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Nasal Polyp Surgery
Ear, Nose and Throat (ENT)

Nasal Polyp Surgery

About This Department

 
Ear, Nose and Throat

Endoscopic sinus surgery clears nasal polyps and opens the sinuses through the nostrils, with no cut on the face. Breathing improves within weeks. Steroid sprays afterward keep the polyps away.

Nasal polyps are soft, painless growths of swollen lining inside the nose and sinuses, caused by long-term inflammation. They block breathing, dull or remove the sense of smell and cause a constant runny or blocked nose. Steroid sprays and short courses of steroid tablets come first. When these fail, endoscopic surgery removes the polyps and opens the sinuses so that sprays and rinses can reach them. In a national audit of 3,128 patients in England and Wales, quality-of-life scores improved by almost half three months after surgery and stayed improved at three years. Polyps can return, and severe cases now also have a biologic injection option. Send us your CT scan and symptoms, and an ear, nose and throat surgeon will tell you what would help and how long to plan.

42 to 25.5
Average SNOT-22 score before and three months after surgery, 3,128 patients
60 to 70%
Patients free of polyp recurrence 18 months after surgery
5 to 7 days
In Istanbul, including the first check
Free
Surgeon's review of your CT scan
Free consultation

Polyps grow slowly, and many people live with them for years before seeking help.

The audit confirms that sino-nasal surgery is generally safe and effective.
National audit of 3,128 patients, Clinical Otolaryngology, 2006
  1. A blocked nose on both sides that sprays no longer clear.
  2. Loss of smell and taste.
  3. A runny nose or mucus running down the back of the throat.
  4. Facial pressure, snoring and repeated sinus infections.
The evidence does not show that one treatment is better than another in terms of patient-reported symptom scores and quality of life measurements.
Cochrane review of surgery against medical treatment, 2014
What nasal polyps are

Polyps form when the lining of the nose and sinuses stays inflamed for months or years, swelling into soft, grape-like growths that fill the nasal passages and block the drainage channels of the sinuses. They are not cancer. Many people with polyps also have asthma, and a smaller group react to aspirin and similar painkillers, a combination linked to more severe and recurrent polyps. A polyp on one side only, or one that bleeds, needs a biopsy to rule out other conditions.

Steroid sprays shrink polyps in many people, and a short course of steroid tablets shrinks them further for weeks. When symptoms persist despite this, surgery becomes the next step.

Patients electing ESS experienced significantly higher levels of improvement in several outcomes.
Multicenter study, 2011

What happens during surgery?

Planning
A CT scan maps the sinuses and the thin bone near the eye and brain. Navigation systems in some operating rooms track the instruments on the scan in real time.
The operation
Under general anesthesia, through the nostrils, the surgeon removes the polyps with fine instruments and opens the blocked sinuses. No cut on the face. One to two hours.
Waking up
Soft dissolving packing or none at all. Home the same day or after one night, breathing through the nose within days as swelling settles.
Surgery is one part of long-term care
Polyps grow from inflammation that surgery does not cure. Surgery removes the polyps and opens the sinuses so that rinses and steroid sprays can reach the lining, and those treatments continue afterward, for years in many patients, to keep the polyps away.

Aftercare decides the long-term result.

In the first weeks, saline rinses twice or more a day wash out crusts and blood, and a short check at the clinic removes any remaining crusts so that the openings heal wide. Steroid spray or steroid rinses then continue every day. Patients who keep up this routine have fewer recurrences, and the team treats early returns in clinic before the blockage builds up again, in many cases without a second operation. People with asthma report their chest improving as the nose settles, since the two share the same inflammation.

Polyp recurrence is common after ESS with control of polyps up to 18 months found in approximately 60% to 70% of patients.
Prospective multicenter cohort, The Laryngoscope, 2017
Warning signs after sinus surgery
Heavy bleeding that does not stop after fifteen minutes of pressure, swelling or bruising around the eye, double vision, clear watery fluid from the nose, a severe headache with stiff neck, or high fever need the surgeon or an emergency department the same day.
There is some evidence that patient selection for surgery could be improved.
Same national audit, 2006

Who should have surgery?

  1. Symptoms continue despite steroid spray used correctly for at least eight to twelve weeks.
  2. A short course of steroid tablets has been tried, or cannot be used.
  3. A CT scan confirms polyps and blocked sinuses.
  4. The patient accepts that sprays and rinses will continue after surgery.
Medical treatment
Daily steroid spray and saline rinses, with a short steroid course, for two to three months.
Review
Endoscopy in clinic and a CT scan if symptoms persist.
Decision
Surgery, a biologic injection for severe cases, or both, agreed with the patient.

What about biologic injections?

