When is nasal polyp surgery needed and can it recur?

Question

Hello doctor,

I am 47 years old, and recently, I had a nasal endoscopy that showed a large nasal polyp on one side. My ENT (otolaryngologist) prescribed a steroid spray, but told me that surgery might be needed.

How do they decide when to remove it?
Will it affect my breathing permanently?
Do nasal polyps always come back even after surgery?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Nasal polyps can be frustrating, especially when they are large enough to affect breathing or require surgery.

ENTs (otolaryngologists) usually recommend intranasal corticosteroid sprays (like Fluticasone or Mometasone), which can shrink polyps over weeks to months. Surgery becomes more likely if the large polyp obstructs airflow, causing trouble breathing through one side. If there is no improvement after two to three months of steroid treatment or if you experience frequent sinus infections, facial pressure, or loss of smell, surgery is recommended.

The polyp recurs after prior treatment, or there is concern for atypical growth. Surgery typically involves endoscopic sinus surgery, which removes the polyp and opens up sinus drainage pathways.

Regarding your breathing problem, surgery usually improves breathing, often significantly. Large polyps can block one or both nasal passages, and removing them can restore airflow and reduce sinus pressure. It is uncommon for surgery to cause permanent breathing problems; in fact, it usually relieves nasal obstruction.

Regarding the recurrence of nasal polyps, they do not always return after surgery. Still, recurrence is relatively common, particularly in individuals with underlying conditions like allergies, asthma, chronic rhinosinusitis, or aspirin-exacerbated respiratory disease (AERD). Although less common, cystic fibrosis can also lead to recurring polyps, especially in younger patients.

To help reduce the risk of regrowth, most ENT specialists recommend continued use of intranasal steroid sprays after surgery to keep inflammation under control. In cases where symptoms flare, a short course of oral steroids may be used.

For patients with severe or recurrent polyps, especially those linked to asthma or AERD (Aspirin-exacerbated respiratory disease), newer biologic therapies like Dupilumab can be highly effective in controlling inflammation and preventing recurrence. Regular follow-up and ongoing medical therapy are essential parts of long-term management.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.