Diagnosis
A diagnosis of nasal polyps starts with symptoms, a medical history and a physical exam.
Tests to diagnose nasal polyps might include:
- Nasal endoscopy. This involves using a narrow tube with a lighted lens or tiny camera to look at the inside of the nose.
- Imaging studies. CT scans can show the size of polyps deep in the sinuses and where they are. These studies can also help rule out other reasons the nose is blocked.
- Allergy tests. Skin tests can show if allergies are causing ongoing inflammation. With a skin prick test, tiny drops of allergy-causing agents are pricked into the skin of the forearm or upper back. A health care provider then watches the skin for allergic reactions.
If a skin test can't be done, a blood test can screen for allergies.
- Test for cystic fibrosis. A child who has nasal polyps might have cystic fibrosis. Cystic fibrosis affects the cells that make mucus, sweat and the juices that help food digest. It's an inherited condition.
A test for cystic fibrosis is a sweat test. A chemical put on the skin causes the area to sweat. The test shows if the sweat is saltier than most people's sweat is.
- Blood tests. These can look for a condition linked to nasal polyps, such as allergies or problems with the immune system.
Treatment
Chronic sinusitis, with or without polyps, is hard to clear up. Treatment depends on the cause of the swelling and irritation. The goal is to lessen symptoms and improve life.
Medicines
Treatments might include:
- Nasal steroids. These nasal sprays include fluticasone (Flonase Allergy Relief, Xhance), budesonide (Rhinocort), mometasone (Nasonex 24hr Allergy), triamcinolone (Nasacort Allergy 24HR), beclomethasone (Beconase AQ, Qnasl) and ciclesonide (Omnaris, Zetonna).
- Steroids taken by mouth. Some nasal polyps can block nasal sprays. If so, taking steroids in pill form such as prednisone might help. Steroids taken by mouth also might be given to shrink polyps before surgery.
The pills can be taken alone or with a nasal spray. Because oral steroids can cause serious side effects, health care providers generally prescribe them only for a short time.
Steroids given as shots may be used if nasal polyps are severe.
- Biologic medicines. Biologics work by aiming at certain cells or proteins to lessen irritation and swelling. These might be used for people whose nasal polyps keep coming back. In the United States, dupilumab (Dupixent), mepolizumab (Nucala) and omalizumab (Xolair) have been approved for treatment of chronic sinusitis with nasal polyps.
- Other medicines. Other prescription medicines can treat conditions that lead to long-term swelling and inflammation in the nose. These might include medicines to treat allergies, also known as antihistamines, and antibiotics to treat infection.
A treatment known as aspirin desensitization might help people with nasal polyps and asthma who react badly to aspirin. An allergy specialist oversees the treatment. The treatment involves taking a little more aspirin bit by bit to help the body get used to taking aspirin.
Surgery to remove the polyps might come before aspirin desensitization. Desensitization might be followed by daily aspirin therapy.
If medicine doesn't shrink or get rid of nasal polyps, endoscopic surgery can remove polyps and correct problems with the sinuses that lead to polyps.
In endoscopic surgery, a surgeon puts a small tube with a lighted lens or tiny camera, also known as an endoscope, through the nostrils into the sinuses. A surgeon then uses tiny tools to remove polyps.
A surgeon can also make the openings to the sinuses larger. This can be done during endoscopic surgery. Or there's a procedure called balloon ostial dilation. This procedure doesn't involve removing tissue from inside the nose.
After surgery, a corticosteroid nasal spray might help keep nasal polyps from coming back. A saltwater rinse can promote healing after surgery.
Preparing for your appointment
You'll likely start by seeing your primary care provider. You might then be referred to an ear, nose and throat (ENT) specialist or an allergy specialist.
Here's some information to help you get ready for your appointment.
What you can do
Ask a family member or friend to go with you, if possible. Having someone with you can help you recall the information you get during the appointment.
Make a list of:
Your symptoms, even if they seem unrelated to your nose or sinuses, and when they began.
Other medical information, including other conditions you have.
All medicines, vitamins and supplements you take, including doses.
Questions to ask your health care provider.
Some basic questions to ask might include:
What is likely causing my symptoms?
What tests do I need?
What treatment do you suggest?
Do I need to see a specialist?
Are there brochures or other printed information I can take have? What websites do you recommend?
Ask other questions you have.
What to expect from your doctor
Your care provider might ask you questions, including:
When did you last have a cold or sinus infection?
How often do you have colds or sinus infections?
Do you have allergies? To what?
Do you have asthma? How controlled is it?
Do you often take aspirin or any other pain medicines?
Do you smoke or are you often around tobacco smoke?
What kind of work do you do?
What are your hobbies?
Have you ever had any sinus or nasal surgery?
