An occasional stuffy nose due to allergies or infection can be annoying or difficult to manage. But if you are experiencing chronic nasal congestion that is also impacting your sleep and ability to breathe, it may be a sign of something more serious—nasal polyps. However, it is easy to mistake the symptoms of nasal polyps for other conditions, including allergies, a deviated septum, or chronic sinusitis.
Madeleine Schaberg, MD, Director of Rhinology and Skull Base Surgery
In this Q&A, Madeleine Schaberg, MD, Director of Rhinology and Skull Base Surgery at New York Eye and Ear Infirmary of Mount Sinai, defines nasal polyps, the indications you might have them, and why it’s important to seek a diagnosis and treatment quickly.
“There is a lot of overlap between symptoms,” explains Dr. Schaberg, who is also Assistant Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai. “Furthermore, polyps tend to grow gradually, which means the symptoms can be somewhat insidious until you reach a tipping point. Many people live with nasal polyps for years before receiving a diagnosis.”
What are nasal polyps?
Nasal polyps are benign, inflammation-related growths that occur in the nose and sinuses. One of the most common causes is environmental allergies, but they are also associated with diseases such as aspirin exacerbated respiratory disease and eosinophilic granulomatosis with polyangiitis. In some cases, nasal polyps can also be the result of caustic environmental exposures, such as construction sites or toxins exposures. Although nasal polyps are often soft and painless, they can become swollen or irritated and result in sinus blockages that can have serious impacts on your quality of life.
How do I know if I have nasal polyps?
Two prominent symptoms are associated with nasal polyps: congestion and loss of smell. The degree of congestion is often serious enough that it becomes difficult to breathe through the nose. Human beings are obligate nasal breathers, which means we are much more comfortable breathing through the nose. Polyps create an obstruction, which typically leads to breathing through the mouth, which is very uncomfortable. It can also lead to several issues that can affect your overall health and well-being, such as sleep apnea, frequent sinus infections, and increased frequency of asthma attacks.
How are nasal polyps diagnosed?
If you think the symptoms that you are experiencing are associated with nasal polyps, see an ear, nose and throat (ENT) specialist for a consultation. This will typically involve an examination, a review of your medical history, and a nasal endoscopy. Endoscopy is the best in-office diagnostic tool we have to determine what is going on. It enables us to evaluate all the structures of the nasal cavity in a safe, easy manner without causing discomfort and then proceed based on what we find.
What are my treatment options for nasal polyps?
There are several treatment options depending on the severity of your polyps:
- For mild cases, a steroid spray is often effective in reducing polyp size and relieving symptoms.
- For more severe cases, oral steroids may be prescribed.
- If topical and oral steroid treatments are not effective, and the nasal polyps are extensive, surgical removal may be recommended as a therapeutic approach. This is typically done in an outpatient center through minimally invasive endoscopic surgery.
- There is also the option of treatment with a biologic medication, such as Dupixent® (dupilumab), which is administered by injection under the skin once every two weeks.
In many cases, patients will receive some combination of these treatments, and then continue treatment with a topical steroid or biologic medication following surgical removal. It is best to think of nasal polyps as a kind of long-term problem, like having high blood pressure. It will be different for every patient, but many require topical steroids, oral steroids, and surgery as an adjunct, along with a biologic medication.
How can I prevent nasal polyps from recurring?
For the most part, maintenance medications, such as topical steroids and biologics, provide the best protection against recurrence. However, nasal polyps are a chronic condition, one that requires regular follow-ups with an ENT specialist to check for signs of regrowth. Furthermore, patients who use topical steroids for maintenance should also be assessed annually by an ophthalmologist for changes in eye pressure related to their medication. As with any condition, early detection and treatment of nasal polyps is ideal. However, a later diagnosis or extreme severity in disease should not ultimately affect the outcomes that you can achieve. The medications, treatments, surgery—everything we offer for polyps—works well at many stages in the course of the disease. The important thing is to see your primary care provider or an ENT specialist if you think you have symptoms.