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Most nasal polyps in cats don't start in the nose. They start in the middle ear, then grow down the narrow tube that connects the ear to the back of the throat.1,2 That one fact explains most of what follows. It's why a cat can have a runny nose and a head tilt at the same time, and why antibiotics never fix them. It also explains why some grow back after surgery and others never do.
They're benign, they're the most common cause of nasopharyngeal disease in cats, and surgery works well. The part that usually gets left out is that the regrowth risk isn't small, and two things change it.
Key Takeaways
A feline inflammatory polyp is a benign, fleshy mass on a stalk. It grows from the mucous membrane lining the tympanic bulla, which is the bony chamber of the middle ear, or from the auditory tube running between that chamber and the throat.1,3
From there it takes one of two routes. It can travel down the auditory tube and sit above the soft palate at the back of the throat, which is what people mean by a nasopharyngeal polyp. Or it can push out through the eardrum into the ear canal, where it becomes an aural polyp. Some cats get both.
You'll see them called nasal polyps, nasopharyngeal polyps, aural polyps and feline inflammatory polyps. They're the same lesion named for wherever it ended up. Worth knowing, because the human condition that shares the name is a different thing entirely. Human nasal polyps grow from the lining of the nose and sinuses. A cat's polyp almost never does.
They turn up most often in kittens and young adults, roughly from three months to five years old, though the reported age range runs much wider than that and older cats do get them.1,5 There's no sex or breed predisposition.1
Nobody knows what causes them. Chronic inflammation of the upper airway is the usual explanation, and congenital and genetic causes have both been proposed.1 The obvious suspects have been ruled out reasonably well: when researchers tested 41 polyp samples for feline calicivirus and feline herpesvirus-1, every one came back negative.5 So if your cat has had cat flu in the past, that isn't why this happened.
It depends which way the polyp grew. A polyp sitting in the throat blocks airflow, so those cats sound wrong before they look unwell:
A polyp in the ear canal looks like an ear problem instead: head shaking, discharge from one ear, a head tilt, wobbliness, flicking eye movements, or a face that isn't moving symmetrically.1,2
The pattern I'd pay attention to is chronic and one-sided. A young cat with a stuffy nose that never quite clears, or recurring ear trouble on the same side, is worth a proper look under sedation. Antibiotics may take the edge off a secondary infection and the signs come straight back, because there's a physical obstruction that no drug can shift. Chronic one-sided discharge in a cat is one of the situations where I'd stop reaching for another course of antibiotics and start looking for a cause.
Open-mouth breathing in a cat is never normal and shouldn't wait for a routine appointment. A polyp is one cause of it. So is fluid around the lungs, which is an emergency, and the two aren't something you can tell apart at home.
Diagnosis takes sedation or a short anesthetic. A nasopharyngeal polyp hides above the soft palate, so it can't be seen in an awake cat. Your vet pulls the palate forward with a hook or spay hook and looks behind it, and the polyp is usually right there.2 An otoscope, ideally a video otoscope, checks the ear canal and eardrum on both sides.1
Imaging is the part I'd push for, and it's the step most often skipped. Skull radiographs will show a thickened or fluid-filled bulla in many cats, but CT is far better at it and is what specialists recommend.1,2,3
The scan changes what happens next. In the Veir study, five of 14 cats treated by simple removal had the polyp come back, and every one of those five had middle ear involvement on their radiographs. Of the nine cats whose bullae looked normal, not one had a recurrence.5 Knowing which group your cat is in before surgery is the difference between a reasonable plan and a guess.
The polyp itself should go to the lab afterwards. Polyps are benign, but they aren't the only thing that grows in a cat's throat or ear canal, and histology is what confirms it.2
Surgery, and there are two versions of it.
Traction-avulsion is the simpler one. Under anesthetic, your vet grips the polyp at its base and draws it free with steady, patient traction until the stalk separates. No incision, quick recovery, most cats go home the same day. Getting the stalk out matters, because whatever is left behind is what regrows.
Ventral bulla osteotomy, or VBO, deals with the problem at its source. The surgeon opens the bony middle ear chamber through an incision under the jaw and clears the diseased lining. It's a longer operation with a longer recovery, and it removes what traction can't reach.1,2
| Traction-avulsion | Ventral bulla osteotomy | |
|---|---|---|
| What's involved | Polyp pulled free under anesthetic, no incision | Bony middle ear opened through an incision under the jaw |
| Regrowth rate | 15% to 50% on its own1 | Under 2% to 10%2 |
| Horner's syndrome | About 40%3 | About 80%2,3 |
| Recovery | Usually home the same day | Longer, with an incision to heal |
| Best suited to | Nasopharyngeal polyp with a normal-looking bulla | Middle ear involvement, a polyp that has already come back, or a narrowed ear canal |
Either way, prednisolone afterwards is the part I wouldn't skip. Published protocols use 1 to 2 mg/kg daily for 14 days, then taper over another 14.3 Note the drug: prednisolone, not prednisone. Cats absorb and activate oral prednisone poorly, with a bioavailability around 21% compared to nearly 100% for prednisolone, so the two aren't interchangeable in a cat the way they are in a dog.6
Cats are usually eating and breathing better within a day or two. If yours hasn't gone back to food after 48 hours, give us a call, because cats that stop eating get into trouble faster than dogs do. Pain relief is generally straightforward, and buprenorphine is what most cats go home on after the bigger procedure.
More likely than the phrase "small risk of recurrence" suggests, and this is the number worth having before you agree to a plan.
After traction-avulsion on its own, regrowth is reported in 15% to 50% of cats.1 In the largest long-term follow-up, 22 cats were tracked after removal by traction and nine of them, 41%, had their signs return and needed the polyp taken out again.4 Two cats in five is not a small risk.
