Nasal Polyps: The Unapologetic Troublemakers of Your Sinuses

Life is full of wonderful smells. Fresh baked cookies, your favorite pizza cooking, backyard flowers……. However, for those with nasal polyps, these things may be less enjoyable as none of these things can be sensed via smell.

What Are Nasal Polyps and Why do They Affect Smell?

Nasal polyps are painless growths inside the nose or the sinuses. They are not cancerous. However, they are problematic. As the polyps grow, they can start to block the nose leading to severe congestion or stuffiness. Congestion makes it difficult to breathe through the nose, which can affect the ability to function during the day or sleep comfortably at night. Many polyps are associated with type 2 inflammation. This inflammation affects the olfactory (smell) nerves, thereby reducing or eliminating the ability to smell. In addition, as the polyps start to block the airflow through the nasal passages, they prevent odor molecules from reaching the smell receptors, which also contributes to the inability to smell.

As one of our 5 main senses, the ability to smell not only helps us enjoy and engage in world around us, but it also helps keep us safe. The smell of your favorite food, pine tree at Christmas time, the earthy smell or rain, coffee brewing in the morning- all of these scents are things which bring comfort to our every day lives. Being unable to smell them due to nasal polyps takes away that meaningful part of your life. Then we have smells that maybe we wish we we could not smell- gasoline, smoke, poopy diapers…. However, being able to smell these things is an important part of our natural defenses. Smelling smoke before your house is fully engulfed in flames could save you and your house. Smelling a gas leak and evacuating could save your life. Being able to smell a poopy diaper helps you to know when your baby needs a diaper change. Simply put, smell is important part of our ability to sense our environment around us and respond appropriately. When nasal polyps take away the ability to smell, its problematic on multiple fronts.

What are My Options?

When it comes to how to stop those polyps from causing havoc in your sinuses, you do have options. Current treatments for polyps include:

• Surgery to have polyps removed

• Injectable biologic medications, such as Dupixent

• Nasal steroid sprays or steroidal sinus rinses

Polyps can be tricky. Although surgery to remove the polyps is effective short term, there is a high likelihood of the polyps returning, with studies showing rates of regrowth varying from 35 – 70%.

Although steroidal nasal sprays are widely used, in many cases they are not as effective as surgical intervention or a biologic, especially when polyps are extensive or large. Biologics such as xolair, dupixent, nucala all targets specific cells. When this happens, we block the chain of events that would normally result in the inflammation that causes the polyps. This causes the polyps to shrink, which dramatically improves congestion and in most cases, restores sense of smell. Lets take Dupixent for example. Dupixent works by stopping signaling of IL4 and IL13- two very specific pathways that are responsible for type 2 inflammation. Think about Dupixent as a crossing guard that holds up the stop sign in the road and stops all of the traffic on that particular road. When we stop the traffic on IL4 and IL13, we stop the inflammation, shrink the polyps and restore nasal function.

If you are unable to smell and think you may have nasal polyps or you know you have nasal polyps and are ready to tackle the problem, schedule an appointment today. Our nurse practitioners can discuss your options and set you on the path towards breathing freely and smelling the world!