Most patients who are told they have nasal polyps are told one of two things: “they are small, let’s monitor them” — or “you need surgery.” Both can be correct. What is rarely communicated is the clinical reasoning behind which applies, why the type of polyp matters as much as the size, and why the loss of smell that accompanies most polyp cases is not simply an inconvenience but a patient safety concern that changes the urgency of treatment.
At Aashwi ENT Hospital in Bodakdev, Ahmedabad, Dr Mihir Mehta evaluates nasal polyp cases with a structured approach — assessing not just the size and location of the polyps but their inflammatory character, the underlying driver, and the patient’s specific risk of recurrence after any treatment. This guide explains what nasal polyps actually are at the cellular level, why two patients with similarly-sized polyps can have very different treatment trajectories, and what the current treatment options involve from least to most intensive.
Nasal Polyps Treatment
What Nasal Polyps Are — and What They Are Not
A nasal polyp is a soft, noncancerous outgrowth of the nasal or sinus mucosal lining. It develops when the mucosal tissue undergoes sustained inflammation long enough that it begins to prolapse — the chronically oedematous mucosa protrudes into the nasal airway, forming a smooth, pale, grape-like mass. Polyps are pale rather than red because they lack the vascular supply of normal mucosa — they are largely oedematous tissue, not inflamed vascular tissue.
What polyps are not: tumours. This is the fear most patients bring to the consultation. A nasal polyp is benign by definition. The concern with polyps is not malignancy — it is obstruction, infection, and olfactory loss. Rarely, unilateral polyps (polyps on one side only) warrant biopsy to exclude uncommon conditions — but bilateral polyps in a patient with a clear history of allergy, sinusitis, or asthma are almost always inflammatory, not neoplastic.
The Two Types of Nasal Polyps — Why the Distinction Matters
This is the clinical distinction that most patients are never told about and that most significantly affects treatment planning.
Eosinophilic nasal polyps are driven by a Type 2 inflammatory cascade — an immune response dominated by eosinophils, IgE antibodies, and interleukins IL-4 and IL-13. This is the same immune pathway responsible for asthma, atopic dermatitis, and allergic rhinitis. Eosinophilic polyps are the more common type in adults in India, particularly those with a personal or family history of atopic disease. They have a specific clinical profile:
- High recurrence rate after surgery — the underlying immune dysregulation that produced the polyps continues to produce them after removal
- Strong association with anosmia — eosinophilic polyps preferentially grow toward the olfactory cleft
- Aspirin sensitivity in a subset of patients — the combination of nasal polyps, asthma, and aspirin intolerance (Samter’s Triad) is the most aggressive eosinophilic polyp phenotype
- Better response to nasal and systemic corticosteroids than non-eosinophilic polyps
Non-eosinophilic nasal polyps are driven by neutrophilic inflammation rather than eosinophilic — more commonly associated with chronic bacterial sinusitis or cystic fibrosis. They are less responsive to corticosteroids, have a lower recurrence rate after surgical removal, and are less strongly associated with systemic atopic disease. In Ahmedabad’s context, chronic bacterial sinusitis from sustained pollution exposure and recurrent infections produces this polyp type in a significant proportion of patients.
The distinction is made through nasal cytology — examination of cells from the nasal mucosal surface — and tissue biopsy at surgery. Knowing the inflammatory type before prescribing treatment avoids applying corticosteroid-heavy regimens to non-eosinophilic polyps that will not respond, and avoids underestimating the recurrence risk of eosinophilic polyps when advising patients about post-surgical management expectations.
Anosmia From Nasal Polyps — More Than an Inconvenience
Loss of smell from nasal polyps is consistently undercommunicated to patients in its practical significance. Most patients understand that losing their sense of smell is unpleasant — fewer understand that it is a patient safety issue.
Smell is the primary warning system for several categories of acute danger: gas leaks, smoke from early-stage fires, the smell of burning food or electrical burning, and the detection of spoiled food before consumption. A person who cannot smell cannot detect any of these hazards reliably. In a household in Ahmedabad using LPG for cooking, anosmia from nasal polyps is not simply a quality-of-life issue — it is a fire and safety risk that deserves the same urgency in treatment planning that it would receive if the patient had described not being able to see clearly.
