Nasal Polyps

Nasal polyps are soft, non-cancerous growths that form in the lining of the nose and sinuses. They arise from chronic inflammation — not from infection or abnormal cell growth. They are benign and are not a sign of cancer. Small polyps may cause no symptoms at all. As they grow, they block airflow, trap mucus, and progressively impair the sense of smell. Left unmanaged, they can cause recurrent sinus infections, worsen asthma, and significantly affect sleep and quality of life. They do not resolve on their own without treatment.

Polyp recurrence is one of the defining features of this condition. Polyps are a symptom of ongoing chronic inflammation — they are not the underlying disease itself. Treating the polyps without controlling the inflammation that drives them means they will usually return. This is why management focuses on suppressing the underlying inflammatory process using intranasal corticosteroid sprays, saline irrigation, and in selected patients, biologic therapy. Surgery removes polyps and opens blocked drainage pathways, but it does not cure the inflammation. Post-surgical medical treatment — particularly ongoing nasal corticosteroid sprays and saline rinses — is essential to delay or prevent recurrence.

According to EPOS 2020 — the international guideline used as the clinical standard in Australia — the cornerstone of first-line treatment is daily intranasal corticosteroid sprays combined with regular saline nasal irrigation. Australian options for intranasal corticosteroids include mometasone furoate (Nasonex), budesonide (Rhinocort), and fluticasone furoate (Avamys). Short courses of oral corticosteroids — such as prednisolone — may be used to rapidly reduce polyp size before or after surgery. Saline rinsing should be performed before using any nasal spray so the medication reaches clean mucosa. These measures are the foundation of treatment at every stage.

Endoscopic sinus surgery (ESS) is recommended when symptoms remain significant despite an adequate trial of medical treatment — typically intranasal corticosteroids with or without a course of oral corticosteroids. Surgery does not remove the polyps in isolation: it opens the natural drainage pathways of the sinuses, removes obstructing polyp tissue, and creates a larger surface area for topical medications to reach the affected mucosa after the operation. Surgery is not a cure — it is part of a broader long-term management plan. Most patients continue nasal corticosteroid sprays and saline rinses after surgery.

Biologics are injectable monoclonal antibodies that target the specific inflammatory pathways driving polyp formation. Three biologics are currently TGA-approved for nasal polyps in Australia: dupilumab (Dupixent), mepolizumab (Nucala — PBS-listed from April 2023), and omalizumab (Xolair — PBS-listed from March 2025). Based on EPOS 2020 criteria, biologics are considered for patients who have bilateral polyps, have already undergone appropriate sinus surgery, and continue to have uncontrolled disease meeting at least three of five type 2 inflammation criteria — including elevated tissue eosinophils, need for repeated courses of oral corticosteroids, significant quality of life impairment, severe smell loss, and comorbid asthma. An important note for Australian patients: PBS-subsidised biologics for nasal polyps must be prescribed by a clinical immunologist, allergist, or respiratory physician — ENT surgeons are not eligible PBS prescribers for this indication. Your rhinologist will assess your candidacy and refer you to the appropriate specialist to initiate subsidised treatment. Both work together to manage your care.

Dupilumab (Dupixent) is a fortnightly subcutaneous injection that blocks the IL-4 and IL-13 signalling pathways — two key drivers of the type 2 inflammatory response that causes polyp formation. Clinical trials have shown that dupilumab significantly reduces polyp size, improves nasal congestion, and restores the sense of smell in patients with severe uncontrolled disease. It is TGA-approved in Australia for this indication and given by self-injection under the skin of the thigh or abdomen, typically every two weeks, alongside intranasal corticosteroids. In Australia, PBS-subsidised dupilumab for nasal polyps must be prescribed by a clinical immunologist, allergist, or respiratory physician. Your rhinologist can assess whether you are a candidate and refer you to the appropriate specialist.

Loss of smell — known as anosmia — is one of the most distressing and impactful symptoms of nasal polyps. It occurs when polyps physically block the airflow needed to reach the olfactory receptor region high in the nasal cavity. In most patients, smell improves significantly with treatment — whether with corticosteroids, surgery, or biologic therapy. However, prolonged untreated anosmia can result in more persistent changes that are slower to recover. This is one of the reasons early assessment and appropriate treatment is important when smell loss is a significant symptom.

Yes — the connection is well established and clinically important. A significant proportion of patients with nasal polyps also have asthma, and the two conditions share the same underlying type 2 inflammatory pathway. This is sometimes called the unified airway — the nose and lungs are part of the same mucosal system, and inflammation in one area commonly affects the other. In patients with both conditions, treating nasal polyps effectively often leads to improvement in asthma control as well. Your surgeon will ask about your respiratory history as part of your assessment.

Aspirin-exacerbated respiratory disease — formerly called Samter's triad — is a recognised clinical pattern involving nasal polyps, asthma, and sensitivity to aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Patients with this condition typically have more aggressive polyp disease with a higher recurrence rate after surgery. Taking aspirin or NSAIDs can trigger severe respiratory reactions in these patients. If you have polyps and asthma and notice that aspirin or anti-inflammatories worsen your breathing, this is important information to share with your surgeon.

Not necessarily — this depends on whether you have aspirin-exacerbated respiratory disease (AERD). Most patients with nasal polyps can take aspirin and ibuprofen safely. However, if you also have asthma and notice that these medications worsen your breathing or nasal symptoms, you should avoid them and discuss this with your surgeon. Paracetamol (Panadol) is generally well tolerated in patients with nasal polyps, including those with AERD.

Nasal polyps are uncommon in children. When they do occur in a child under twelve, cystic fibrosis must always be investigated — it is a recognised cause of nasal polyposis in children and warrants genetic and respiratory assessment if not already excluded. In adults, the common driver is type 2 eosinophilic inflammation; in children this pattern is less typical. Any child found to have nasal polyps should be assessed by a specialist with experience in paediatric sinonasal disease.

Individual surgeons within My-ENT may approach assessment and management differently based on their subspecialty training and clinical experience. Your surgeon will discuss the most appropriate pathway for your specific situation at your consultation.