How to manage nasal polyps with loss of smell?

Question

Hello doctor,

I have had constant nasal blockage for months, and it is getting worse. I can barely breathe through my nose, especially at night. I thought it was allergies, but antihistamines do not help at all. The ENT said it might be nasal polyps; is that serious? I keep losing my sense of smell and taste.

I have tried sprays, saline rinses, everything. I am just tired of waking up congested every single morning. Do people actually need surgery for this, or are there injections or newer medicines that can shrink them?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Persistent nasal blockage with worsening symptoms, especially when associated with loss of smell and taste, can indeed indicate nasal polyps, which are noncancerous inflammatory growths in the nasal and sinus lining.

Nasal polyps are serious in that they cause chronic nasal obstruction and significantly affect quality of life, but they are not life-threatening. Treatments aim to reduce inflammation, shrink polyps, and restore nasal airflow and smell.

Treatment options are as follows:

Medications:

Intranasal corticosteroid (glucocorticoid) sprays are the first-line treatment to reduce polyp size and inflammation. These sprays need to be used regularly and sometimes in higher doses or with specialized delivery devices like breath-powered sprays for improved effect.
Oral corticosteroids (glucocorticoids) are used short-term in more severe cases to reduce polyp size quickly, but have side effects limiting long-term use.
Newer biologic therapies (like Dupilumab, Mepolizumab, and Omalizumab) have been Food and Drug Administration (FDA) approved recently, especially for patients with recurrent or severe nasal polyps or those with asthma. These targeted therapies reduce inflammation and polyp growth effectively but are costly and usually used after surgery or when other treatments fail.

Surgery:

Functional endoscopic sinus surgery (FESS) or nasal polypectomy is considered when medical therapy fails to relieve symptoms or in cases of significant obstruction affecting breathing and smell.
Surgery removes large polyps and opens sinus drainage pathways to improve airflow and enhance medication delivery.
Surgery is not a cure but often necessary for long-term symptom control; postoperative steroid treatments and sometimes biologics help prevent recurrence.

The smell and taste loss are often due to blockage and inflammation caused by polyps. Usually improves with reducing the polyps and inflammation via medical or surgical treatments. Biologics have shown promise in improving smell alongside shrinking polyps.

For you, worsening nasal blockage, loss of smell, and poor response to antihistamines and sprays, nasal polyps are a likely cause.

Surgery is commonly needed when medical therapy is insufficient, but newer biologics offer promising non-surgical options, especially in recurrent or severe cases. Continued use of nasal steroids and saline rinses is essential even after surgery for better long-term control.

I suggest you undergo the following investigations:

Non-contrast computed tomography (NCCT) nose and paranasal sinuses (PNS).
Immunoglobulin E (IgE) levels.
Absolute eosinophil counts (cells per microlitre).

Share investigation reports with me for further guidance.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.