Nasal polyps

Soft growths in the nose causing permanent blockage and loss of smell. Steroid spray technique is what makes or breaks the treatment.

What it is

Soft, painless, non-cancerous swellings of the lining of the nose and sinuses, caused by long-term inflammation. They are more common in men and over 40.

They cause a blocked nose that does not vary the way a cold does, and loss of the sense of smell, which is the symptom people most underestimate and most regret.

They are strongly associated with asthma and with chronic sinusitis, and with a particular pattern worth knowing: **aspirin-exacerbated respiratory disease**, the combination of polyps, asthma and severe reactions to aspirin and anti-inflammatory painkillers. Anybody with polyps and asthma should be asked about ibuprofen, because a reaction can be severe.

They also occur in cystic fibrosis, and polyps in a child should prompt a sweat test.

Treatment is steroid nasal spray or drops, long term, and surgery where that fails. Newer biologic drugs are now available for severe recurrent disease.

They recur after surgery in a large proportion of people, which is why ongoing steroid treatment after an operation is essential rather than optional, and why stopping it is the commonest reason surgery seems to have failed.

Signs you might notice

A persistently blocked or stuffy nose, often both sides, that does not come and go.

Reduced or absent sense of smell, and consequently of taste.

A runny nose, or mucus running down the back of the throat.

Snoring, and disturbed sleep.

Facial pressure, and headaches.

Reduced response to ordinary decongestants.

See a GP urgently for: polyps on one side only; any bleeding; pain; numbness of the face; or visual changes. One-sided symptoms need examining properly, because rarer growths can look similar.

Also: any polyps in a child, which needs assessment for cystic fibrosis.

How it can affect day-to-day life

Loss of smell is not a minor symptom. It affects appetite, weight, mood and safety, because gas leaks, smoke and spoiled food go unnoticed. People frequently describe it as the thing they miss most and are rarely offered anything for it.

Nasal spray technique is the difference between treatment working and not. Spraying straight up the nose hits the septum and achieves nothing; the spray should be aimed outwards, towards the ear on the same side, using the opposite hand, without sniffing hard afterwards.

Steroid drops, given lying with the head tilted back or in the head-down position, reach further than sprays and are prescribed when sprays are not enough. The position matters and is often not explained.

Treatment must continue after surgery. Stopping it is why polyps come back within a year for so many people.

For anybody with asthma and polyps, avoiding ibuprofen and aspirin unless specifically cleared is a genuine safety measure.

Supporting someone well

Learn the spray technique: aim outwards towards the ear on the same side, opposite hand, no hard sniff afterwards.

Use the steroid every day, long term. It is a maintenance treatment, not a course.

Use it after surgery, indefinitely, unless told otherwise.

Ask about steroid drops and the correct head position if sprays are not working.

Use saline rinses; they help and are cheap.

Ask about ibuprofen and aspirin if there is also asthma.

Get one-sided symptoms, bleeding, pain or facial numbness assessed promptly.

Ask about biologic treatment for severe recurrent polyps with asthma.

Ask for a smell training programme, which has reasonable evidence and is rarely offered.

Where to get help

A GP practice for diagnosis and initial treatment; ear, nose and throat services for persistent or severe polyps.

Urgent referral for one-sided or bleeding polyps.

ENT UK publish patient information on nasal polyps and sinus surgery.

Asthma + Lung UK helpline: 0300 222 5800 for the asthma connection.