Nasal Polyp Surgery: When You Need It, What to Expect, and How It Compares to Dupixent
If steroid sprays have stopped keeping your nose open and you still can't smell your coffee, you have probably heard two options: nasal polyp surgery or a biologic injection like Dupixent. Both can help. They work in different ways, suit different patients, and are often used together.
Nasal polyps are soft, noncancerous growths in the lining of the nose and sinuses. Most people start with medication. Surgery comes in when medication isn't enough, and it removes the polyps and opens the sinuses so medicine can reach them afterward.
This article covers when surgery makes sense, what recovery involves, how often polyps return, and how surgery compares with Dupixent. Dr. Aaron Feinstein, a board-certified otolaryngologist, evaluates and treats nasal polyps at his office in Tarzana.
What nasal polyps are and why they cause problems
Nasal polyps grow out of long-standing inflammation in the sinus lining, a condition doctors call chronic rhinosinusitis with nasal polyps. Cleveland Clinic's overview of nasal polyps notes they are most common in people with asthma, allergies, repeated sinus infections, or a sensitivity to aspirin and other NSAIDs.
Small polyps may cause no symptoms. Larger ones block airflow and sinus drainage, which can lead to:
a stuffy nose that never fully clears
loss of smell and taste
postnasal drip and sinus pressure
repeated sinus infections
snoring and poor sleep
Polyps are one of several reasons you can't breathe through your nose at night, and an exam with a nasal endoscope shows whether they are the cause.
Medication comes first
Nasal polyps treatment almost always starts with medication. The usual first step is a daily steroid nasal spray, often paired with saline rinses. Nasal corticosteroids reduce sinus inflammation and can shrink smaller polyps.
When sprays aren't enough, a short course of oral steroids can shrink polyps quickly, though the effect fades and repeated courses carry side effects. Antibiotics treat infections that come with polyps but do not shrink the polyps themselves.
If you have used a steroid spray correctly for months and still can't breathe or smell, it's time to look at the next step.
When nasal polyp surgery makes sense
Nasal polyp surgery is usually considered when polyps keep blocking your nose despite steroid sprays and other medication, or when they keep causing sinus infections. Loss of smell that hasn't returned with medication is another common reason.
Before surgery, a CT scan maps which sinuses are involved. Dr. Feinstein has an in-office cone beam CT scanner, so imaging can be done at the same visit as the endoscopy. If your symptoms look more like chronic sinusitis that won't go away than polyps, that workup is the same first step.
Balloon sinuplasty is not a substitute here. It widens sinus openings but removes no tissue, so it isn't used to treat polyps, as Dr. Feinstein covers in whether balloon sinuplasty is permanent. Indiana Sinus Centers' comparison of balloon sinuplasty vs. FESS makes the same point.
What to expect during and after surgery
The operation for nasal polyps is endoscopic sinus surgery. Dr. Feinstein performs endoscopic sinus surgery under general anesthesia, working through the nostrils with a thin camera and specialized instruments. There are no external cuts or scars. He removes the polyps (a polypectomy) and opens the blocked sinuses, while preserving healthy tissue.
Nasal polyp removal recovery
Most patients have dissolving foam packing for the first week after surgery. It breaks down gradually and is flushed out by the saline sinus rinses you'll start using at home. Expect some congestion and drainage while the lining heals, and follow-up visits so Dr. Feinstein can check healing with the endoscope.
Surgery doesn't end the treatment, unfortunately. Steroid sprays or rinses usually continue afterward, and the wider openings let that medicine reach the sinus lining far better than before.
Can nasal polyps come back after surgery?
Yes, and it's better to know that going in. In a multicenter study of patients who had endoscopic sinus surgery for polyps and stayed on medical therapy, polyps had returned in 35% at 6 months, 38% at 12 months, and 40% at 18 months (DeConde et al., 2017). Prior sinus surgery and more severe polyps beforehand raised the risk.
Seen the other way, polyps stayed controlled in roughly 60% to 70% of patients through 18 months. Atkins Expert Sinus Care explains why polyp disease is managed over time in its article on whether nasal polyps can be cured. If polyps do return, options include more medication, a biologic, or revision sinus surgery.
Where Dupixent fits
Dupixent (dupilumab) is one of the biologics for nasal polyps, an injectable medication that blocks two signals, IL-4 and IL-13, that drive the type of inflammation behind most nasal polyps. In the two trials that led to its approval for nasal polyps, 724 adults with severe polyps who were already using steroid sprays received Dupixent 300 mg or placebo every two weeks. Dupixent reduced polyp size, nasal congestion, and sinus disease on CT (Bachert et al., 2019).
It is meant for people whose polyps aren't controlled with standard treatment, often after oral steroids or surgery. DocFinderPro's guide to medical management of nasal polyps walks through where biologics sit alongside sprays and steroids. Dupixent is an ongoing medication: it works while you keep taking it.
There are now a variety of biologic drugs, including Dupixent, Nucala, and Tezspire. Some medications may be more effective for certain patients than others.
Nasal polyp surgery vs. Dupixent
Surgery is a one-time procedure that physically removes polyps and opens the sinuses. Relief from blockage tends to come quickly once healing is done, and it lets topical medication work better. The trade-offs are general anesthesia, a recovery period, and the chance that polyps return.
Dupixent avoids an operation but means injections every two weeks for the long term. It is usually considered for people with severe or recurrent polyps, especially those who have already had surgery or who also have asthma.
The two aren't either-or. Some patients have surgery first and add a biologic if polyps come back. The right order depends on how large the polyps are, your history, and what you prefer.
Frequently asked questions
Can nasal polyps be removed without surgery?
Medication can shrink them. Steroid sprays, oral steroids, and biologics like Dupixent reduce polyp size, but only surgery physically removes them.
Will my sense of smell come back after surgery?
Often it improves, but not always fully. People with long-standing smell loss may not regain all of it.
Can balloon sinuplasty treat nasal polyps?
No. Balloon dilation removes no tissue, so polyps call for endoscopic sinus surgery along with medical therapy.
Do polyps that come back always need another surgery?
No. Recurrent polyps are often managed with medication or a biologic first. Revision surgery is an option when those aren't enough.
Getting help for nasal polyps in Los Angeles
Nasal polyps are manageable, and the right plan depends on an accurate exam and an honest look at what each option can and can't do. For some patients that means surgery, for some a biologic, and for many a combination over time.
If steroid sprays aren't keeping your nose open, Dr. Feinstein sees patients at his office in Tarzana. Contact Dr. Feinstein's office to schedule an evaluation or call (818) 609-0600.