Chronic Rhinosinusitis With Nasal Polyps

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Nasal Polyps

Chronic rhinosinusitis with nasal polyps is a condition that can cause frustrating symptoms, from sinus pain and nose stuffiness to loss of smell. Nasal polyps are growths in the nose or sinuses. They are not cancerous, but they can make you miserable and interfere with your quality of life and make sleeping difficult. Treatment includes nasal or oral medications, biologic injections, and surgery. However, these polyps may grow back. Your doctor can work with you to try another treatment if necessary. You may see more than one type of doctor, such as an allergist and an ear, nose, and throat specialist (ENT) specialist (otolaryngologist). Sometimes, these two types of doctors will work together.

Symptoms

Anybody can get nasal polyps, but they are more common in those who have asthma, and in people 40-60 years old. The most common symptoms are:
  • Stuffy or runny nose
  • Loss or decreased sense of smell
  • Facial pressure or pain
  • Postnasal drip – mucus that runs down the back of your nose into your throat
  • Pain in your upper teeth
  • Snoring
  • Headache
If you have had any of these symptoms for longer than three months, see your allergist or ENT specialist. Nasal polyps usually are diagnosed by a procedure called a nasal endoscopy, in which a tiny camera is inserted in your nose in the allergist or ENT’s office. Your doctor might order a CT scan, which is an image of your nose and sinuses. Your allergist might also do allergy testing to see if you may be allergic to something that may be making your condition worse.

Triggers

There are several things that can irritate your nasal passages and make your nasal polyps swell, including things you breathe or medicines you take. Avoiding the following may help reduce your symptoms:
  • Tobacco smoke
  • Incense
  • Aspirin and nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen sodium)
  • Chemical fumes
  • Dust or debris
In addition to avoiding those triggers, there are a few simple things you can try at home to improve mucus flow so you can breathe better:
  • Use a saline (saltwater) spray you can buy, or make without a prescription
  • Rinse out your nasal passages with a device such as a neti pot that you can purchase over the counter. It will include directions for mixing salt and water (which should be distilled, sterile or boiled and cooled) and pouring it into your nostrils. Be sure to rinse and dry the neti pot thoroughly after each use.
Many people with nasal polyps also have asthma. Inflamed sinuses from nasal polyps can make asthma worse. Your allergist can work with you to control both conditions. In many cases, treating nasal polyps can improve your asthma control.

Nasal Polyp Treatment

If home remedies don’t provide relief, it might be time to see an allergist or an ENT specialist. If this is the first time you are seeking treatment for nasal polyps, the doctor may recommend one of the following, depending on your symptoms and the number and size of your polyps:
  • Corticosteroid nasal spray
    • Several over the counter or prescription corticosteroid nasal sprays are available to help relieve symptoms and can be sprayed once or twice daily in each nostril. These medications are easy to use and inexpensive. However, they can cause burning and stinging or bleeding in the nose and may not work well if your polyps are large.
  • Fluticasone breath-powered corticosteroid device (Xhance®)
    • This device delivers corticosteroid medication deep into your nose using the power of your own breath. You need to be able to breathe out strongly for the device to work, and it must be used every day.
  • Surgery
    • If your polyps are large and medications haven’t helped, your ENT may recommend surgery to remove them. Your surgeon also can make the sinus opening larger, so medications work better. With surgery, you usually need to continue to take medications.
  • Biologics
    • These medications, often prescribed to asthma patients to treat underlying inflammation, can also be used to treat nasal polyps. Biologics are injected under the skin and may need to be taken long-term. Biologics approved for nasal polyps include:
      • Dupixent®, which you inject yourself every two weeks
      • Xolair®, which is injected by the allergist or at home after the first three doses in the physician’s office, every two to four weeks

    If your nasal polyps come back

    You may get permanent relief using medications or having your polyps surgically removed. In many cases, though, the polyps – and the frustrating symptoms – come back. Your allergist or ENT specialist will work with you to determine what treatment to try next, including different medications or first-time or repeat surgery. There is an additional treatment that is only available to people who have had nasal polyps return after surgery. It involves placing tiny, corticosteroid-coated implants (Sinuva®) in your sinuses. These implants, called stents, slowly release the medication and dissolve over several weeks. The procedure can be performed in the ENT’s office. The benefits of the implants last several months, and the doctor may recommend you continue using a corticosteroid nasal spray and/or saline rinse or spray. You may need the implant procedure again once the benefits wear off.

    This page was reviewed for accuracy 7/27/2021.

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