Nasal polyps and sinus infections are two conditions connected in several ways, including their symptoms and how each may lead to the other.
Nasal polyps are painless lumps of soft, noncancerous tissue growing on the lining of the sinuses or nasal passages. They hang down like grapes or teardrops singly or in clusters. They are caused by chronic inflammation and are frequently associated with sinus infections, allergies, some immune disorders, and other health problems.
Both sinus infections and nasal polyps can block the nasal passages, causing facial pain and a reduced sense of smell. These symptoms are often nonspecific, meaning they are seen in many conditions, so it can be confusing to determine the exact cause of the problem. If you are having frequent sinus infections, it may be a sign of nasal polyps.
This article will discuss the connection between nasal polyps and sinus infections, as well as polyps' symptoms, causes, and treatment.
The Link Between Nasal Polyps and Sinus Infections
Sinus infections (rhinosinusitis) are classified as chronic when they last for more than 12 weeks. Nasal polyps are commonly seen in people who have chronic inflammation of the sinuses.1 How they develop is not well understood, but chronic inflammation is at the root of most theories.
Nasal polyps are inflammatory growths that are likely develop due to a complex interplay of factors that include those involving the immune system and genetics. Viruses, bacteria, and fungi can trigger immune and inflammatory reactions that damage the lining of the nasal surfaces.
In some people, the chronic inflammation they experience leads to growth of cells and blood vessels that form a polyp.2
Small polyps may not cause any symptoms, but large polyps that block the nasal passages can severely impact breathing, sleeping, and overall quality of life.
Even more, polyps may become a breeding ground for infection, worsening existing infections and causing new ones due to constant irritation and the breakdown of nasal epithelial tissue, which is tissue that lines body surfaces, including the nasal cavity.1
Symptoms and Causes of Chronic Sinusitis with Nasal Polyps
Chronic infection of the sinuses can lead to inflammation that stimulates the formation of nasal polyps. Viruses and bacteria may cause these infections, but a person may have immune system factors that result in their symptoms lingering and going from acute to chronic.1
Also, polyps themselves can cause infections. If your nose is constantly blocked, irritation can cause the epithelial tissue in the nose to break down, leading to inflammation and a buildup of fluid. This fluid allows bacteria to grow. Chronic inflammation of the sinuses makes the area more prone to viral and bacterial infections, adding to the cycle of polyp growth and generation.1
During the early stages of polyp formation, you may not experience any symptoms, but as polyps get larger and larger and the obstruction worsens, you may develop symptoms, including:3
- Nasal congestion
- A runny nose
- Postnasal drip
- Decreased sense of smell (anosmia)
- Decreased sense of taste
- New episodes of snoring
- Facial pain
- Difficulty breathing through the nose
If your polyps block most of your nasal passage, you may experience symptoms such as:
- Insomnia (trouble sleeping)
- Frequent asthma attacks
- Severe headaches
- Difficulty breathing
- Impaired concentration4
- Vision changes
These symptoms are caused by reduced oxygen flow to the brain and sinusitis risk.
Sinusitis usually is triggered by bacteria and viruses.5 Allergic reactions to airborne fungi (allergic fungal sinusitis) are a rare trigger of nasal infection. Viruses often cause acute sinus infections, and early symptoms, such as nasal congestion and postnasal drip, resolve on their own.
Lingering symptoms for two or more weeks can indicate a bacterial infection. Of note, antibiotic overuse—which can occur when people mistakenly take these drugs for viruses—can increase your risk of future bacterial infections.5
Chronic sinusitis may be difficult to differentiate from upper respiratory conditions like allergies and asthma because it has similar symptoms, including a runny nose and a reduced sense of smell. Still, symptoms are usually more severe in sinusitis due to long-term swelling of the mucous membranes.
Chronic or recurrent nasal infections by viruses and bacteria are not the only cause of nasal polyps. The following noninfectious conditions may also trigger nasal polyps:6
- Seasonal allergies (such as to pollen) and allergic rhinitis due to contact with antigens like dust mites, cockroaches, and mold spores
- Sensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen)
- Cystic fibrosis: An inherited disorder that creates thick mucus that clogs the airways
- Churg-Strauss syndrome: A rare autoimmune condition causing blood vessel inflammation
If you have difficulty breathing or sleeping, experience vision changes, or have developed a worsening of your symptoms, such as more frequent asthma attacks or more severe headaches, contact a healthcare provider.
