Nasal polyp

Disease Description (Causes and Symptoms)

• Definition: Nasal polyps are benign edematous growths (cyst-like masses) that arise from the mucous membrane of the nasal cavity and are commonly associated with chronic sinusitis.
• Causes·pathophysiology: Although the exact cause is unknown, they are thought to form when the mucous membranes of the nasal cavity and paranasal sinuses become edematous due to chronic inflammation (allergies, recurrent infections, etc.), accompanied by proliferation of mucus glands and connective tissue. In some patients, they are associated with asthma and aspirin-exacerbated respiratory disease (AERD).
• Main symptoms: Gradually worsening nasal congestion (often bilateral), reduced sense of smell (anosmia), yellow nasal discharge or rhinorrhea, difficulty breathing and snoring due to nasal obstruction, headache, and facial pressure. They usually progress slowly, but as they enlarge, external deformity (changes in the shape of the nose) or severe obstruction may develop.

Treatment Methods (Latest Standard Treatment · Medications · Procedures · Lifestyle Management · Precautions)

• Conservative (medication) treatment

  • Topical (intranasal) steroids (sprays) are the first-line standard treatment and are effective in reducing polyp size and improving symptoms; long-term use is recommended.
  • Short-term oral steroids can rapidly reduce polyp size and are used before surgery or to manage exacerbations, but long-term use is limited due to concerns about side effects.
  • Nasal decongestants can help relieve symptoms in the short term, but prolonged use is prohibited (risk of rebound rhinitis).
  • Antibiotics are used only when concurrent bacterial sinusitis is suspected.
  • Oral medications such as leukotriene antagonists may be considered as adjunctive treatment in patients with a history of asthma or AERD.
  • Latest treatment: In recurrent or severe chronic rhinosinusitis with nasal polyps (CRSwNP), biologics (e.g., anti-IL pathway-targeted treatments such as dupilumab) are being used as an effective option when surgery and medication therapy fail (indications and availability vary by country and insurance coverage).

• Surgical treatment

  • Functional endoscopic sinus surgery (FESS): Considered when there is no response to medication, recurrent infections, complications (e.g., frontal or maxillary sinus abscess), airway obstruction, or severe loss of smell.
  • The goals of surgery are to remove the polyps, establish ventilation and drainage pathways, and treat lesions of accompanying sinusitis.
  • Continued management, including topical steroids and nasal irrigation, is needed after surgery to reduce recurrence.

• Lifestyle management·self-care

  • Nasal irrigation with saline solution (normal saline) helps remove secretions and relieve inflammation.
  • Avoid allergy triggers (dust mites, pets, smoking, etc.).
  • If asthma or allergic rhinitis is present, manage it actively (including inhaled steroids, etc.).
  • If aspirin sensitivity is suspected, use caution with aspirin (consult a doctor).

• Precautions·risk of complications

  • Nasal polyps commonly recur (they are difficult to cure completely), so long-term follow-up is necessary.
  • In severe cases, loss of smell, recurrent sinusitis, and sleep disturbances (due to nasal congestion) may worsen.
  • Tell your doctor about steroid use before or after surgery, use of anticoagulants, smoking history, and other relevant information.

Outpatient Visit Checklist (Including Preparation Items and Example Questions)

• Preparation items

  • List of medications currently being taken (including prescription drugs, OTC medications, supplements, and herbs)
  • Allergy history (including medications, foods, and aspirin)
  • History of asthma, atopic conditions, and previous sinus or nasal surgery
  • Record of recent changes in nasal symptoms (when they began, unilateral or bilateral, aggravating factors) and changes in the sense of smell
  • Previous test results (nasal endoscopy findings, CT images/reports (sinus CT))
  • Symptom diary (impact on quality of life, presence of sleep disturbances, etc.)

• Key information to provide the doctor during the outpatient visit

  • When symptoms began and how they have progressed (gradual vs. acute worsening)
  • Whether you are currently using topical or taking oral steroids, and for how long
  • Whether you are receiving treatment for asthma or allergies
  • Whether you have experienced breathing difficulty or a rash after taking aspirin or NSAIDs

General Example Questions to Ask the Doctor

• "What are the side effects of this medication (topical or oral steroids)? Is it safe to use it long term?"
• "Do I need surgery in my case? What are the expected benefits and risks of the surgery?"
• "What can I do to reduce the risk of recurrence?"
• "If I have asthma or an allergic disease, how should they be managed together?"

Disease-Specific Example Questions

• "I experienced respiratory symptoms after taking aspirin (or another NSAID). Should I be evaluated for aspirin-exacerbated respiratory disease (AERD)? What tests or treatment options are available?"
• "In my case, my sense of smell has decreased significantly. To what extent can surgery or biologics help restore my sense of smell?"

(If necessary, consult a doctor to determine whether tests (nasal endoscopy·sinus CT), asthma evaluation, allergy testing, medication suitability, and indications for biologics are needed.)