What Are Nasopharyngeal Polyps?
Nasopharyngeal polyps are benign, fleshy growths that arise from the mucous membranes lining the middle ear or the Eustachian tube. As they grow, they can extend into the nasopharynx — the area at the back of the nasal cavity above the soft palate — or downward into the external ear canal. Despite being non-cancerous, their location makes them capable of causing significant respiratory and neurological disruption.
These polyps occur almost exclusively in cats, with a strong tendency to appear in younger animals, often under two years of age. This pattern suggests that either a congenital abnormality or early-life infection may play a role in their development, though the exact cause remains uncertain.
What Causes Them?
The precise origin of nasopharyngeal polyps is not fully understood. Current thinking points to chronic inflammation of the middle ear or Eustachian tube as the likely trigger, possibly initiated by an upper respiratory infection. Feline herpesvirus and calicivirus, both common culprits in respiratory illness in young cats, have been proposed as potential initiating factors.
Cats that spent their early weeks in environments with high infection pressure — such as shelters or multi-cat households — may be at slightly higher risk, though polyps can and do occur in cats from any background.
Recognising the Symptoms
The symptoms of nasopharyngeal polyps depend on where the growth is located and how large it has become. Because polyps often develop slowly, signs can be subtle at first and easily attributed to recurrent upper respiratory infections.
- Chronic nasal discharge, typically from one nostril
- Noisy, snuffly breathing, particularly during sleep
- Stertor — a low, snoring-like sound caused by partial obstruction of the airway
- Difficulty swallowing or altered eating habits
- Voice changes or altered meowing
- Head shaking and ear scratching when the polyp affects the ear canal
- Otitis — recurring ear infection producing dark, waxy discharge
When polyps extend into the middle ear or apply pressure to surrounding structures, neurological signs can emerge. Horner's syndrome — characterised by a drooping upper eyelid, a sunken eye, a raised third eyelid, and a constricted pupil — is a recognised complication. Vestibular signs such as head tilt, loss of balance, and circling may also appear.
Diagnosis
A veterinarian examining the back of the throat under sedation or anaesthesia can often visualise a nasopharyngeal polyp directly. The growth typically appears as a smooth, pink, round mass visible when the soft palate is retracted. Otoscopic examination of the ear canal may reveal a polyp protruding from the external canal.
Imaging is important for planning treatment. Skull radiographs can show changes in the bulla (the bony housing of the middle ear), and CT scanning provides the most detailed picture of polyp extent and involvement of the middle ear. CT is particularly useful in guiding the surgical approach and predicting recurrence risk.
Treatment Options
The primary treatment for nasopharyngeal polyps is surgical removal. The approach taken has a major bearing on outcomes, particularly the likelihood of recurrence.
Traction Avulsion
The simplest technique involves grasping the polyp and pulling it free under general anaesthesia. This can be performed via the mouth or through the ear canal depending on the location. It is a quick procedure, but it leaves the stalk of the polyp behind and carries a high recurrence rate — studies suggest that polyps return in roughly half of cats treated this way within a few months to years.
Ventral Bulla Osteotomy
This surgical procedure involves opening the bulla to remove the polyp at its root and clear any inflammatory tissue from within the middle ear. It is technically more demanding and carries a higher risk of short-term complications — including Horner's syndrome and vestibular disturbance — but significantly reduces recurrence rates. Most cats that develop post-operative neurological signs recover fully within weeks to months.
For cats with significant middle ear involvement on CT imaging, ventral bulla osteotomy is generally the recommended approach.
Recovery and Aftercare
Recovery from traction avulsion is typically rapid. Cats are often back to normal eating and behaviour within a day or two. Post-operative care is minimal, though a short course of anti-inflammatory medication may be prescribed.
Recovery from ventral bulla osteotomy requires more time and monitoring. Cats may show balance issues and head tilt immediately after surgery. Owners should be prepared to offer supportive care — providing easily accessible food and water, preventing falls, and monitoring closely for any signs of pain or deterioration. Most neurological signs resolve on their own without additional intervention.
Recurrence: What to Watch For
Even after successful surgical treatment, monitoring for recurrence is important. Signs to watch for include the return of nasal discharge, noisy breathing, ear problems, or any neurological changes. Regular veterinary check-ups in the months following surgery allow early detection if a polyp regrows.
Cats treated with ventral bulla osteotomy have a considerably lower risk of recurrence. If a polyp does return after initial traction avulsion, many surgeons recommend proceeding directly to bulla osteotomy rather than repeating the simpler procedure.
A Manageable Condition With the Right Approach
Nasopharyngeal polyps are a source of genuine discomfort for affected cats, but with appropriate diagnosis and surgical treatment, the outlook is generally good. The key is early recognition and choosing the right surgical strategy. Young cats with recurrent respiratory symptoms, unusual breathing sounds, or chronic ear problems deserve thorough investigation — what seems like a persistent cold may in fact be a very treatable structural problem.