Nasal polyps are soft, noncancerous growths that develop on the lining of the nose or sinuses due to chronic inflammation. They commonly occur in adults with long-standing sinus disease and can cause persistent nasal blockage, loss of smell, facial pressure, and recurrent sinus infections. When medical treatment fails, nasal polyps surgery is often recommended to restore normal nasal breathing and sinus drainage.

Understanding Nasal Polyps – A Brief History

Nasal polyps have been described in medical literature for centuries, with early anatomical studies identifying fleshy growths within the nasal cavity. Over time, it became clear that polyps arise from chronic inflammation of the nasal and sinus mucosa rather than infection alone.

The introduction of nasal endoscopy and CT imaging in the late 20th century revolutionised diagnosis and management, allowing accurate visualisation and targeted treatment through endoscopic sinus surgery.

Causes and Risk Factors of Nasal Polyps

• Chronic Rhinosinusitis: The most common underlying cause.
• Allergic Rhinitis & Asthma: Strongly associated, especially in AERD.
• Genetic & Immune Factors: Increased inflammatory response in some individuals.
• Environmental Irritants: Pollution, smoke, and airborne irritants.
• Cystic Fibrosis & Systemic Conditions: Seen in selected patients.

Indian ENT centres report nasal polyps as a frequent cause of specialist referral, often presenting late with bilateral disease and recurrent sinus infections.

Why Nasal Polyps Surgery Is Required

Initial treatment usually includes nasal steroid sprays, short courses of oral steroids, antihistamines, antibiotics, and saline irrigation. Surgery is considered when symptoms persist or recur.

• Large or obstructive nasal polyps
• Recurrent or medically refractory polyps
• Loss of smell and chronic sinus pain
• Sleep disturbance and reduced quality of life
• Complications of chronic sinus disease

Pre-Operative Evaluation

• Detailed clinical history and nasal endoscopy
• CT scan of paranasal sinuses for surgical planning
• Allergy testing and immunological assessment
• Asthma and respiratory evaluation when indicated
• Assessment of aspirin sensitivity or systemic disease

Types of Nasal Polyps Surgery

Endoscopic Sinus Surgery (ESS)

ESS is the standard treatment for nasal polyps. Using nasal endoscopes, surgeons remove polyps and open blocked sinus pathways without external incisions, restoring ventilation and drainage.

Image-Guided Surgery

Used in complex or revision cases to enhance precision and protect vital structures.

Balloon Sinuplasty (Adjunct)

In selected cases, balloon dilation is used to widen sinus openings with minimal tissue trauma.

Recent Advances in Nasal Polyps Surgery

• High-definition endoscopic imaging
• Image-guided navigation and 3D mapping
• Drug-eluting steroid stents
• Minimally invasive targeted instruments
• Biologic therapies for severe or recurrent disease

Potential Side Effects and Complications

• Mild bleeding and postoperative congestion
• Crusting and nasal discharge
• Infection or scar formation
• Adhesions (synechiae)
• Recurrence of nasal polyps
• Rare risks: CSF leak, orbital injury, vision changes