In Pakistan, nasal Polyps is managed by ents. Nasal polyps are soft, pale, fluid-filled outgrowths of the sinus and nasal lining driven by years of type-2 (eosinophilic) inflammation. They affect roughly 1-4% of adults globally and almost always arise on both sides of the nose at once — a unilateral polyp is treated as a red flag for tumor until proven otherwise.
Nasal polyps (ICD-10: J33) are non-cancerous, edematous swellings of the sinonasal mucosa that herniate into the nasal cavity, most often originating from the ethmoid sinuses and the middle meatus. Histologically the lesions are loose stromal tissue heavily infiltrated with eosinophils, mast cells, and CD4 T cells skewed toward type-2 cytokines IL-4, IL-5, and IL-13. They are the visible endpoint of chronic rhinosinusitis with nasal polyposis (CRSwNP), which sits within the broader umbrella of chronic rhinosinusitis (CRS). Polyps are graded endoscopically using the Lildholdt or Lund-Mackay scoring systems, and severity is increasingly classified by inflammatory endotype rather than appearance alone — over 80% of cases in Western populations are eosinophilic, while non-eosinophilic polyps predominate in parts of East Asia.
The key symptoms of Nasal Polyps are: Persistent bilateral nasal obstruction that does not clear with decongestant sprays and worsens over months — the most common presenting complaint in over 90% of CRSwNP patients., Reduction or complete loss of the sense of smell (hyposmia or anosmia), often the symptom that bothers patients most and the slowest to recover after treatment., Loss or distortion of taste, which follows the loss of smell because flavor recognition depends largely on retronasal olfaction., Postnasal drip with thick, often discoloured mucus that triggers throat-clearing, chronic cough, and morning sore throat., Dull facial pressure or fullness across the cheeks, forehead, and bridge of the nose, sometimes mistaken for migraine or tension headache., Mouth-breathing, snoring, and disturbed sleep, with daytime fatigue out of proportion to the nasal symptoms., Recurrent acute sinus infections layered on top of the chronic congestion — three or more antibiotic courses in a year is a typical history..
Diagnosis of nasal polyps rests on a focused history, endoscopic examination, and selective imaging rather than a single test. The 2020 European Position Paper on Rhinosinusitis (EPOS 2020) and the 2023 AAO-HNS Clinical Practice Guideline update both require two or more cardiac sinonasal symptoms — nasal obstruction, anterior or posterior nasal discharge, facial pressure, and reduced sense of smell — lasting 12 weeks or longer, plus objective evidence of inflammation. The objective evidence is nasal endoscopy demonstrating polyps in the middle meatus or CT findings of opacified sinuses with characteristic ethmoid mucosal thickening. Anterior rhinoscopy alone misses smaller polyps and is no longer considered sufficient; flexible or rigid endoscopy is the standard of care. The Lund-Mackay CT score quantifies the extent of sinus opacification and guides surgical planning. Smell testing (UPSIT or Sniffin' Sticks) is routinely added because olfactory loss is both a strong diagnostic clue and a sensitive outcome measure. Allergy testing (skin-prick or specific IgE) and a check for asthma should be done in every adult with polyps. Biopsy is reserved for unilateral polyps, asymmetric disease, vascular or fleshy lesions, or any feature suggesting inverted papilloma, sinonasal malignancy, or granulomatosis with polyangiitis — these red-flag presentations need an ENT review rather than empirical medical therapy. In children, every polyp should trigger a sweat chloride test for cystic fibrosis. Once a CRSwNP diagnosis is established, blood eosinophils, total IgE, and questionnaires such as SNOT-22 and an asthma control test stratify disease severity and guide the choice between topical therapy alone, surgery, and biologic treatment.
CRSwNP is a chronic disease — like asthma or eczema, it is controlled rather than cured. With continuous intranasal or irrigation steroid therapy, around 60% of patients maintain acceptable symptom control without surgery. After FESS, roughly 80% of patients report meaningful quality-of-life improvement at 12 months, but polyps recur in about 40% within 18 months without ongoing topical therapy and in over 80% of AERD patients by 5 years. Biologics have shifted the trajectory: dupilumab, omalizumab, and mepolizumab reduce repeat surgery, restore smell in a meaningful proportion of patients, and cut oral steroid exposure substantially. Smell recovery is the most patient-relevant outcome and the slowest — full return is reported in 30-50% of treated patients at 6-12 months. Untreated severe polyposis is rarely life-threatening but causes durable loss of smell, sleep disturbance, repeated antibiotic exposure, and a measurable reduction in work productivity. The strongest predictors of poor long-term outcome are AERD, severe asthma, current smoking, very high eosinophilia, and missed follow-up.
An ENT specialist should be involved when nasal symptoms persist beyond 12 weeks despite intranasal steroids, when polyps are visible on examination, when there is unilateral disease or bleeding, when oral steroids are needed more than once or twice a year, or when smell loss is severe. Allergists and pulmonologists co-manage patients with concurrent severe asthma, AERD, or where biologic therapy is being considered. Pediatric polyps almost always justify ENT plus cystic fibrosis screening.
Find specialists →After a short oral steroid course, smell and nasal patency typically improve within 3-7 days and benefit lasts 3-6 months. After FESS, the nose feels worse for 7-14 days due to swelling and crusting; saline rinses begin on day 1 or 2 and continue for life. Most patients are back to office work within 7-10 days, with strenuous exercise and air travel deferred 2 weeks. Endoscopic appearance settles by week 6-8, and the benefit of surgery peaks at month 3-6. Biologics begin to reduce polyp size and improve smell by week 4-8 and reach maximum effect by month 6; therapy is continued indefinitely with periodic reassessment.
Regular aerobic exercise (brisk walking, swimming, cycling) for 150 minutes per week supports immune regulation and weight management and is safe in stable CRSwNP. Patients with concurrent asthma should have a personalized asthma action plan and pre-exercise short-acting bronchodilator if prescribed. Avoid heavy exertion in air-quality-warning conditions, and rinse nasal passages with saline after swimming in chlorinated pools or freshwater lakes.
Look for an otolaryngologist with rhinology fellowship training or substantial CRSwNP volume, comfort with both office-based endoscopy and full FESS, and access to image-guided navigation for revision cases. Ask whether the practice routinely uses high-volume budesonide irrigations, whether biologics are prescribed in-house or referred to allergy, and how aspirin desensitization is handled. Continuity matters — CRSwNP is a lifelong disease and outcomes correlate strongly with consistent follow-up.
Medically reviewed by AIHealz Medical Editorial Board · May 12, 2026
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