Olfactory loss from nasal polyps is of two types:
- Conductive anosmia — polyps physically blocking the olfactory cleft, preventing odour molecules from reaching the olfactory epithelium. This type is largely reversible with treatment — when the polyps are reduced or removed, the olfactory nerve fibres are intact, and smell returns as airflow to the olfactory region is restored.
- Sensorineural anosmia — prolonged obstruction leads to olfactory nerve fibre loss from disuse and direct inflammatory damage. This type is less reversible and is the reason that early treatment of polyp-related anosmia produces better olfactory outcomes than delayed treatment. Waiting until “the polyps are bigger” before treating anosmia from polyps risks permanent olfactory nerve damage.
At Aashwi ENT Hospital, Dr Mihir Mehta discusses the reversibility of anosmia with every polyp patient at the first consultation — specifically because this changes the urgency calculation for patients who are inclined to defer treatment.
Predicting Recurrence — The JESREC Score
Not all nasal polyps recur at the same rate after treatment. Knowing a patient’s individual recurrence risk allows the management plan to be calibrated appropriately — avoiding under-treatment of high-recurrence patients and avoiding over-treatment of those whose polyps are unlikely to return.
The JESREC score (Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis) provides a validated recurrence risk prediction tool based on:
- Bilateral polyposis (versus unilateral) — higher recurrence
- Peripheral blood eosinophil percentage — higher eosinophil count predicts higher recurrence
- Blood IgE level — elevated IgE associated with higher recurrence
- CT findings of ethmoid sinus involvement — more extensive ethmoid disease predicts recurrence
A high JESREC score identifies patients who are likely to need biological therapy, long-term maintenance medication, and more frequent post-surgical surveillance rather than the standard post-operative protocol. A low score identifies patients who are likely to remain in remission with standard post-operative nasal spray and occasional follow-up.
This risk stratification is one of the aspects of nasal polyp management that Dr Mihir Mehta applies at Aashwi ENT Hospital — because treating all polyp cases the same way regardless of individual recurrence risk is one of the most common reasons patients experience “my polyps keep coming back” despite multiple surgeries.
Treatment Options — Matched to Polyp Type and Recurrence Risk
- Nasal corticosteroid spray — first-line for small and early polyps: Daily intranasal corticosteroid spray reduces eosinophilic mucosal inflammation and can shrink small polyps over six to twelve weeks of consistent use. It is first-line treatment and is most effective for early, small polyps in patients who have not yet developed significant nasal obstruction or sinus disease. Technique matters — the spray must be directed toward the polyp mass rather than the septal wall, which requires a specific head-forward, spray-lateral technique.
- Short-course oral corticosteroids — for moderate polyps and anosmia: A seven- to fourteen-day course of oral prednisolone produces rapid reduction in polyp size and often dramatic restoration of smell within days of starting. This produces an immediate quality-of-life improvement and confirms the diagnosis of eosinophilic polyps — non-eosinophilic polyps respond far less dramatically to oral steroids. It is not a long-term solution — polyps typically regrow weeks to months after the steroid course ends — but it provides rapid relief and guides treatment planning.
- Functional Endoscopic Sinus Surgery (FESS) — for moderate to large polyps: When polyps are producing significant nasal obstruction, when anosmia has been present for more than a few months, when sinus disease accompanies the polyps, or when medical treatment has not produced adequate reduction — endoscopic surgery removes the polyps and opens the sinus drainage pathways. The surgery is performed entirely through the nostrils, under general anaesthesia, with no external incisions. Recovery takes two to three weeks, with follow-up endoscopy at one and four weeks to clear post-operative crusting and confirm sinus openings remain patent.
FESS does not cure the underlying inflammatory tendency. It removes what is present. Post-operative maintenance — daily nasal spray, saline irrigation, allergy management — is what prevents recurrence. Patients who discontinue maintenance after surgery have significantly higher recurrence rates at two years than those who continue it.
- Biological therapy — for refractory high-recurrence eosinophilic polyps: Dupilumab — a monoclonal antibody targeting the IL-4 receptor alpha subunit — blocks both IL-4 and IL-13, the two interleukins central to the eosinophilic inflammatory cascade. In patients with severe eosinophilic polyps that have recurred after surgery or who are not surgical candidates, dupilumab injections every two weeks produce significant polyp reduction, restoration of smell in many patients, and reduction in the frequency and severity of recurrence. Clinical trials have shown a 50 percent or greater reduction in polyp score in the majority of treated patients.
