Nasal polyps are benign inflammatory growths that usually arise from the sinuses, most commonly the ethmoid sinuses. They are typically present on both sides of the nose. Polyps affecting only one side require further evaluation to rule out other conditions.

Nasal polyps most often develop in adulthood, usually in the 30s or 40s, and are associated with long-standing inflammation of the nasal and sinus lining.

The exact cause of chronic rhinosinusitis with nasal polyps (CRSwNP) is not fully understood. In many patients, nasal polyp tissue shows high levels of eosinophils, a type of inflammatory cell often associated with allergic-type immune responses. Certain bacteria, including Staphylococcus aureus, may also contribute to ongoing inflammation.

Symptoms typically last longer than 12 weeks and may include:

• Persistent nasal congestion or blockage

• Thick nasal drainage

• Facial pressure or sinus discomfort

• Decreased or lost sense of smell

• Reduced sense of taste

Among these, nasal congestion and loss of smell are often the most bothersome symptoms.

Diagnosis is based on:

• A detailed medical history

• Physical examination of the nose

• Nasal endoscopy to directly visualize polyps

• Sinus CT scan to assess the extent of sinus involvement

Imaging helps distinguish chronic sinus disease with polyps from chronic sinusitis without polyps and guides treatment planning.

Nasal polyps frequently occur alongside other medical conditions that can affect disease severity:

Asthma
Asthma is present in approximately 25–50% of patients with nasal polyps.

Aspirin-Exacerbated Respiratory Disease (AERD)
Some patients with asthma and nasal polyps experience worsening nasal or breathing symptoms after taking aspirin or other NSAIDs. This condition tends to be associated with more severe sinus disease.

Allergic Fungal Rhinosinusitis (AFRS)
A subset of patients develop an allergic reaction to inhaled fungi, leading to thick nasal discharge and characteristic imaging findings. Surgery is often required in these cases.

Cystic Fibrosis
While nasal polyps usually occur in adults, their presence in children should prompt evaluation for cystic fibrosis.

Treatment focuses on:

• Reducing nasal and sinus inflammation

• Shrinking or eliminating polyps

• Improving nasal airflow and sense of smell

• Preventing recurrence

• Reducing the need for repeated oral steroids or surgery

Topical Therapy

• Daily nasal saline rinses

• Nasal steroid sprays for long-term inflammation control

• Large-volume steroid rinses, which are often more effective than sprays

Short-Term Oral Steroids
Short courses of oral corticosteroids can temporarily shrink polyps and improve smell but are used cautiously due to potential side effects.

Advanced Steroid Delivery

• Exhalation-delivery steroid devices

• Steroid-eluting sinus stents placed by ENT surgeons

Biologic medications target specific inflammatory pathways and are FDA-approved for patients with moderate to severe CRSwNP. These injections are given every 2–4 weeks and can:

• Reduce polyp size

• Improve sense of smell

• Decrease need for surgery

• Reduce reliance on oral steroids

Approved biologics include dupilumab, mepolizumab, omalizumab, and tezepelumab.

Endoscopic sinus surgery may be recommended if symptoms remain severe despite optimal medical therapy. Surgery improves sinus drainage and medication delivery but does not cure the underlying inflammation. Ongoing medical treatment is usually required after surgery to prevent recurrence.