If left untreated, nasal polyps can potentially cause sleep apnea. In sleep apnea, your breathing stops and starts repeatedly during sleep. In rare cases, nasal polyps can lead to meningitis, which is inflammation of the protective lining of the brain and spinal cord.6
Managing and Treating Nasal Polyps and Sinus Infection
If you have ever experienced nasal polyps you know that the best treatment is prevention. Living with nasal polyps can be miserable, especially if you are experiencing chronic and severe symptoms like trouble breathing, insomnia, and headache.
The following strategies either kill germs or keep the airways moist and hydrated, thereby preventing sinusitis:7
- Frequent and thorough handwashing, preferably washing for 20 seconds with soap and warm water
- Staying hydrated
- Treating allergies with antihistamines, but only as prescribed since overuse may thicken your mucus and worsen symptoms
- Using a humidifier
- Avoiding nasal irritants, such as passive smoke, high-pollution areas, and allergy triggers, and wearing a high-filtration mask, such as an N95, when avoiding irritants is impossible
- Nasal irrigation using a steam vaporizer, saline sprays, or another nasal irrigation system, including the regular use of a neti pot, which is particularly helpful in reducing nasal polyps and sinusitis symptoms
If these prevention and home treatments are unsuccessful, you may need to consult a healthcare provider. A provider can perform a detailed evaluation of your symptoms and suggest treatments that are right for you.
Medical and surgical treatments include:
- Nasal endoscopy: An ear, nose, and throat doctor (ENT, or otolaryngologist) uses a thin, flexible tube with a tiny camera to examine the nasal passages. This quick and painless procedure is usually performed after an ENT has seen a polyp with an otoscope (a small microscope). Otoscopic visualization is limited. Nasal endoscopy is a better tool to detect nasal polyps in the parts of the airway that are more difficult to see with the naked eye.3
- Topical or intranasal steroid sprays: Topical steroid sprays, like Flonase (fluticasone), are the first-line treatment for nasal polyps.3 Intranasal sprays reduce the size of polyps, relieving nasal congestion, runny nose, and increasing nasal airflow. They also prevent regrowth after surgery.
- Oral antibiotics: Oral antibiotics may be used for bacterial sinusitis.5
- Anti-inflammatory medications: Inflammation is at the root of polyp formation. Therefore, NSAIDs may be used for symptomatic treatment. But beware of the overuse of anti-inflammatory medications, as this may actually be associated with reactive polyp formation.8
- Computed tomography (CT)–guided surgery. CT is particularly helpful at visualizing the tissues in the nasal passages. CT-guided surgery is only recommended if conservative treatment with medical therapy has failed or if your symptoms return or worsen and greatly impact your quality of life.
- Sinus implant: If you have unsuccessful surgery or your polyps remain despite medical therapy, a sinus implant may be a good option for you. Sinuva—a biodegradable polymer that slowly releases polyp-reducing steroids for 30 or 90 days—is an innovative, effective, and proven method to reduce polyps and provide sustained relief. Sinus implants are placed in the nose by an ENT under local anesthesia.9
- Balloon sinuplasty: Balloon sinuplasty is a minimally invasive technique that is used in chronic sinusitis cases, but before polyp formation. A small balloon is inflated in the sinuses, widening the walls of the sinus without irritating the tissues, and improving drainage. Balloon sinuplasty is permanent and is not recommended for those who have large polyps or a prior history of nasal surgery.10
Chronic sinusitis (inflammation of the sinuses) can lead to nasal polyps, which are noncancerous growths in the nasal passages or sinuses. In turn, nasal polyps can lead to further sinus infections. They can cause symptoms such as nasal congestion, runny nose, headache, facial pain, and decreased smell or taste.
Nasal polyps are treated with nasal steroids and sometimes surgery. Lifestyle measures to avoid germs and keep airways moisturized may help prevent sinus inflammation.