Nasal polyps: Unassuming growths with a powerful effect

The nose is the subject of many sayings. A measurement could be on the nose or an object be right under your nose. You may be reminded to keep your nose clean and keep it out of another's affairs.

While often the focus of these idioms, your nose also can be affected by physical conditions, such as nasal polyps. These are soft, painless, noncancerous growths on your nasal passages or sinus linings and hang down like teardrops or grapes.

Nasal polyps may form anywhere in your sinuses or nasal passages. But they most often appear in an area where the sinuses near your eyes, nose and cheekbones drain through winding passages into your nose.

Here's what you need to know about these small growths.

What causes nasal polyps?

Nasal polyps often result from chronic inflammation of the nasal passages. That's why people who have chronic sinusitis have an increased risk of developing nasal polyps. Chronic sinusitis is when the sinuses become swollen and inflamed for more than 12 weeks. This causes the lining in the nose to make more mucus, while the swollen lining interferes with drainage.

People with asthma, allergies, drug sensitivities or certain immune disorders also have an increased risk for nasal polyps.

Scientists don't yet fully understand why certain conditions and inflammation trigger polyps to form in some people and not in others. Nasal polyps can develop at any age but are most common in young and middle-aged adults.

What are the common symptoms of nasal polyps?

A person can have nasal polyps and not know it, especially small ones. Larger or multiple polyps can cause a sensation of nasal congestion, impaired sense of smell and taste, decreased airflow and recurring sinus infections.

Some people with nasal polyps develop an intolerance to over-the-counter pain-relieving medications like ibuprofen and naproxen.

Can nasal polyps cause health complications?

Nasal polyps can cause complications because they block airflow, fluid drainage and long-term inflammation underlying their development. In some people, they cause worsening asthma or structural changes in the sinuses.

Many people with nasal polyps have recurring sinus infections. This increases antibiotic exposure and could lead to clostridium difficile, also called C-diff, a potentially severe gastrointestinal infection.

How are nasal polyps treated?

The treatment goal for nasal polyps is to reduce their size or eliminate them. Medication usually is the first approach. Surgery sometimes may be needed, but it may not provide a permanent solution because polyps tend to recur.

Nasal steroids and budesonide rinses may reduce swelling and irritation. These treatments may shrink polyps or eliminate them completely.

If you have nasal polyps and chronic sinusitis, your healthcare team may give you an injection of a medication called dupilumab, commonly known as Dupixent, to treat your condition. This biologic medication may reduce the size of the nasal polyps and lessen congestion. It's often prescribed by an allergist and can be administered at home.

Nasal polyps in children typically are treated with topical medications and dupilumab.

Can you prevent nasal polyps?

You may be able to reduce your chances of developing nasal polyps or having polyps come back after treatment by reducing inflammation in your nose and sinuses.

Start by following these tips:

• Manage allergies and asthma.
  Follow treatment recommendations from your healthcare team. If your symptoms aren't well-controlled, ask about changing your treatment plan.
• Avoid nasal irritants.
  As much as possible, avoid breathing airborne substances that are likely to contribute to swelling or irritation in your nose and sinuses, such as allergens, or allergy-causing agents; tobacco smoke; chemical fumes; dust; and fine debris.
• Practice good hygiene.
  Wash your hands regularly and thoroughly. This is one of the best ways to protect against bacterial and viral infections that can cause inflammation of the nasal passages and sinuses.
• Humidify your home.
  Using a humidifier may help moisten your breathing passages, improve the flow of mucus from your sinuses, and help prevent blockages and inflammation. Clean the humidifier daily to eliminate bacterial growth.
• Use a nasal rinse.
  Use a saline spray or nasal wash to rinse your nasal passages. This may improve mucus flow, and remove allergens and other irritants.

How are nasal polyps diagnosed?

Your healthcare team usually can make a diagnosis based on your answers to questions about your symptoms, a general physical exam and an examination of your nose. Polyps may be visible with the aid of a simple lighted instrument called a nasal endoscope.

They also may suggest skin tests to determine if allergies are causing chronic inflammation. With a skin prick test, tiny drops of allergens are pricked into the skin of your forearm or upper back. Your healthcare team observes your skin for signs of allergic reactions. If a skin test can't be performed, a blood test can screen for specific antibodies to various allergens.

Talk with your healthcare team if you have recurring sinus infections, infections that last longer than 12 weeks, impaired smell or taste, or are having trouble breathing through your nose.

John Wheeler Jr, M.D., is an allergist in Allergy & Asthma in La Crosse, Wisconsin.