The Cat That Sounds Congested but Never Gets Better
If your cat has had a persistent snuffling noise, noisy breathing, or a voice that sounds different, and repeated courses of antibiotics have made little lasting difference, a nasopharyngeal polyp may be the explanation no one has yet considered. These benign fleshy growths are one of the more commonly overlooked causes of chronic upper respiratory signs in cats, particularly younger animals. The good news is that they are not cancerous — but they do need to be found and removed.
What Are Nasopharyngeal Polyps
Nasopharyngeal polyps are non-cancerous, inflammatory growths that arise from the mucous membrane lining of the middle ear or the Eustachian tube — the narrow channel connecting the middle ear to the back of the throat. As they grow, they extend along the path of least resistance, typically emerging into the nasopharynx (the space at the back of the nasal passage, above the soft palate) or into the external ear canal. Occasionally a single polyp will extend in both directions simultaneously.
They are composed of fibrous connective tissue covered by respiratory epithelium, with variable inflammatory cell infiltrate. Despite their size and the problems they cause, they carry no malignant potential.
Who Gets Them and Why
Nasopharyngeal polyps occur most commonly in young cats, with many cases diagnosed before two years of age, though they can occur in cats of any age. There is no strong breed predisposition identified in the available evidence, though some clinicians observe them more frequently in certain populations.
The exact cause is not fully established. Chronic inflammation secondary to feline herpesvirus or calicivirus infection is one leading hypothesis, as these viruses are endemic in cat populations and can cause persistent inflammation of the middle ear and Eustachian tube mucosa. Some researchers have proposed a congenital component in certain cases. The reality is that in most individual cases the precise trigger cannot be identified.
Clinical Signs to Watch For
Respiratory Signs
The most characteristic presentation is noisy breathing — stertor, which is a low snoring or snuffling sound generated in the upper airway, as opposed to the higher-pitched wheeze of lower airway disease. The cat may breathe through its mouth in severe cases, or show laboured breathing during activity. There may be nasal discharge, though this is often secondary to the obstructed drainage rather than infection per se. Cats with large polyps occupying the nasopharynx may have a markedly changed voice or appear to be permanently congested.
Ear Signs
When the polyp extends into the external ear canal, signs overlap with those of ear disease — head shaking, scratching at the ear, head tilt, and occasionally vestibular disturbance if the middle ear is significantly affected. A mass may be visible in the ear canal on otoscopic examination.
Swallowing Difficulties
In some cats, particularly when the polyp is large, there may be difficulties swallowing or a reluctance to eat, as the mass partially obstructs the pharyngeal space.
Reaching a Diagnosis
Diagnosis requires examination under sedation or general anaesthesia. Visual inspection of the nasopharynx — by retracting the soft palate with a dental mirror or using a flexible endoscope — will reveal the polyp if it has extended into that space. Otoscopic examination assesses the ear canals. Advanced imaging, particularly CT scanning, is highly recommended prior to surgery because it defines the precise origin and extent of the polyp, identifies involvement of the middle ear (tympanic bulla), and guides surgical planning. This information directly influences which surgical approach will give the best outcome and lowest recurrence rate.
Treatment
Traction Avulsion
The traditional approach to removal is traction avulsion — the polyp is grasped with forceps and removed by applying steady traction until the stalk breaks. This is straightforward and can be performed with basic equipment under general anaesthesia. However, recurrence rates are relatively high, reported in various studies as anywhere from 25 to 50 per cent, because the origin within the Eustachian tube or middle ear is not addressed.
Ventral Bulla Osteotomy
When CT imaging confirms involvement of the tympanic bulla — or where recurrence has occurred after traction avulsion — a ventral bulla osteotomy (VBO) is recommended. This surgical procedure opens the bulla via an incision under the jaw, allows thorough removal of inflammatory tissue from within the middle ear, and dramatically reduces the recurrence rate to under 5 per cent in most series. It is a more involved procedure but represents the most definitive treatment, particularly for polyps arising from the middle ear.
Post-Operative Considerations
Horner's syndrome — characterised by a small pupil, drooping eyelid, elevated third eyelid, and sunken eye on the operated side — is a recognised complication of VBO due to the proximity of sympathetic nerve fibres. In most cats this resolves spontaneously over weeks to months. Vestibular signs can also occur temporarily. Your vet should discuss these possibilities with you before surgery.
Outlook After Treatment
The prognosis following appropriate treatment is excellent. Most cats recover breathing that is markedly quieter and more comfortable, and the quality of life improvement is often dramatic. Regular monitoring is advisable to detect any recurrence early, and any underlying viral or inflammatory conditions should be managed to reduce the risk of new polyp formation.
Summary for Cat Owners
- Persistent noisy breathing, snuffling, or ear problems in a young cat — especially one that has not responded fully to antibiotics — warrants investigation for a nasopharyngeal polyp.
- Diagnosis requires examination under anaesthesia and ideally CT imaging to plan appropriate treatment.
- Traction avulsion is simple but has a significant recurrence rate; ventral bulla osteotomy offers a much higher cure rate when the middle ear is involved.
- The condition is benign and entirely treatable — early diagnosis leads to the best outcomes.
- Always work with a veterinarian, and consider referral to a specialist if imaging or surgical expertise is required.