Nasopharyngeal Polyps in Cats: Why They Keep Coming Back and When Surgery Is the Best Option.

By Steve Mehler, DVM, DACVS

A young cat develops chronic sneezing. Another has noisy breathing. A third suddenly develops a head tilt and one constricted pupil.

At first glance, these problems may seem unrelated.

But they can all be caused by the same disease:

Feline inflammatory nasopharyngeal (aural) polyps.

Although these growths are benign, they can significantly affect a cat's quality of life and frequently originate deep within one of the most fascinating structures in feline anatomy—the tympanic bulla.

Understanding where these polyps arise helps explain why some cats are cured with simple traction while others require surgery.

What Is a Nasopharyngeal Polyp?

A feline inflammatory polyp is a non-neoplastic inflammatory growth that most commonly develops from the mucosal lining of the:

• Middle ear (tympanic bulla)

• Auditory (Eustachian) tube

As the polyp enlarges, it can extend:

• Into the external ear canal

• Into the nasopharynx

• Occasionally in both directions simultaneously

Unlike tumors, these lesions do not metastasize.

However, because of their location, they can produce an impressive variety of clinical signs.

Common Clinical Signs

Depending on where the polyp extends, cats may develop:

Nasopharyngeal signs

• Stertor

• Loud breathing

• Chronic sneezing

• Nasal discharge

• Dysphagia

• Gagging

• Open-mouth breathing

Ear signs

• Chronic otitis

• Ear scratching

• Head shaking

• Ear discharge

• Head tilt

• Vestibular dysfunction

• Facial nerve paralysis

Sometimes the neurologic signs are more obvious than the respiratory signs.

The Anatomy Behind the Disease

The feline tympanic bulla is unlike the middle ear of many other species.

Instead of one large chamber, it contains two compartments separated by a thin bony septum.

Ventromedial compartment

• Larger chamber

• Lines much of the middle ear

• Common origin for inflammatory polyps

Dorsolateral compartment

• Smaller compartment

• Houses the auditory ossicles

• Closely associated with important nerves

Running immediately adjacent to the bulla are several critical neurologic structures:

• Sympathetic trunk

• Facial nerve (CN VII)

• Vestibulocochlear nerve (CN VIII)

This close relationship explains why middle ear disease can produce neurologic abnormalities.

Why Does Horner's Syndrome Occur?

One of the classic complications associated with middle ear surgery—or severe middle ear inflammation—is Horner's syndrome.

The sympathetic nerves that supply the eye pass immediately adjacent to the ventromedial aspect of the tympanic bulla.

Inflammation, stretching, or surgical manipulation can temporarily disrupt these nerves.

Cats with Horner's syndrome develop:

• Small pupil (miosis)

• Drooping upper eyelid (ptosis)

• Protrusion of the third eyelid

• Apparent sinking of the globe (enophthalmos)

Fortunately, Horner's syndrome is usually temporary.

Most cats gradually recover over weeks to months as the nerves heal.

How Are Polyps Diagnosed?

Diagnosis often begins with:

• Otoscopic examination

• Oral examination under anesthesia

However, what is visible frequently represents only part of the disease.

Advanced imaging has dramatically improved surgical planning.

A recent retrospective study of 154 cats demonstrated:

• 51% had bilateral disease 

• 98.5% showed involvement of multiple compartments of the middle ear 

These findings highlight why CT has become such a valuable tool before surgery.

CT allows surgeons to determine:

• Which compartments are involved

• Degree of bulla disease

• Surgical planning

• Presence of bilateral disease

Treatment Option 1: Traction Avulsion

The simplest treatment involves grasping the visible polyp and applying steady traction until it detaches.

Advantages include:

• Fast

• Inexpensive

• Minimally invasive

Unfortunately, traction avulsion usually removes only the visible portion.

The inflammatory stalk frequently remains attached within the tympanic bulla.

Because of this, recurrence remains a significant concern.

Published studies report recurrence rates of approximately:

• 35–40% in many modern series

• 50–60% in older reports

• As high as 57–64% in some historical studies

Endoscopic-assisted traction appears to improve these numbers, with reported recurrence rates around 13–14%, likely because visualization allows more complete removal of the stalk.

Treatment Option 2: Ventral Bulla Osteotomy (VBO)

During a ventral bulla osteotomy, the surgeon approaches the middle ear through the underside of the neck.

The tympanic bulla is opened.

The surgeon can then directly visualize and remove:

• The entire inflammatory stalk

• Diseased mucosa

• Inflammatory debris within the bulla

Because the source of the polyp is removed, recurrence rates are dramatically lower.

In the recent study of 154 cats, no recurrences were reported in cats treated with ventral bulla osteotomy during the follow-up period. As with any retrospective study, follow-up duration varied, so these results should be interpreted in that context.

Potential Complications of VBO

Although VBO provides the best long-term disease control in appropriately selected patients, it is not without risk.

Possible complications include:

• Temporary Horner's syndrome

• Vestibular dysfunction

• Facial nerve paralysis

• Mild bleeding

• Rare recurrence

Fortunately, many neurologic complications improve over time.

Should Every Cat Have a Ventral Bulla Osteotomy?

Not necessarily.

Many cats improve after traction avulsion alone.

However, VBO should be strongly considered when:

• CT demonstrates extensive middle ear disease

• The polyp recurs

• Multiple compartments of the bulla are involved

• There is persistent middle ear inflammation

• Neurologic disease suggests significant middle ear pathology

Treatment should always be individualized based on imaging findings, clinical signs, and discussion with the owner.

The Bottom Line

Inflammatory nasopharyngeal polyps are one of the most rewarding diseases to treat in feline surgery.

The key is recognizing that the visible portion of the polyp is often only the tip of the iceberg.

Advanced imaging has shown that nearly all affected cats have multicompartment middle ear involvement, helping explain why simple traction may fail and why ventral bulla osteotomy offers the lowest recurrence rate in appropriately selected cases.

As our understanding of feline middle ear anatomy continues to improve, treatment decisions are becoming increasingly evidence-based—allowing us to tailor therapy to each individual cat and maximize the chances of a permanent cure.

References

Demirutku A, Bektaş Bilgiç E. Feline inflammatory aural polyps: a retrospective imaging-based evaluation. Frontiers in Veterinary Science. 2026;13:1777956.

Muilenburg RK, Fry TR. Feline nasopharyngeal polyps. Veterinary Clinics of North America: Small Animal Practice. 2002;32(4):839-849.

Tremaine WH, Brockman DJ. Feline inflammatory polyps: recurrence following traction-avulsion. Journal of Feline Medicine and Surgery. 2006.

Moissonnier P, et al. Endoscopic-assisted traction avulsion of feline nasopharyngeal polyps. Journal of Small Animal Practice.