Dupilumab is appropriate for patients with confirmed eosinophilic polyp phenotype, high JESREC score, previous recurrence after surgery, or coexisting asthma that makes surgery higher-risk. It is significantly more expensive than other treatment options — and requires ongoing treatment to maintain effect. Dr Mihir Mehta discusses biological therapy candidacy at the consultation for patients who meet the clinical profile.
Frequently Asked Questions
How long does it take for nasal polyps to grow back after surgery?
This depends entirely on the eosinophilic load and the quality of post-operative maintenance. Patients with high JESREC scores who discontinue nasal spray after surgery often see recurrence within six to eighteen months. Patients with lower recurrence risk profiles who maintain consistent daily nasal spray and manage underlying allergy have substantially lower and slower recurrence — many remain polyp-free for five years or more after a single surgical intervention. The post-operative maintenance phase is as important as the surgery itself.
Can nasal polyps cause snoring?
Yes — large nasal polyps causing significant nasal obstruction force habitual mouth breathing, which repositions the tongue base and soft palate in a way that increases airway resistance during sleep and worsens snoring. In some patients, the snoring and sleep quality impairment is the presenting complaint rather than nasal obstruction. Treating the polyps restores nasal breathing and often significantly reduces snoring without any specific sleep apnea intervention.
Is there a test that confirms whether my polyps are eosinophilic or not?
Nasal cytology — examination of cells obtained by gently wiping the nasal mucosal surface — can identify an eosinophilic versus neutrophilic inflammation pattern. Full confirmation requires tissue biopsy from the polyp itself, typically obtained at the time of surgical removal. Blood eosinophil count and total IgE level provide supporting evidence. At Aashwi ENT Hospital, Dr Mihir Mehta incorporates these markers into the treatment planning for every polyp case.
Will my sense of smell return after nasal polyp treatment?
If the anosmia is primarily conductive — from polyps blocking the olfactory cleft — smell typically improves within days to weeks of treatment, whether medical or surgical. If olfactory nerve fibre loss has occurred from prolonged obstruction, recovery is partial and slower, taking weeks to months, and is less complete the longer the anosmia was present before treatment. This is one of the strongest clinical arguments for treating nasal polyps before anosmia becomes established rather than after.
Do I need to use nasal spray forever after polyp surgery?
For patients with eosinophilic polyps and moderate-to-high recurrence risk, yes — daily maintenance nasal corticosteroid spray is a long-term commitment, not a temporary post-operative measure. The underlying immune dysregulation that produced the polyps persists after surgery. The spray suppresses the mucosal inflammation that would otherwise allow polyps to reform. Stopping it consistently produces earlier recurrence. For patients with lower recurrence risk and non-eosinophilic polyps, a shorter maintenance period followed by monitoring is appropriate.
Where can I get nasal polyps assessed and treated in Ahmedabad?
Dr Mihir K. Mehta at Aashwi ENT Hospital, Bodakdev, Ahmedabad provides nasal endoscopy, CT sinus assessment, nasal cytology, and full nasal polyp evaluation and treatment — from medical management through endoscopic surgery. The hospital is at 25, Sumangalam Co-op Housing Society, Drive-In Road, opp. Sunset Drive Cinema, Bodakdev, Ahmedabad – 380054. Contact: +91 997 989 1672.
“Monitor Them” Is Not a Management Plan
Small polyps can be monitored — but monitoring requires defined checkpoints, a clear trigger for active treatment, and an understanding of the anosmia risk that accumulates during observation. Monitoring without a plan is simply deferring the treatment conversation until the polyps are large enough that the options are fewer.
Dr Mihir Mehta at Aashwi ENT Hospital provides the endoscopic assessment, the inflammatory phenotyping, and the recurrence risk estimation that converts a “wait and see” situation into a structured management decision.
Book your nasal polyp assessment today.
Aashwi ENT Hospital — 25, Sumangalam Co-op Housing Society, Drive-In Road, opp. Sunset Drive Cinema, Bodakdev, Ahmedabad – 380054 
+91 997 989 1672 
Dr Mihir K. Mehta — MBBS, DLO, MS-ENT | 23+ Years ENT Experience
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Dr Mihir Mehta, Satellite, Ahmedabad | Top ENT, Throat, Nose, Sleep Apnea Doctor, Specialist