CRSwNP
Nasal polyps.
Nasal polyps are soft, painless, non-cancerous swellings of the inflamed sinus lining. They are a sign of a chronic inflammatory disease rather than a disease in themselves, and the practice treats them that way: diagnosis first, then the options, medical, surgical and biologic, laid out side by side so that the decision is yours.
General education only. Your diagnosis, options and coverage are individual, and are established at your consultation.
The Condition
A chronic disease, not a growth.
Polyps form when the lining of the sinuses, inflamed over a long period, swells into smooth, grape-like masses that hang down into the nasal passages. They usually arise from the ethmoid sinuses between the eyes, on both sides, and they block the nose from the top down. The earliest symptom is often a fading sense of smell, sometimes noticed only in retrospect; blockage, thick discharge, facial fullness and snoring follow as the polyps enlarge. Because the polyps themselves have no nerve supply, they are painless, and people are sometimes surprised by how large they have become.
The medical name for the disease is chronic rhinosinusitis with nasal polyps, CRSwNP. It is driven by a particular kind of inflammation, the same kind that underlies much asthma, and the two conditions frequently coexist. A smaller group of patients have aspirin-exacerbated respiratory disease: polyps, asthma and reactions to aspirin or anti-inflammatory painkillers together, a combination that tends to be more stubborn and is asked about specifically.
Polyps are not cancer, and they do not become cancer. A polyp on one side only, a polyp that bleeds, or a mass with facial numbness or visual symptoms is a different matter and is investigated promptly, because a one-sided process is treated as a possible tumour until shown otherwise.
Symptoms of nasal polyps
- A sense of smell that has faded or gone, often the first sign
- Blocked breathing through the nose, usually both sides
- Thick discharge, postnasal drip and a feeling of fullness rather than pain
- Snoring and mouth breathing
- Asthma that is hard to control, or reactions to aspirin or anti-inflammatories
- Sinus symptoms that returned after a previous operation
Having several of these does not confirm the diagnosis, and having few does not exclude it. The examination does that.
Why It Happens
Inflammation that the body keeps renewing.
Why one person's chronic sinusitis grows polyps and another's does not is only partly understood. What is clear is that in CRSwNP the lining is inflamed in a specific way, involving immune cells and signals that also drive allergic asthma and eczema, and that this inflammation continues even when infection is absent. Remove the polyps and, without ongoing treatment of the inflammation, the lining tends to grow them again. That is the central fact of the disease, and it is why treatment is planned as long-term control rather than a single cure.
It is also why the newer biologic medicines exist. They target the signals that sustain this inflammation, and they were developed and tested in exactly this group of patients. Which patients benefit most, for how long, and how these medicines fit alongside surgery are the questions the practice's clinical research is part of answering.
Both sides, usually
Polyps in CRSwNP are typically bilateral. A one-sided polyp is investigated differently.
Asthma travels with it
A large proportion of patients with polyps also have asthma, and controlling one often helps the other.
Recurrence is the norm without control
Polyps tend to regrow after surgery if the inflammation is not treated afterwards. Long-term medical therapy is part of every plan.
Smell is the sensitive measure
The sense of smell often responds first, in both directions, and is one of the outcomes the practice tracks.
Assessment First
How polyps are assessed.
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History
How long, which symptoms, and in what order; asthma and its control; reactions to aspirin or anti-inflammatories; previous sprays, rinses, steroid courses, antibiotics and operations, with dates.
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Nasal endoscopy
Shows the polyps directly, where they arise and how far they extend, and whether pus or other findings accompany them. Their size is recorded so that change can be measured.
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CT imaging
Maps which sinuses are involved and the drainage anatomy. Polyps confirmed on CT also qualify a referral for the expedited Centres of Excellence pathway.
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The wider picture
Smell testing, assessment of asthma, and where indicated blood tests or allergy testing, because the choice between surgery and a biologic depends on the whole pattern of disease, not the polyps alone.
Your Options
The options, with their trade-offs.
