose, which can make it difficult to breathe through your nose
• a runny nose
• mucus that drips from the back of your nose down your throat (post-nasal drip)
• a reduced sense of smell or taste
• a feeling of fullness or pressure in the face
• snoring
• obstructive sleep apnoea (OSA) – your airways become temporarily blocked while you're asleep, which can disturb your sleep
If polyps block your sinuses, they can cause a build-up of fluid that may become infected (sinusitis). If this happens, you may have facial pain, toothache and a high temperature (fever).
When to see your GP
The symptoms of nasal polyps can be very similar to those of more common conditions, such as a cold. However, colds tend to clear up within a few days, whereas nasal polyps usually won't get better unless they're treated.
You should see your GP if you have nasal symptoms that last a month or more.
What causes nasal polyps?
Nasal polyps are thought to develop as a result of inflammation of the lining of the nasal passages and sinuses. The lining becomes increasingly swollen and then hangs down.
It's unclear exactly what triggers this inflammation, although certain things can increase your risk of developing nasal polyps, including:
• asthma – 20-40% of people with nasal polyps also have asthma
• aspirin intolerance – allergy-like symptoms, such as a watery nose, occur if you take aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
Nasal polyps usually affect adults and are more common in men than women. They're rare in children.
Diagnosing nasal polyps
Your GP will ask you about your symptoms and examine the inside of your nose.
Further tests carried out at the ear, nose and throat (ENT) department of your local hospital will often be needed to confirm polyps and to determine how large they are and how many you have.
This will usually involve an endoscopy (where a small tube with a camera at one end is inserted up your nostril) or a computerised tomography (CT) scan.
Treating nasal polyps
Nasal polyps can be difficult to get rid of permanently, but steroid medication can often help shrink them, and surgery to remove them can be carried out if medication doesn't help.
The main treatments are:
• corticosteroid nose drops or nasal sprays to shrink the polyps over a number of weeks or months
• corticosteroid tablets to shrink larger or more troublesome polyps quickly, although they're not usually used for more than 10 days because of the risk of side effects
• surgery to remove large or persistent polyps using tiny surgical instruments inserted up your nostrils
As polyps can grow back after treatment, including after surgery, you will usually be advised to continue using corticosteroid nasal sprays to help stop them returning quickly.
SINUSITIS
Sinusitis is a common condition in which the lining of the sinuses becomes inflamed. It's usually caused by a viral infection and often improves within two or three weeks.
The sinuses are small, air-filled cavities behind your cheekbones and forehead.
The mucus produced by your sinuses usually drains into your nose through small channels. In sinusitis, these channels become blocked because the sinus linings are inflamed (swollen).
Signs and symptoms
Sinusitis usually occurs after an upper respiratory tract infection, such as a cold. If you have a persistent cold and develop the symptoms below, you may have sinusitis.
Symptoms of sinusitis include:
• a green or yellow discharge from your nose
• a blocked nose
• pain and tenderness around your cheeks, eyes or forehead
• a sinus headache
• a high temperature (fever) of 38C (100.4F) or more
• toothache
• a reduced sense of smell
• bad breath (halitosis)
Children with sinusitis may be irritable, breathe through their mouth, and have difficulty feeding. Their speech may also sound nasal (as though they have a stuffy cold).
The symptoms of sinusitis often clear up within a few weeks (acute sinusitis), although occasionally they can last three months or more (chronic sinusitis).
When to see your GP
If your symptoms are mild and getting better, you don't usually need to see your GP and can look after yourself at home.
See your GP if:
• your symptoms are severe or getting worse
• your symptoms haven't started to improve after around 7-10 days
• you experience episodes of sinusitis frequently
Your GP will usually be able to diagnose sinusitis from your symptoms and by examining the inside of your nose.
If you have severe or recurrent sinusitis, they may refer you to an ear, nose and throat (ENT) specialist for further assessment.
How sinusitis is treated
Most people with sinusitis will feel better within two or three weeks and can look after themselves at home.
You can help relieve your symptoms by:
• taking over-the-counter painkillers such as paracetamol or ibuprofen
• using nasal decongestants – these shouldn't be used for more than a week, as this might make things worse
• holding warm packs to your face
• regularly cleaning the inside of your nose with a saline solution – you can make this at home yourself or use sachets of ingredients bought from a pharmacy
If your symptoms aren't improving or are getting worse, your GP may prescribe antibiotics or corticosteroid spray or drops to see if they help.
If your symptoms don't get better after trying these treatments, you may be referred to an ENT specialist for surgery to improve the drainage of your sinuses.
What causes sinusitis?
Sinusitis is usually the result of a cold or flu virus spreading to the sinuses from the upper airways. Only a few cases are caused by bacteria infecting the sinuses.
An infected tooth or fungal infection can also occasionally cause the sinuses to become inflamed.
It's not clear exactly what causes sinusitis to become chronic (long-lasting), but it has been associated with:
• allergies and related conditions, including allergic rhinitis, asthma and hay fever
• nasal polyps (growths inside the nose)
• smoking
• a weakened immune system
Making sure underlying conditions such as allergies and asthma are well controlled may improve the symptoms of chronic sinusitis.