Two things move that number, and both are within your control at the time of surgery.
The first is prednisolone. In the same study, none of the cats given prednisolone after traction had a recurrence.4 A later series reported the same pattern.
The second is knowing where the polyp came from. Cats with nasopharyngeal polyps were close to four times more likely to be cured by traction alone than cats whose polyps involved the ear.4 That lines up with the imaging finding above: a normal bulla predicted a clean result, and an abnormal one predicted regrowth.5 Where the middle ear is clearly involved, VBO takes recurrence down under 10%, and one series reported a single recurrence in 13 cats.2,5
If your cat has a nasopharyngeal polyp and a normal-looking middle ear, I'd recommend traction with prednisolone afterwards and expect a good result. If the bulla is involved, or the polyp has already been pulled once and come back, I'd be talking to you about VBO rather than trying traction a second time.
Possibly, and it's worth knowing what it looks like beforehand so it doesn't frighten you.
Horner's syndrome happens when the sympathetic nerve fibres running through the middle ear are disturbed during surgery. On the operated side you'll see a drooping upper eyelid, a smaller pupil, an eye that looks sunken, and a third eyelid raised across the corner. The eye itself is fine. Your cat isn't in pain from it and usually doesn't seem bothered.
It's common. Around 40% of cats after traction and roughly 80% after VBO.2,3 That difference is the trade-off between the two operations. The one less likely to need doing twice is also the one more likely to leave your cat with a droopy eye for a few weeks.
It nearly always resolves on its own, usually within a month, sometimes taking a few months.2,3 No treatment is needed and the outcome stays excellent even in the cats that develop it.2
Good, and better than that when the middle ear gets dealt with properly.
These are benign growths. They don't spread and they aren't cancer. Once the obstruction is gone, most cats breathe normally, eat normally and go back to being themselves, and the recovery from even the larger operation is usually smooth.2
Removal by traction with prednisolone afterwards clears the signs in the large majority of cats with a nasopharyngeal polyp.3 Where the bulla is involved, VBO succeeds first time in around 98% of cases.3 Recurrence is manageable, and it's usually handled by moving to the larger operation.
What I'd watch for at home afterwards is the sound. Snorting or snoring breathing that creeps back in over weeks or months is the first sign of regrowth, and it's easier to deal with early. Same for a head tilt or a return of ear discharge on the operated side.
If your cat is snoring, sneezing on one side, or breathing with an effort you haven't seen before, give us a call at (519) 896-0532 and we'll take a look.
A polyp itself won't shorten your cat's life, but leaving one in place isn't a neutral choice. It's a physical obstruction that tends to grow, and it keeps the airway partly blocked and the middle ear inflamed. Cats left untreated are prone to repeated upper respiratory infections, and a fully obstructed nasopharynx makes eating and breathing genuinely hard work. If your cat has no signs of distress and is eating and breathing comfortably, there's no emergency. If the breathing is noisy, laboured, or open-mouthed, that needs seeing rather than watching. Removal is usually straightforward and most cats are back to normal within a day or two.
It's a benign fleshy growth on a stalk that sits in the nasopharynx, the part of the throat above the soft palate and behind the nose. Despite the name it doesn't start there. It grows from the lining of the middle ear or the auditory tube, then travels down that tube into the throat. The same lesion is called an aural polyp when it pushes out through the eardrum into the ear canal instead, and a feline inflammatory polyp when referring to it generally. They're all the same thing named for wherever it ended up.
There aren't any, and the reason is worth understanding. A polyp is a solid piece of tissue growing on a stalk from the lining of the middle ear. It isn't mucus, congestion, an allergy or an infection, so there's nothing for a steam treatment, a supplement, a saline rinse or a change of diet to act on. Nothing given by mouth or breathed in will dissolve it or shrink it. Steroids can settle the inflammation around a polyp and may make the breathing sound better for a while, which is where the idea that something is working usually comes from, but the polyp is still there and the signs return. The only thing that removes a polyp is physically removing it, and in most cats that's a short procedure under anesthetic with same-day discharge. If cost is the concern, say so directly when you call. That's a normal conversation and there are usually options worth discussing.
No, because nobody knows what causes them. Chronic inflammation of the upper airway is the leading explanation, and congenital and genetic causes have both been suggested, but none of it is settled. Researchers have tested polyp tissue for feline calicivirus and feline herpesvirus-1 and found neither, so a history of cat flu doesn't appear to be the reason. Since there's nothing to prevent, the practical goal is catching one early. Any young cat with chronic one-sided nasal discharge, noisy breathing, or recurring ear trouble on the same side is worth examining properly rather than treating repeatedly for an infection.
Sometimes, and more often than owners are usually told. After removal by traction alone, regrowth is reported in 15% to 50% of cats, and 41% of the cats in the largest long-term follow-up needed the polyp removed a second time. Two things change that. Prednisolone given after the procedure made a large difference in that study, where no cat treated with it had a recurrence. The second is whether the middle ear is involved, which is what imaging tells you. Cats with a normal-looking bulla did well with simple removal, while recurrences clustered in the cats whose middle ear was already affected. Those cats do better with a ventral bulla osteotomy, which brings recurrence below 10%.
I rarely recommend it, but it is there if we need it. A CT shows whether the middle ear chamber is involved, and that's the single best predictor of whether the polyp will come back after simple removal. In one study every recurrence after traction happened in a cat with middle ear involvement, and none of the cats with a normal bulla had one. If the scan is clear, traction with prednisolone afterwards is a reasonable plan. If the middle ear is affected, that's the conversation about a ventral bulla osteotomy instead of pulling the polyp and hoping. Skull radiographs are a cheaper starting point and will show some of this, but they miss more than CT does.
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