Smell deserves its own mention. Loss of smell is the symptom many patients mind most, and it responds to treatment less predictably than blockage. It returns within weeks in many people once the polyps are gone and the lining calms, more slowly in others, and in a minority who have lost it for many years it does not come back fully. Steroid rinses, smell training with a set of strong scents twice a day, and in severe cases biologic injections give the best chance.

For severe polyps that return despite surgery and steroids, biologic medicines that block the inflammation behind them are an option. In two international trials of 724 adults with severe polyps, dupilumab, an injection every two weeks, shrank the polyps, cleared the sinuses on CT and improved nasal blockage and smell compared with placebo, and was well tolerated. The polyps return in many people when the injections stop, and the medicine is costly, so it is used for patients who need it most, in many cases alongside surgery.

What do the results show?

Three sets of numbers tell the story, the benefit of surgery, how frequently polyps return, and what the newer injections add.

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

National audit of sinus surgery, England and Wales
Measure Result
Patients 3,128 at 87 hospitals
SNOT-22 before and 3 months after surgery, polyp patients 41.0 to 23.1
Score at 12 and 36 months Similar to 3 months
Bleeding during surgery 5 percent
Complications involving the eye 0.2 percent
Revision surgery by 36 months 11.4 percent

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

Polyp recurrence after surgery, US multicenter cohort
Time after surgery Recurrence
6 months 35 percent
12 months 38 percent
18 months 40 percent

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

Dupilumab trials, 724 adults with severe polyps
Outcome at 24 weeks Effect against placebo
Polyp size score Reduced by about 2 points
Nasal blockage Improved
Sinus CT score Improved
Side effects Fewer than with placebo
  • Previous sinus surgery more than doubled the risk of recurrence.
  • More extensive polyps before surgery raised it further.
  • Asthma and aspirin sensitivity are linked to more persistent disease.
In adult patients with severe CRSwNP, dupilumab reduced polyp size, sinus opacification, and severity of symptoms and was well tolerated.
LIBERTY NP SINUS-24 and SINUS-52 trials, The Lancet, 2019

Days, cost and the trip

Plan five to seven days in Istanbul. The first day covers the consultation, endoscopy and review of the CT, the operation follows, and an endoscopic check and cleaning of the nose a few days later confirms healing before you fly. Flying is comfortable once the nose has been cleaned at that check, and saline rinses before the flight ease pressure changes.

Cost depends on the extent of surgery, navigation, the anesthesia and the hospital stay. Your own figure follows the free review of your CT scan.

One coordinator plans the visit, from the visa invitation letter sent ten days ahead to the transfer and a hotel near the hospital for you and a companion. The team works in seven languages with halal meals and a prayer room available, and a female doctor is assigned on request when the schedule allows. Back home, the surgeon reviews your symptoms and any endoscopy photographs from your local doctor and stays reachable on the same WhatsApp number, and the written plan you take home lists the rinse and spray routine, the dates of the first follow-up checks, the signs that the polyps are returning and the point at which a biologic injection or a revision should be discussed, so that your local ear, nose and throat doctor can continue the care exactly where we left it.

Nasal polyp surgery FAQ

Will nasal polyps come back after surgery?
In some patients. In a US multicenter cohort, 60 to 70 percent remained free of recurrence at 18 months, and regular steroid sprays and rinses lower the risk.
Is nasal polyp surgery painful?
Pressure and congestion, more than pain.
Will my sense of smell come back?
It improves in many patients once the polyps are removed and the inflammation is controlled, though not in all.
Are there alternatives to surgery?
Steroid sprays and tablets come first. For severe recurrent polyps, biologic injections such as dupilumab shrink polyps and improve symptoms.
How long will I stay in Istanbul?
Five to seven days, including the check after surgery.
Can my family come with me?
Yes. A companion stays at the hotel we arrange.

References

  1. Hopkins C, Browne JP, Slack R, et al. The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Clinical Otolaryngology. 2006;31(5):390-398.
  2. DeConde AS, Mace JC, Levy JM, et al. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. Laryngoscope. 2017;127(3):550-555.
  3. Smith TL, Kern RC, Palmer JN, et al. Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study. International Forum of Allergy and Rhinology. 2011;1(4):235-241.
  4. Rimmer J, Fokkens W, Chong LY, Hopkins C. Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database of Systematic Reviews. 2014, issue 12, CD006991.
  5. Bachert C, Han JK, Desrosiers M, et al. Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52). Lancet. 2019;394(10209):1638-1650.

Editor's note

Written by the Biruni Hospital medical editorial team. Reviewed by Assoc. Prof. Dr. Selçuk ALVER, Anesthesia and Reanimation.

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