Grapes on a vine — and the vine is inflammation.
Nasal polyps are soft, non-cancerous growths of inflamed sinus lining — pale, glistening, grape-like tissue that fills the nasal cavity and blocks airflow, drainage, and smell. They are the defining feature of chronic rhinosinusitis with nasal polyposis (CRSwNP), the eosinophilic end of the chronic sinusitis spectrum.
The biology matters because it predicts behavior. Most polyp disease is driven by Type 2 inflammation — an immune cascade involving the cytokines IL-4, IL-5, and IL-13 and tissue eosinophils. The same cascade drives asthma and aspirin-exacerbated respiratory disease (AERD), which is why these conditions cluster together and why treating one improves the others.
One critical caveat: polyps on one side only are a different problem. Unilateral masses can be inverted papilloma or sinonasal tumors and warrant prompt endoscopic evaluation and imaging — not a steroid spray and a follow-up in six months.
Obstruction first. Smell loss always.
Polyp disease announces itself with:
- Progressive nasal obstruction — often described as "permanently blocked," worse than any cold
- Loss of smell and taste — the single most characteristic symptom, often the first and the most distressing
- Thick post-nasal drainage and facial fullness
- Worsening asthma control in patients who have asthma
- Reactions to aspirin or NSAIDs in AERD
Because polyps grow slowly, patients adapt to remarkable degrees of obstruction before seeking care — many haven't smelled coffee in years by the time of first endoscopy. If smell has faded along with congestion, polyps belong high on the differential. Read more about smell loss →
Steroids that actually reach the polyps.
The foundation of polyp management is topical corticosteroid — but the delivery method decides whether it works. A metered nasal spray deposits most of its dose on the front of a polyp-filled nose. High-volume steroid irrigation — budesonide mixed into a saline rinse — bathes the sinus lining itself and is the evidence-based default for established polyposis.
Short courses of oral corticosteroids shrink polyps quickly and dramatically, but the effect is temporary and the systemic cost of repeated courses is real — they are used strategically (pre-operatively, or to break an acute exacerbation), never as maintenance.
Allergy evaluation, asthma co-management, and AERD screening round out the medical picture. For AERD patients, aspirin desensitization after surgery is an underused, durable option that this practice coordinates with allergy colleagues at Mount Sinai.
Remove the burden, open the delivery routes.
Surgery for polyp disease has two jobs: clear the polyp burden, and convert the sinuses from closed pockets into open, irrigable cavities so that topical and biologic therapy can reach the lining long-term. A well-executed first surgery changes the entire downstream course of the disease.
Endoscopic sinus surgery (FESS)
Complete, image-guided opening of the involved sinuses with thorough but mucosa-preserving polyp removal — through the nostrils, no facial incisions. Navigation referenced to your own CT is used in every case; extensive or revision disease is handled in the hospital OR at Mount Sinai with advanced visualization.
In-office polypectomy
For recurrent or obstructing polyps in patients who have had prior surgery — or as targeted debulking — polypectomy can often be performed in the practice's dedicated in-office hybrid operating suites under local anesthesia with patient-controlled nitrous oxide. Same-morning, no general anesthesia, dramatically lower cost than a return to the OR.
Recovery
Most patients return to desk work within five to seven days, begin saline irrigations the day after surgery, and notice smell returning over the following weeks as the olfactory cleft decompresses. No routine nasal packing.
Turning off the cascade — Dupixent and beyond.
Three biologics are FDA-approved for CRSwNP, each targeting a different node of the Type 2 cascade:
- Dupilumab (Dupixent®) — blocks IL-4/IL-13 signaling; injection every two weeks; the most extensively studied agent in polyposis, with large reductions in polyp score and meaningful smell recovery in trials
- Mepolizumab (Nucala®) — anti-IL-5; injection every four weeks; particularly logical in eosinophil-predominant disease with asthma
- Omalizumab (Xolair®) — anti-IgE; dosing by weight and IgE level; useful where the allergic signature dominates
Selection is individualized — polyp grade, SNOT-22 symptom burden, blood eosinophils, IgE, asthma and AERD status, and prior surgical history all enter the decision. Insurance authorization typically requires documented failure of intranasal steroids and, often, prior surgery; the practice runs that authorization process in-house.
Biologics and surgery are partners, not rivals: surgery creates the open, irrigable sinuses through which topical therapy works and gives biologics a lower disease burden to maintain. The most durable results in severe disease come from the combination.
Common questions, direct answers.
Do nasal polyps go away on their own?
No. Established nasal polyps do not resolve spontaneously. They can shrink substantially with steroid therapy and biologic medications, and they can be removed surgically — but untreated, the underlying Type 2 inflammation that produces them persists, and polyps tend to enlarge and recur over time.
Are nasal polyps cancerous?
Typical bilateral inflammatory nasal polyps are benign. However, a one-sided polyp or mass deserves prompt specialist evaluation, because unilateral lesions can represent inverted papilloma or, rarely, a sinonasal malignancy — conditions that look similar on casual exam but are managed entirely differently.
What is Dupixent, and does it really work for polyps?
Dupilumab (Dupixent) is an injectable biologic that blocks IL-4 and IL-13 signaling — two central drivers of the Type 2 inflammation behind most polyp disease. In clinical trials and practice it meaningfully shrinks polyps, restores sense of smell in many patients, and reduces the need for repeat surgery. It is given as a self-administered injection every two weeks, and candidacy is assessed against your polyp grade, symptoms, eosinophil markers, and treatment history.
Surgery or biologics — which should come first?
They answer different questions. Surgery rapidly removes polyp burden and opens the sinuses so that sprays, rinses, and biologics can actually reach the inflamed lining; biologics control the inflammation that causes polyps to regrow. Many patients with severe disease do best with a well-performed surgery followed by biologic or topical maintenance. The sequencing is individualized — insurance pathways also typically require documented medical therapy and often prior surgery before approving a biologic.
Why did my polyps come back after surgery?
Because surgery treats the polyps, not the immune biology that created them. Recurrence is common in eosinophilic disease, especially with comorbid asthma or aspirin sensitivity (AERD). Modern management pairs surgery with long-term anti-inflammatory control — steroid irrigations, biologics where indicated, and AERD-directed therapy — to break the cycle of repeated operations.
I lost my sense of smell — will treatment bring it back?
Often, yes. Smell loss from polyp obstruction and inflammation is among the most reversible forms of anosmia. Both surgical removal of polyps and biologic therapy restore meaningful smell in a majority of patients, though the degree of recovery varies with how long and how severely the olfactory cleft has been inflamed.
Related conditions & procedures.
- Chronic Rhinosinusitis — the broader disease spectrum polyps belong to.
- Loss of Smell (Anosmia) — the most reversible smell loss is polyp-related.
- In-Office Procedures — office polypectomy in dedicated hybrid OR suites.
- Nasal Allergies & Allergic Rhinitis — allergic disease that travels with polyps.