Nasal Polyps

Nasal polyps are benign, grape-like and translucent growths that develop on the mucosal lining of the nose and sinuses on a background of long-standing inflammation. They are usually bilateral, often arise from the middle meatus where the sinuses drain, and behave less like a tumour than like a persistent form of swelling that chronic inflammation creates in the mucosa. Because the growth is a symptom of an underlying inflammatory process, removing the polyp alone is rarely enough — the process that fuels it must also be managed.

Summary: Nasal polyps are benign mucosal growths seen most often on a background of chronic rhinosinusitis, asthma and aspirin sensitivity (Samter’s triad), with an allergic component in some patients. The hallmark symptoms are progressive bilateral obstruction and loss of smell. Diagnosis is made with nasal endoscopy, and CT when surgery is considered. First-line treatment is medical (corticosteroid sprays and short courses); endoscopic sinus surgery (FESS) is used for resistant cases. Because polyps can recur, maintenance treatment and follow-up are essential.

Table of Contents

• What Are Nasal Polyps?
• Who Is at Risk of Nasal Polyps?
• What Are the Symptoms of Nasal Polyps?
• How Are Nasal Polyps Diagnosed?
• How Are Nasal Polyps Treated?
• Relationship With Sinusitis and Loss of Smell
• How It Differs From Structural Nose Surgery
• International Patients
• Frequently Asked Questions
• References

What Are Nasal Polyps?

A nasal polyp is a benign, pendulous and gelatinous tissue growth that forms on the lining of the nose and sinuses. Structurally it consists of oedematous stroma rich in eosinophils, which is why it looks like a peeled grape. Polyps may occur singly or in clusters and are usually bilateral. A one-sided polyp always warrants special attention, because it can be confused with other diagnoses and requires histopathological examination.

Who Is at Risk of Nasal Polyps?

Nasal polyps arise most often in people with long-standing mucosal inflammation, so they rarely appear in isolation. The clearest risk background is chronic rhinosinusitis — the combination is classified as CRSwNP (chronic rhinosinusitis with nasal polyps). Several conditions raise the likelihood.

• Chronic rhinosinusitis: the most common background; polyps are considered a subgroup of this disease.
• Asthma: adult-onset asthma in particular is frequently linked with nasal polyps.
• Aspirin / NSAID sensitivity: the coexistence of asthma, nasal polyps and aspirin intolerance is a well-established clinical entity — Samter’s triad, also called aspirin-exacerbated respiratory disease.
• Allergy: an allergic background can contribute, but it is not as dominant a cause as commonly assumed; in most cases eosinophilic inflammation is the driver, and many polyp patients have a negative allergy test.
• Cystic fibrosis: especially in children, bilateral polyps should always prompt screening for cystic fibrosis.

What Are the Symptoms of Nasal Polyps?

Because polyps grow slowly, patients often cannot pinpoint when their complaints began. The hallmark is persistent, progressive bilateral nasal obstruction that does not respond to ordinary sprays, together with a reduced or absent sense of smell. Loss of smell (hyposmia or anosmia) is one of the most characteristic findings and the symptom that most directly affects quality of life. Common symptoms include:

• Progressive, bilateral nasal obstruction that persists despite sprays
• Loss of smell (anosmia) or perceiving odours very faintly, with food tasting flavourless
• Postnasal drip and constant throat clearing
• Fullness in the face and forehead, headache
• Sleeping with the mouth open, snoring and a nasal-sounding voice
• Occasionally a sensation of a hanging mass inside the nose

How Are Nasal Polyps Diagnosed?

Diagnosis is a stepwise process from a simple examination to advanced imaging. The history covers the duration of obstruction, loss of smell, asthma, aspirin reactions and previous sinus surgery. The most valuable single tool is nasal endoscopy, which shows the location, size and side of the polyp; CT is added when surgery is being considered. The main steps are:

1. History and anterior examination — duration of symptoms and associated conditions; large polyps may already be visible on anterior rhinoscopy.
2. Nasal endoscopy — a thin endoscope gives a clear view of the middle meatus and sinus openings; this is the key diagnostic tool.
3. Paranasal sinus CT — shows how much of the sinuses is filled and provides the anatomical map needed for surgical planning; a surgical decision is not made without it.
4. Additional tests — smell testing, allergy and eosinophil assessment when needed, and histopathology of any tissue removed at surgery, which is always examined to exclude other pathology.

How Are Nasal Polyps Treated?

Treating nasal polyps is not a single-step event but long-term management. The aim is to shrink the polyps, control symptoms and delay recurrence. Treatment almost always begins with medication; surgery is considered when the response is inadequate. The table below contrasts the two approaches.

