Polypectomy Surgery

What are nasal polyps? How is the treatment done?

Polypectomy is a minimally invasive surgical procedure for patients who suffer from nasal polyps. When medical treatments cannot adequately control the symptoms, surgery is a safe and effective alternative to restore nasal breathing and improve quality of life.

What nasal polyps are

Nasal polyps are benign, soft formations that grow in the lining (mucosa) of the nose and the paranasal sinuses. They are not cancer or a tumor: they are the consequence of chronic inflammation of the mucosa, a condition called chronic rhinosinusitis with nasal polyps. They resemble small drops or grapes and, when they grow, they can block the nose and impair the sense of smell.

Nasal polyposis is frequently associated with allergic rhinitis, chronic sinusitis, asthma and aspirin intolerance. The most common symptoms include persistent nasal congestion, decreased or lost sense of smell and taste, a feeling of pressure in the face, frequent nasal secretions and difficulty breathing through the nose.

Nasal polyps affect about 1% to 4% of the population and become more common with age. The link with asthma and with intolerance to anti-inflammatory drugs (aspirin and NSAIDs) is important: the combination of the three is known as Samter’s triad. People with this presentation tend to have more severe polyps, a more pronounced loss of smell and a higher chance of recurrence, and for this reason they warrant closer follow-up.

Treatment begins with medication

Treatment begins with medication: a continuous-use nasal corticosteroid spray and nasal rinses with saline solution and, during flare-ups, short courses of oral corticosteroids. Surgery is indicated when symptoms persist despite well-conducted clinical treatment. Even after surgery, the nasal spray is maintained to preserve the result and reduce the chance of the polyps coming back.

Indications for surgery

Polypectomy is indicated when clinical treatment with topical or systemic corticosteroids cannot provide adequate relief of the symptoms. The main situations that justify the surgical procedure include:

• Severe nasal obstruction that significantly compromises breathing
• Substantial loss of smell and taste
• Recurrent respiratory infections
• Polyps that do not respond to drug treatment
• Association with severe asthma or refractory chronic sinusitis
• Impairment of the patient’s quality of life

An accurate diagnosis is made through a detailed clinical examination, nasal endoscopy and imaging tests such as a CT scan of the paranasal sinuses, allowing a complete assessment of the extent of the polyps and proper surgical planning.

How the surgery works

Polypectomy is performed using an endoscopic technique, a minimally invasive procedure that uses a nasal endoscope for direct visualization of the internal structures. The procedure is carried out under general anesthesia and lasts approximately 60 minutes to 2 hours, depending on the complexity of the case.

During the surgery, the surgeon uses a microdebrider, a high-precision instrument with a rotating tip capable of simultaneously cutting and aspirating the polyp tissue. This technology allows precise removal of the polyps with minimal bleeding and greater control over the structures being removed.

The procedure requires no external incisions, being performed entirely through the nostrils, which eliminates visible scars. In addition to removing the polyps, complementary procedures are frequently performed to restore the normal anatomy of the nose, such as septum correction, treatment of the turbinates and the opening of the paranasal sinuses.

Advantages and benefits

Polypectomy offers advantages that directly impact patients’ quality of life:

• Significant breathing improvement: removing the polyps restores nasal airflow, providing relief from the obstruction. Studies pooling thousands of patients show a marked improvement in quality of life: the SNOT-22 questionnaire score drops, on average, about 23 points after endoscopic surgery, well above what is considered clinically relevant.
• Recovery of smell: many patients experience substantial or complete recovery of their sense of smell, which is frequently compromised by the presence of the polyps. It is one of the gains most valued by patients.
• Reduction of infections: the surgery reduces sinusitis flare-ups and recurrent respiratory infections, lowering the need for antibiotics and systemic corticosteroids.
• Improved sleep quality: with the airways cleared, patients frequently report better sleep and reduced snoring.
• Safe and minimally invasive procedure: the modern endoscopic technique offers greater precision, less trauma and faster recovery. The risk of complications is low, and most patients can return home the same day.

What about biologic drugs?

In recent years, biologic drugs (immunobiologics) have emerged, such as dupilumab, omalizumab and mepolizumab, indicated for severe cases of polyposis that do not respond well to standard treatment. They act on the inflammation that causes the polyps, reducing their size, improving the sense of smell and quality of life and lowering the need for further surgery. In large studies with dupilumab, the proportion of patients who needed surgery fell substantially. The indication is individualized and made by the otolaryngologist.

Recovery and postoperative care

Recovery from polypectomy is usually quick and uneventful. In the first few days after surgery, it is normal to feel some swelling and tenderness in the nose, as well as temporary congestion due to the healing process.

The surgery is performed inside the nose, without external incisions and without dressings on the face. Often no nasal packing is needed; when it is used, a self-dissolving material that does not have to be removed is preferred, which makes the postoperative period more comfortable. Essential care includes keeping the head elevated while resting, performing nasal rinses as directed and avoiding physical exertion that could cause bleeding.

Most patients return to normal activities within 5 to 7 days, and follow-up appointments serve for cleaning and assessment of healing. Regular medical follow-up is essential to monitor recovery and prevent recurrence, and the continued use of topical medications and nasal rinses helps maintain the results.

Surgery is very effective at clearing the nose and restoring the sense of smell, but polyposis is a chronic disease that can come back. Studies show that about 1 in 5 patients needs further surgery over the years, and this risk is higher in those with asthma or intolerance to anti-inflammatory drugs. For this reason, treatment does not end with surgery: follow-up and continuous use of nasal medication are an essential part of control.

At the practice of Dr. José Eduardo Marcondes, an ENT physician (CRM SP 107711 | RQE 43840), you will find careful assessment and individualized treatment of nasal polyposis, from clinical control to surgical options and biologics when needed. Schedule your appointment in São Paulo (Faria Lima and Morumbi) or in Alphaville.

References

1. Fokkens WJ, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020). Rhinology. 2020.
2. Bachert C, et al. Dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (SINUS-24 and SINUS-52). The Lancet. 2019.
3. Chen FH, et al. Meta-analysis of SNOT-22 outcomes after endoscopic sinus surgery. Otolaryngology-Head and Neck Surgery. 2018.
4. Loftus CA, et al. Revision surgery rates in chronic rhinosinusitis with nasal polyps: systematic review and meta-analysis. International Forum of Allergy and Rhinology. 2020.

This content is informational and does not replace a medical consultation.