Is surgery needed for recurrent nasal polyps?

Question

Hello doctor,

My father is 46 years old and has been experiencing persistent nasal blockage and a reduced sense of smell for more than a year. ENT evaluation revealed nasal polyps, and he was treated with a nasal steroid spray, which improved symptoms temporarily.

However, the blockage has gradually returned, and he now has difficulty breathing through the nose, especially at night. A CT scan showed polyp growth in the sinus cavity.

Why do nasal polyps often recur even after treatment, and when is surgery considered necessary?

Kindly suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Based on the symptoms described, your father most likely has chronic polypous rhinosinusitis. A condition in which nasal polyps develop in the nasal cavity and sinuses due to long-standing inflammation of the mucous membrane.

Polyps often tend to recur even after treatment because the underlying cause of inflammation is not eliminated. These causes may include

Chronic allergic reactions (to dust, mites, animal dander, mold).
Bronchial asthma.
Recurrent infections.
A deviated nasal septum,
Impaired local immunity of the nasal mucosa.
Exposure to polluted air or smoking,
As well as the so-called “aspirin triad” (NSAID (non-steroidal anti-inflammatory drugs) intolerance plus asthma plus polyps).

Steroid nasal sprays help reduce inflammation and temporarily relieve symptoms, but if the trigger persists, the polyps can grow back.

If your father is noticing worsening symptoms, significant nasal blockage, and especially if he cannot breathe through his nose at night, this may already be an indication for surgical treatment (endoscopic removal of nasal polyps), but the decision should be made after further evaluation

Surgery is also considered when medical therapy is ineffective, there is loss of smell, or extensive polyp growth is seen on CT (computed tomography). It is important to understand that surgery removes the consequence, not the cause, so ongoing maintenance therapy is necessary to reduce the risk of recurrence.

I recommend additional evaluation to clarify the cause of inflammation:

A complete blood count (CBC).
C-reactive protein (CRP).
Total immunoglobulin E (IgE).
A nasal cytology (rhinocytogram) to determine whether the inflammation is allergic or infectious in nature.

If needed, a doctor may also recommend consultation with an allergist and further testing to choose the most effective treatment and help prevent recurrence.

Follow up with the reports.

I hope this helps you.

Thank you.