Criterion	Medical treatment	Surgical treatment (FESS)
When used	First-line; mild-to-moderate polyps	When medication is insufficient; large or resistant polyp clusters
How it works	Corticosteroid nasal spray, short oral steroid course, saline rinses	Endoscopic clearance of polyps and blocked sinus openings through the nostrils, without any external incision
What to expect	Shrinkage of polyps, easing of obstruction and smell loss	Reopened airway and sinus drainage, so sprays reach the sinuses far better
Continuity	Regular long-term daily use is essential	Maintenance spray and rinses are required afterwards

First-line: medical treatment

Intranasal corticosteroid sprays (mometasone, fluticasone, budesonide and similar) are the mainstay of treatment. Regular, daily, long-term use is essential; a few days’ trial will not produce a result, and the effect takes weeks to appear. For large polyps or when smell needs to be recovered quickly, a short oral corticosteroid course may be added. Saline rinses improve mucus clearance and support the spray, while antihistamines are added only when an allergic component is present. Antibiotics have no routine role and are reserved for acute bacterial flare-ups.

Surgery: endoscopic sinus surgery (FESS)

For polyp clusters that do not respond adequately to medication and that seriously affect breathing or smell, the standard approach is functional endoscopic sinus surgery (FESS). Under endoscopic guidance, and without any external incision, the polyps and blocked sinus openings are cleared through the nostrils — a polypectomy that preserves healthy mucosa and removes only diseased tissue. Because the sinus drainage pathways are opened, spray treatments afterwards reach the sinuses much more effectively. When required, septoplasty or turbinate reduction may be performed in the same session.

Recurrence and maintenance

The most important point with nasal polyps is honest expectation: polyps can recur after surgery because the underlying inflammation remains. Neither surgery nor medication eliminates the disease — they keep it under control. For this reason a steroid spray and saline rinses are started early after surgery and continued for the long term, and any accompanying asthma, allergy or aspirin intolerance is treated in parallel. Regular endoscopic follow-up helps catch recurrence early, and daily spray use should become a routine habit rather than a short course.

Biologic therapy in severe cases

For recurrent, resistant polyps — particularly when asthma is also present and the disease returns despite surgery — targeted biologic (antibody) therapies may be considered. These treatments are planned through joint assessment by the relevant specialties and by physician decision; they are not suitable for every patient and require individual evaluation.

This content is for informational purposes only; diagnosis and treatment require an in-person physician examination. Surgical outcomes vary from person to person.

Relationship With Sinusitis and Loss of Smell

Nasal polyps rarely occur alone; they are most often part of a chronic sinusitis picture. By blocking the sinus openings, polyps impair drainage, which in turn makes sinusitis attacks more frequent and deepens the obstruction. Because the two conditions are intertwined, assessment is directed not only at the polyp but at the whole upper airway. Loss of smell is one of the clearest consequences of this process, as polyps and inflammation prevent air from reaching the smell region. With correct treatment the sense of smell gradually returns in most patients, though the gain can be more limited in those obstructed for a very long time.

How It Differs From Structural Nose Surgery

Nasal polyp surgery follows a different logic from aesthetic or structural nose operations. In polyp surgery the goal is to clear inflammatory tissue growth and restore sinus ventilation, working from inside the nose with an endoscope. By contrast, rhinoplasty reshapes the bone and cartilage framework of the nose — a structural procedure with entirely different aims. When a patient has both a structural problem (such as a deviated septum) and polyps, the two can be addressed in the same session, but their indications and objectives remain distinct.

International Patients

Patients travelling to Istanbul for a nasal polyp assessment usually begin with a remote consultation, sharing their history and any previous endoscopy or CT images for review. On arrival, an in-person examination and nasal endoscopy confirm the diagnosis and the appropriate treatment path — medical management, surgery, or a combination. Because polyp disease is chronic and maintenance-dependent, the plan also covers follow-up arrangements and a clear medication routine to continue after returning home. This paragraph describes the process only; every treatment decision follows an individual physician evaluation.

Frequently Asked Questions

What triggers nasal polyps? Nasal polyps do not have a single cause; the common thread is chronic mucosal inflammation. Chronic rhinosinusitis, asthma, aspirin sensitivity (Samter’s triad) and eosinophilic inflammation are the main backgrounds, while environmental irritants such as tobacco smoke and a genetic predisposition can contribute.

Can nasal polyps go away on their own? Nasal polyps rarely resolve without treatment, because the inflammation that produces them persists. Corticosteroid sprays can shrink smaller polyps, but larger ones usually need a structured medical course and sometimes surgery. Leaving them untreated tends to worsen obstruction and smell loss over time.

What is the first-line treatment for nasal polyps? The first-line treatment is medical: a regular intranasal corticosteroid spray, sometimes supported by a short oral steroid course and saline rinses. Surgery is considered only when medication does not adequately control large or resistant polyps, and maintenance spray treatment continues afterwards.

How long does a steroid spray take to work on polyps? Corticosteroid nasal sprays are not a quick fix; their effect appears with regular use over weeks, not days. A brief trial will not shrink polyps. After surgery, spray treatment is continued long term, as advised by the physician, to help prevent recurrence.

Are nasal polyps dangerous? Nasal polyps are benign and not cancer in themselves. Their main harm is a progressive decline in quality of life through obstruction, smell loss and recurrent sinusitis. However, a one-sided, bleeding or rapidly growing lesion should be evaluated promptly, as it may point to a different diagnosis.

References

• Mayo Clinic — Nasal polyps
• NHS — Nasal polyps
• American Academy of Allergy, Asthma & Immunology (AAAAI) — Aspirin-Exacerbated Respiratory Disease Defined