Chronic rhinosinusitis with nasal polyps: symptoms and treatment

The NHS says sinusitis is swelling of the sinuses, small empty spaces behind the cheekbones and forehead that connect to the inside of the nose, and that the lining swelling prevents mucus draining properly. Long-term sinus inflammation can occur with nasal polyps. The NHS describes nasal polyps as painless soft growths inside the nose that are not usually serious but can block the nose if not treated. If polyps block the sinuses, symptoms of sinusitis can follow.

Long-term sinus inflammation together with polyps is what the term chronic rhinosinusitis with nasal polyps refers to. NICE describes the severe form as a condition for which usual treatment includes intranasal and systemic corticosteroids and further sinus surgery.

The NHS lists the symptoms of nasal polyps as:

• A blocked nose.

• A runny nose.

• A feeling that mucus is slowly dripping down the back of the throat (postnasal drip).

• A reduced sense of smell or taste.

• Snoring.

The NHS lists pain, swelling and tenderness around the cheeks, eyes or forehead, a blocked or runny nose, a reduced sense of smell, green or yellow mucus and a high temperature as the main symptoms of sinusitis, with headache, toothache, bad breath, cough and a feeling of ear pressure as other symptoms. Sinusitis usually clears within 4 weeks and is usually caused by a virus, so long-lasting symptoms with blockage and loss of smell need a different assessment. The NHS says nasal polyps can sometimes feel like a cold but will not clear up unless treated.

The NHS says it is not clear what causes nasal polyps. It lists asthma and an intolerance or sensitivity to aspirin as things that can increase the risk, and notes that nasal polyps are rare in children. Because asthma is a risk factor, anyone with polyps and wheeze or breathlessness should mention both.

The NHS says a GP should be able to tell whether you have nasal polyps by looking inside your nose. See a GP if you think you may have polyps, have difficulty breathing, your symptoms are getting worse, or you notice changes to your sense of smell. A GP may refer to an ear, nose and throat (ENT) specialist if you still have sinusitis after 3 months of treatment, keep getting sinusitis, or only have symptoms on one side of the face.

The NHS says people with nasal polyps are usually given steroid nose drops or a spray to shrink the polyps, and sometimes steroid tablets, usually for up to 2 weeks, to relieve symptoms. It stresses following the GP's advice about how to use the medicine and for how long. After seeing a GP, a pharmacist can recommend steroid nasal sprays that do not need a prescription and salt water washes, which are not suitable for children. For sinusitis the NHS also mentions a steroid spray used for a few months in some people.

The NHS says that if there is no sign of improvement after about 12 weeks, the GP may suggest surgery to remove the polyps. Most people who have surgery see an improvement, but it is common for polyps to grow back, usually within a few years, and a steroid nasal spray may need to be continued after surgery to stop them returning quickly. For chronic sinusitis the NHS describes functional endoscopic sinus surgery (FESS), done under general anaesthetic, in which the surgeon widens the sinuses by removing blocked tissue or by inflating a tiny balloon in the blocked sinuses and then removing it.

NICE technology appraisal TA1134, published in February 2026, says dupilumab, added to intranasal corticosteroids, can be used as an option for severe chronic rhinosinusitis with nasal polyps in adults if the condition is not controlled well enough by systemic corticosteroids or sinus surgery, they have had at least one sinus operation, and the 22-item sinonasal outcome test (SNOT-22) score is at least 50, subject to the company's commercial arrangement. NICE says clinical trial evidence suggests dupilumab plus usual treatment reduces symptoms and polyp size compared with placebo plus usual treatment in that subgroup, but notes uncertainties.

This is a prescription-only specialist treatment with eligibility criteria, not a first-line option, and decisions rest with an ENT or relevant specialist team.

Most people start with a GP and pharmacy treatment, with ENT referral when treatment fails or symptoms are one-sided. Private ENT can offer nasal endoscopy, CT sinus imaging and surgery sooner. Ask whether medicines have been tried properly first, what improvement in smell is realistically expected, what the chance of regrowth is, and what follow-up treatment will be needed after surgery.