Medical therapy, surgery and biologic medicines are not rivals; most patients use more than one over time. Set out side by side so you can weigh them yourself.
| Option | What it involves | Trade-offs to weigh |
|---|---|---|
| Structured medical therapy | Corticosteroid delivered into the nose daily, as a spray or in a rinse, with large-volume saline irrigation, and short courses of oral corticosteroid when a flare calls for one. Treatment of asthma alongside. The foundation of every plan, before and after anything else. | Asks for daily consistency. Controls mild and moderate disease in many patients; oral steroid courses shrink polyps quickly but temporarily, and repeated courses carry real side effects, so they are used deliberately rather than routinely. |
| Endoscopic sinus surgery | Removes the polyps and opens the sinuses through the nostrils under general anesthesia, usually as day surgery, preserving healthy lining so that rinses and sprays can reach the tissue afterwards. Generally OHIP-insured when medically indicated. | An operation, with its risks: bleeding, infection, scarring, changes in smell, and rare but serious injury near the eye or skull base. Relieves blockage reliably; polyps can regrow over the years without ongoing medical therapy, and some patients need further surgery. |
| Biologic therapy | Injectable medicines that target the inflammation driving the polyps, given at regular intervals, usually at home, and continued for as long as they are working. Biologic medicines are approved in Canada for adults with CRSwNP; which, if any, suits you depends on the pattern of disease, on asthma and other conditions, and on previous surgery. | Not a cure: polyps tend to return if the medicine is stopped. Long-term injections, monitoring, and coverage criteria under public or private drug plans that the practice explains and helps with. Response is not universal, and it is reviewed at set intervals. |
| No treatment | A legitimate choice after understanding what each option asks of you, particularly when symptoms are tolerable. | Polyps are not dangerous in most people, but they generally enlarge slowly, and smell lost for a long time is harder to recover. You can return if your situation changes. |
Dr. Khetani is an active investigator in Phase 3 clinical trials of biologic therapies and contributes to national specialist advisory work on emerging treatments. Patients who may be eligible for a study are told about it as information, never as a condition of their care.
When not to wait
Polyps on one side only, bleeding from the nose with a polyp, a mass with numbness of the cheek or teeth, double vision, a bulging eye or a severe headache need prompt assessment: ask your physician to mark the referral urgent. Swelling or redness around an eye with a sinus infection, or visual change, is an emergency: go to the nearest emergency department.
Common Questions
Nasal Polyps, answered plainly.
No. Polyps in chronic rhinosinusitis are benign swellings of inflamed lining, usually on both sides, and they do not turn into cancer. A growth on one side only, or one that bleeds, is assessed differently and promptly, because the rare tumours of the nose can look similar at first glance.
They can, and over the years they often do if the underlying inflammation is not treated. Surgery removes the polyps and opens the sinuses so that medication can reach the lining; ongoing medical therapy afterwards is what keeps the result. Some patients need further surgery over their lifetime, and some are candidates for a biologic to reduce that likelihood.
Sometimes; sometimes the other way round; often both over time. The answer depends on how extensive the disease is, whether you have asthma, what previous surgery achieved, what the coverage criteria allow, and what you would rather live with: an operation and its recovery, or long-term injections. The consultation sets the two out side by side so that you can decide with the facts in front of you.
Corticosteroid in the nose, as a spray or in a rinse, can reduce polyp size and keep small polyps in check, and it is the foundation of long-term control. Large polyps that block the nose completely usually need more: a short course of oral steroid, surgery, or a biologic, with the spray or rinse continuing afterwards.
Because the same kind of inflammation drives both. Polyp disease and asthma frequently coexist, and each tends to worsen the other. Treating the sinuses often improves asthma control, and the reverse; and aspirin or anti-inflammatory sensitivity, when present, is part of the same picture and is asked about specifically.
Referrals for polyps confirmed on CT are expedited: the practice is listed among the Canadian Rhinologic Society's Centres of Excellence, which commit to assessing these patients within four months of referral. Ask your physician to note the CT findings on the referral. Other referrals are triaged by urgency, and the office tells you the expected wait when it calls.
Assessment first. Then the options are yours.
An OHIP-insured assessment begins with a referral from your physician or nurse practitioner. The office contacts you once it is received.