Nasal Polyps Treatment in Singapore

What are Nasal Polyps?

Nasal polyps are soft, painless, non-cancerous growths that develop from inflamed lining of the nasal passages and sinuses. They look like small grey-pink "grapes" hanging into the nasal cavity. Crucially, they are not the cause of inflammation — they are the result of it. The underlying problem is chronic, type-2 inflammation of the sinonasal mucosa, which is why polyps almost always come back if the inflammation is not controlled long-term.

Polyps typically affect both sides of the nose. A single, one-sided polyp in an adult is treated very differently and is always biopsied — it can occasionally be an inverted papilloma or, very rarely, a malignancy.

What Conditions are Nasal Polyps Associated With?

Nasal polyps rarely occur in isolation. Most patients have one or more of the following:

• Chronic rhinosinusitis — the most common association; the formal medical term is chronic rhinosinusitis with nasal polyposis (CRSwNP)
• Asthma — about 40% of polyp patients also have asthma; controlling one usually helps the other
• Aspirin-exacerbated respiratory disease (Samter's triad) — the combination of nasal polyps, asthma, and reactions to aspirin/NSAIDs; tends to be more aggressive and recurrent
• Allergic rhinitis — common but not always present; treating the allergy alone is rarely enough to clear polyps (see allergic rhinitis)
• Cystic fibrosis — should be considered in any child or young adult with bilateral polyps

Symptoms of Nasal Polyps

• Progressive, persistent nasal obstruction on both sides — usually the first symptom patients notice
• Reduced or completely lost sense of smell (anosmia) — and with it, much of the sense of taste
• Constant post-nasal drip and a feeling of mucus stuck at the back of the throat
• Facial pressure or fullness across the cheeks and forehead
• Snoring, mouth-breathing, and disturbed sleep from the nasal blockage
• Recurrent sinus infections with thick yellow or green discharge
• Headaches and reduced quality of life — many patients describe years of feeling "perpetually unwell"

How are Nasal Polyps Diagnosed?

Polyps deep in the nose are invisible from the outside. A proper diagnosis needs more than a torch and a tongue depressor:

• Detailed history — duration, smell loss, asthma, aspirin sensitivity, previous surgery, response to medication
• Nasoendoscopy — a thin flexible camera passed gently into the nose. Polyps are seen directly, and their size, side, and position are mapped. The procedure takes about a minute and is performed in clinic with topical anaesthetic.
• CT scan of the paranasal sinuses — the standard pre-operative scan; shows which sinuses are affected, the extent of disease, and important anatomical landmarks (skull base, optic nerve, internal carotid artery)
• Allergy testing — skin prick testing or specific IgE blood tests, since coexisting allergic rhinitis affects long-term management
• Spirometry / asthma assessment — recommended before sinus surgery in any patient with chest symptoms

Treatment Options for Nasal Polyps in Singapore

Medical (Non-Surgical) Treatment — First Line

Mild to moderate polyps are managed medically first. Many patients can be controlled long-term without surgery.

• Intranasal corticosteroid sprays (fluticasone, mometasone) — daily, long-term; safe for years of use; the foundation of treatment
• High-volume saline sinus rinses — using a sinus rinse bottle once or twice daily to physically wash out mucus and allergens; far more effective than ordinary nasal spray
• Steroid-budesonide rinses — adding a steroid into the saline rinse delivers medication deep into the sinuses; used in moderate-severe cases
• Short course oral corticosteroids (prednisolone, 1–2 weeks) — to shrink polyps quickly during a flare or before assessment for surgery; not for long-term use
• Antibiotics — only when there is an active bacterial sinus infection on top of polyp disease
• Treating allergic rhinitis in parallel — antihistamines, allergen avoidance, and immunotherapy where appropriate

Biologic Therapy — Newer Option

For patients with severe, recurrent polyps that do not respond to maximal medical therapy or recur quickly after surgery, biologic injections such as dupilumab (Dupixent) are a major recent advance. These monoclonal antibodies block specific inflammatory pathways (IL-4 and IL-13) and have been shown in clinical trials to shrink polyps, restore smell, and reduce the need for repeat surgery. They are given as a fortnightly subcutaneous injection. Suitability and cost are discussed individually.

Surgery — Functional Endoscopic Sinus Surgery (FESS)

FESS is the gold-standard surgical treatment for moderate-to-severe nasal polyps and is recommended when:

• Polyps continue to block the nose despite optimal medical treatment
• Smell loss has not improved with steroids
• Sinus infections keep recurring
• CT shows widespread sinus disease
• There is suspicion of a one-sided lesion that needs to be biopsied and removed

What FESS Involves

• Day-surgery procedure under general anaesthesia — usually 1.5 to 3 hours depending on the extent of disease
• Performed entirely through the nostrils — no external cuts, no facial swelling, no visible scars
• Image-guided navigation — Dr Pang established the Image Guided Surgery Program at the National University Hospital ENT Department. Image guidance uses the patient's CT scan as a real-time GPS during surgery, allowing safer dissection close to the eye, brain, and major blood vessels — particularly important in revision surgery and extensive polyp disease.
• Polyps and diseased tissue are removed, and natural sinus drainage pathways are widened so that topical medications can reach the sinuses afterwards
• Histology — tissue is sent to confirm the diagnosis and exclude rare alternative pathology

Recovery After FESS

• Mild bleeding and nasal stuffiness for 1–2 weeks while the lining heals
• Most patients resume desk work in 5–7 days; strenuous exercise avoided for 2–3 weeks
• Daily saline sinus rinses from day 1 are essential for a smooth recovery
• Endoscopic post-operative cleaning at 1, 3, and 6 weeks in clinic — gently removes crusts and debris so the new sinus openings stay open
• Smell typically begins to return within 4–6 weeks
• Long-term intranasal steroid sprays continue indefinitely to reduce recurrence

Costs and Medisave

FESS at Mt Elizabeth typically ranges from S$8,000 to S$18,000 depending on the extent of surgery, image guidance, and whether one or both sides are operated. The procedure is Medisave-claimable up to standard surgical limits and is covered by most integrated shield plans (AIA, Great Eastern, Income, Prudential, Singlife, AXA). Our clinic team will provide a detailed written quote and assist with insurance pre-authorisation before surgery.

Long-Term Maintenance — Why Polyps Recur

Surgery clears the polyps but does not cure the underlying inflammation. Recurrence is common when post-operative care is neglected. The patients who do best long-term are those who:

• Continue daily intranasal steroid sprays or steroid rinses indefinitely
• Perform saline sinus rinses every day
• Treat coexisting allergic rhinitis and asthma optimally
• Attend regular ENT follow-up so early recurrence is caught and managed before symptoms return
• Are considered for biologic therapy if polyps recur despite the above

Why Choose Dr Pang for Nasal Polyp Treatment?

• Established the Image Guided Surgery Program at the National University Hospital ENT Department
• Over 20 years of senior ENT practice across the United Kingdom, United States, and Singapore — former Senior Consultant and Clinical Director at NUH ENT
• Sub-specialises in allergy, sinus, and chronic rhinosinusitis — diagnosis, medical management, and surgery all under one specialist
• In-clinic nasoendoscopy and direct access to CT imaging at Mt Elizabeth Medical Centre
• FESS performed as Medisave-claimable day surgery; full insurance pre-authorisation support
• Long-term follow-up plan to minimise recurrence and avoid revision surgery

Read more about sinusitis and sinus surgery at CENTAS.

Frequently Asked Questions