Sinus411.org

The web site for people with sinus problems

How can I tell if I have polyps?   What are the symptoms?

Well, polyps come in different size and shapes, and symptoms from polyps will vary from patient to patient, depending on the size of the polyps, and the patients other medical conditions.    Generally, as polyps swell or get larger the polyps start to fill the nose and cause nasal blockage or obstruction.   Some patients call that “congestion”, but I find that many patients describe “congestion” in many different ways (for instance some say congestion is "fullness of the head" or a different sound to their voice), so I’ll stick to “obstruction” or “blockage” to describe what polyps typically cause. 

As the polyps start to fill more than about 50% of the nose, patients begin to notice the obstruction.   On bad days, the polyps may swell a little more and cause more obstruction, and on good days they may shrink a bit and cause less symptoms.  There are probably many things that cause polyps to swell.   If a person with polyps and allergies, a “bad allergy day” will frequently cause the polyps to swell more and cause more symptoms.  Likewise, treating a patient’s allergies will often cause the polyps to shrink (at least some) and may give some relief from the blockage.

As polyps get larger, say for instance filling 75% to 90% of the nasal cavity, patiens really start to complain of nasal obstruction, and this often motivates them to seek medical care.   We’ll talk about treatment in a moment.

When polyps fill the entire nose, then patients are miserable.  They can’t breath through their nose at all.   They mouth breath during the day and at night.   During the day it becomes difficult to eat when the polyps fill both nasal cavities, because one must chew with their mouth open in order to breath while eating.   Moms golden rule “don’t chew with your mouth open” becomes impossible.

At night, patients can’t breathe through their nose, so they mouth breathe while sleeping.  This is bothersome because the patient’s mouth dries during the night, within a couple of hours, and patients wake up frequently to drink water.   Also, when patients sleep with their mouth open, their tongue falls back into their throat a bit and they tend to snore more, and some become severe snorers.  Patients who already snore some may develop sleep apnea (more on sleep apnea later).  Sleep apnea is when the throat is so narrow that patients stop “moving air”, despite the chest moving,  for more than 10 seconds.   Some patients may not have complete “stoppage” of air (apnea), but may get just a small amount of air with each attempted breath.  This is called “hypopnea”.   Either Apneas or Hypopneas are not normal.   When a patient has more than 10 apnea or hypopneas each hour, they meet the criteria to be called suffering from “sleep apnea”.    So, sometimes nasal polyps can make snoring severe enough to tip a “snorer” over to “sleep apnea”.  Sleep apnea can vary in degree from mild (10-20 apneas or hypopneas per hour) to moderate (20-40 apneas or hypopneas per hour) to severe 40 or more per hour.   Sleep apnea has substantial effect on patients.  As it becomes moderate to severe, patients not only don’t sleep well (tossing and turning because they wake up short of breath), but also at highter risk other problems, including heart disease, heart attack, stroke, memory, and concentration problems.   If you think this may be an issue for someone you know, you should discuss it with your primary care doctor or ENT doctor, lung doctor, allergist, cardiologist  (and some other medical specialists).   The test needed to diagnose this is called a sleep study, and it will identify the presence or severity of the sleep apnea. 

I cant taste anything very well
Patients with medium to large polyps will usually complain of loss of sense of smell and taste.  Why?

Well, the sense of smell occurs at the very top of the nasal cavity in an area of tissue called “olfactory epithelium”.  If you think about your nose as a tall thin triangle, you can imagine that lots of air will pass through the lower (wider) portion of this triangle, but less air will pass though the top of the triangle (where the sense of smell occurs).  The slow passage of air in the top of the nose allows for people to smell odors.  

When there are polyps filling about 50% of the nose or more, the air is blocked and does not reach the area where these smell nerves are located.   When air and odors can’t get to the nerve endings, then a person cannot smell well, or may not smell anything at all.  So what?   People with normal smell say:  “that would be great, I couldn’t smell diapers or skunks”.   Well, unfortunately, its not that simple.   Because most of what we enjoy about eating is not about “taste”, its about the sense of smell that goes with eating food.   Most people don’t realize that the tongue can only taste four things:  sweet, sour, salty, and bitter.  Everything else about the wonderful taste of foods is really related to the sense of smell.   So as polyps obstruct airflow or otherwise limit the sense of smell, patients with polyps complain bitterly about losing their sense of taste.   They complain about foods having little taste, that they can’t enjoy eating, that cooking isn’t “fun” any more, and that they need to salt foods to help with flavoring.   Others are justifiably concerned that they can’t smell smoke, natural gas from stoves that might leak, food that has spoiled, or personal odors that they want emphasize (perfumes) or mask (body odor).   Its quite bothersome to patients, and this sometimes drives them to the doctor for medical and/ or surgical care of their polyps.