Nasal Polyps: What They Are and How We Treat Them

What are nasal polyps?

Nasal polyps are soft, non-cancerous swellings that grow from the lining of the nose and sinuses. They are usually caused by long-standing inflammation, most commonly a condition called chronic rhinosinusitis.

Polyps can block airflow and sinus drainage, leading to:

• Persistent nasal blockage

• Reduced or lost sense of smell

• Nasal discharge or postnasal drip

• Facial pressure

• Recurrent infections

• Disturbed sleep and fatigue

  
  

For many patients, the loss of smell and constant congestion can significantly affect daily life.

Why do nasal polyps develop?

In most adults, nasal polyps are driven by a specific type of immune inflammation known as Type 2 inflammation. This is the same pathway seen in asthma and eczema, which is why many patients with nasal polyps also have:

• Asthma

• Hay fever

• Aspirin sensitivity

  
  

This is not something you have caused — it is an inflammatory condition of the sinus lining.

How are nasal polyps treated?

Treatment is always stepwise and tailored to the individual.

1. Medical treatment (first-line)

Most patients begin with:

• Steroid nasal sprays

• Steroid impregnated saline rinses

• Short courses of oral steroids ONLY when needed due to harmful systemic effects of oral steroids

2. Comprehensive endoscopic sinus surgery

If symptoms remain uncontrolled despite appropriate medical treatment, surgery may be recommended.

Modern sinus surgery is performed through the nostrils using a small camera (endoscope). The aim is not simply to “remove polyps.” It is to:

• Remove inflammatory disease

• Restore ventilation and drainage

• Create long-term access for topical treatment

• Improve sense of smell

• Reduce the need for repeated oral steroids

Why comprehensive surgery matters

Limited surgery — for example, simply trimming visible polyps — often leads to early recurrence.

For patients with more extensive disease, comprehensive sinus surgery may involve carefully opening all affected sinuses, including:

• Maxillary sinuses

• Ethmoid sinuses (front and back)

• Sphenoid sinuses

• Frontal sinuses

Opening all involved areas allows medication to work effectively and gives the best chance of long-term control.

As a consultant rhinologist with a subspecialist focus in advanced endoscopic sinus surgery, I specialise in complete sinus surgery, designed to optimise long-term disease control rather than temporary relief.

3. Biologic therapies (advanced treatment)

In some patients, inflammation remains active despite appropriate surgery and medical therapy.

In these cases, biologic medications may be considered. These are targeted treatments that block specific inflammatory pathways involved in polyp formation.

I have extensive clinical and academic interest in the role of biologics in nasal polyps, including:

• Identifying which patients are most likely to benefit

• Ensuring surgery has been appropriately comprehensive

• Providing evidence-based guidance on when biologics are appropriate

• Biologics are powerful treatments, and careful patient selection is essential to ensure the right therapy is chosen.

A specialist, personalised approach

Every patient with nasal polyps is different.

The key questions are:

• Is inflammation optimally treated?

• Has surgery (if performed) addressed all affected sinus areas?

• Is recurrence due to persistent inflammation?

• Would further surgery or biologics provide better control?

At Midland Nose & Sinus Clinic, I focus exclusively on nasal and sinus conditions. My approach combines:

• Evidence-based medical management

• Comprehensive minimally invasive sinus surgery

• Advanced expertise in biologic treatments

• Long-term disease control strategies

The goal is simple: restore breathing, restore smell, and restore quality of life.

If you are struggling with persistent nasal blockage or loss of smell, a specialist assessment can help determine the most appropriate next step.