What Are Nasal Polyps — And How Do I Know If I Have Them?

A nasal polyp is a benign growth that forms inside the nose or sinuses. Benign means it is not cancerous — but that does not mean it is harmless. Polyps can grow large enough to block the breathing pathways through the nose and obstruct the drainage pathways of the sinuses, which leads directly to chronic rhinosinusitis. They are soft, non-painful, and the patient often has no idea they are there — until the symptoms that polyps cause make it impossible to ignore them any longer.

Understanding what polyps are, what they feel like, and how they are identified is the first step toward getting a diagnosis that actually explains what has been happening — and a treatment plan that addresses it.

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The Symptom That Makes Me Most Suspicious

Patients with nasal polyps present with congestion, pressure, post-nasal drainage, and recurring sinus infections — the same constellation of symptoms that many sinus conditions produce. But there is one symptom that makes me most suspicious of polyps specifically, and it is one that patients often do not think to mention because they have adapted to it over time: loss of the sense of smell.

Anosmia — the partial or complete loss of smell — is closely associated with nasal polyposis. As polyps grow and begin to obstruct the upper nasal cavity near the olfactory cleft, airflow to the smell receptors is reduced or eliminated. Patients often describe it as a gradual fading — foods began to taste flat, flowers stopped having a scent, they cannot smell smoke or gas. Some patients have been living with significantly reduced smell for years before they connect it to a sinus problem. When a patient tells me their sense of smell has declined, polyps move immediately to the top of my differential.

What Polyps Look Like — And Where They Grow

When I perform nasal endoscopy and find polyps, what I am looking at is something that resembles a skinless grape or a pearl onion. They are pale, smooth, semi-translucent, and soft. They do not bleed easily when touched. They vary considerably in size — some are small and confined to a single sinus opening, while others grow large enough to fill the nasal cavity entirely and extend beyond it.

It is not uncommon to see polyps extending into the posterior nasal cavity — the space behind the nose that connects to the throat. In advanced cases, they can grow down toward the uvula and into the oropharynx, the back of the throat. When a patient opens their mouth and I can see tissue extending from the nasopharynx downward, that is a polyp that has been there for a long time and has grown without treatment. These cases require surgical intervention — there is no medical therapy that will shrink a polyp of that size back to nothing.

Why CT Scans Can Miss Them — And Why Endoscopy Is Essential

Nasal endoscopy is the gold standard for identifying polyps, and there is a specific reason why CT scans alone can be insufficient. On CT imaging, polyps appear as soft tissue density within the sinus cavity — which looks identical to retained secretions or mucosal thickening from inflammation. A radiologist reading a CT scan may describe “opacification” or “soft tissue density” in a sinus without being able to definitively distinguish polyp tissue from fluid or mucosal swelling. Only direct visualization through the scope confirms what is actually present.

That said, CT imaging is still an essential part of the workup. Once polyps are identified on endoscopy, CT helps us understand how extensively they have filled the sinus cavities, whether they are unilateral or bilateral, and what the anatomy looks like for surgical planning. There is also a grading scale for polyp size — it grades how large they are and how far down toward the floor of the nose they have grown — and that grade guides both the urgency of intervention and the likely surgical complexity.

What Causes Polyps — Allergy, Genetics, or Something Else?

The honest answer is that polyp formation is not fully understood, and it is almost certainly multifactorial. What we do know is that polyps are linked to allergy — the chronic eosinophilic inflammation driven by allergic disease creates the mucosal environment in which polyps tend to form and grow. Fungal infection has also been associated with polyposis, particularly in cases where the immune response to fungal elements in the sinus produces a distinctive type of inflammation. And there is a clear familial pattern — patients who ask me whether their children are at risk for polyps are not being unreasonable. There is enough genetic loading that a family history of polyps should be taken seriously.

Some patients with identical allergy profiles never develop polyps. Others develop them severely. The difference almost certainly lies in the specific immune endotype — the pattern of immune dysregulation — and in individual genetic susceptibility. This is exactly why the new biologic therapies that target specific inflammatory pathways are such a significant advance: they address the immune mechanism driving growth rather than just suppressing inflammation broadly.

Treatment Options — From Steroids to Surgery to Biologics

Surgery is the primary treatment for nasal polyps of significant size, and it serves two purposes. The first is mechanical — removing the obstructing tissue to restore airflow and sinus drainage. The second is diagnostic — the surgical specimen is sent to the pathology laboratory, where cell typing tells us the specific inflammatory profile of the polyps. That information directly guides what medical therapy will be most effective at keeping them from growing back.

And they do grow back. This is one of the most important things I tell patients about polyps: surgery solves the immediate obstruction, but polyps have a strong tendency to recur without effective medical management to control the underlying inflammatory driver.

Steroid nasal sprays are a first-line medical option and can be effective for small polyps or as maintenance after surgery. Adding budesonide to a saline rinse — one respule mixed into the irrigation bottle — delivers corticosteroid directly to the mucosal surface and the sinus cavities in a way that a nasal spray alone cannot reach. This approach has meaningful benefit for patients with mild to moderate disease or post-surgical maintenance.

For patients with more severe polyposis, and particularly for those who also suffer from asthma — a combination that is more common than most patients realize — biologics have been genuinely life-changing. Dupilumab, approved for chronic rhinosinusitis with nasal polyps, targets the Type 2 inflammatory pathway that drives both polyp growth and asthma simultaneously. For the right patient, the response can be dramatic: polyps shrink, smell returns, asthma improves, and quality of life changes in ways that surgery and steroids alone never achieved. These are not cheap treatments, and patient selection matters — but for patients who meet the criteria, they represent a genuine turning point in how polyp disease is managed.

Want to Understand More?

This post is part of the Understanding Your Symptoms section of the Airway & Sinus Wellness Review.

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About the Author

Franklyn R. Gergits, DO, MBA, FAOCO is an otolaryngologist and rhinologist with over 30 years of clinical experience. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale, where he performs in-office balloon sinuplasty, turbinate reduction, NEUROMARK® posterior nasal nerve ablation (Neurent Medical, FDA-cleared radiofrequency ablation system), and Eustachian tube dilation under local anesthesia. He performed the first balloon sinuplasty in Pennsylvania and holds dual Entellus Centers of Excellence certifications. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis, with a preprint available at Preprints.org (DOI: 10.20944/preprints202603.0858.v1). ORCID: 0009-0000-4893-6332.

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This content is for educational purposes only and does not constitute medical advice. If you are experiencing nasal or sinus symptoms, please consult a qualified physician for evaluation and individualized treatment recommendations.