Nasal polyps are soft, non-cancerous growths that form on the lining of the nasal passages or sinuses. They are a physical manifestation of chronic inflammation, typically occurring where the sinuses drain into the nasal cavity. While small polyps may cause no noticeable symptoms, larger ones can obstruct airflow and drainage, leading to persistent nasal congestion, loss of smell, and recurring sinus infections. Management begins with medication to reduce inflammation and progresses to specialized biologic treatments or surgery when initial methods fail.
Non-Surgical Treatment Methods
The first line of defense against nasal polyps focuses on reducing the inflammation that fuels their growth. Intranasal corticosteroid sprays are the standard initial treatment, working directly on the nasal lining to decrease swelling and shrink the polyps over time. Medications such as fluticasone or mometasone are applied topically, delivering a concentrated anti-inflammatory dose with minimal systemic absorption. Consistent, daily use of these sprays is necessary to improve airflow and restore a diminished sense of smell.
A simple yet effective complementary method is the use of saline nasal irrigation or rinses. This involves flushing the nasal passages with a sterile saltwater solution, often using a neti pot or squeeze bottle. Saline rinses mechanically wash away mucus and irritants that contribute to inflammation. Rinsing the nasal passages before applying the corticosteroid spray can improve the medication’s reach and effectiveness by clearing the path for the drug.
When polyps are large or symptoms are severe, a healthcare provider may prescribe a short course of oral corticosteroids, such as prednisone. Oral steroids offer a powerful, systemic anti-inflammatory effect that can rapidly shrink polyps and relieve severe congestion. This treatment is typically used as a rescue measure to gain control over symptoms or to prepare for topical sprays. Due to potential side effects, oral courses are kept brief, often involving a tapering dose over two to three weeks.
Addressing Complex or Recurrent Polyps
For patients whose polyps persist or return despite consistent use of intranasal steroids and oral medication, advanced non-surgical options are considered. This often represents a severe form of the disease, characterized by a Type 2 inflammatory pattern involving specific immune system components. Underlying conditions like severe asthma or aspirin-exacerbated respiratory disease (AERD) frequently contribute to this chronic inflammation.
Biologic agents, which are monoclonal antibodies, represent a targeted approach for these refractory cases. These injectable or infused medications work by blocking specific signaling proteins—such as Interleukin-4, Interleukin-5, or Immunoglobulin E (IgE)—that drive the Type 2 inflammation responsible for polyp formation. Examples of approved biologics include dupilumab, omalizumab, and mepolizumab, each targeting a different part of the inflammatory cascade.
These treatments are reserved for those with severe disease who have failed standard care. Biologics significantly shrink polyps, improve nasal airflow, and restore the sense of smell. By targeting the root immunological cause, they reduce the need for repeated oral steroid courses and can potentially delay or avoid surgery. Before starting therapy, a thorough diagnostic workup helps confirm the inflammatory profile and determines the most appropriate agent.
Surgical Intervention Procedures
When medical management, including advanced biologics, is insufficient to control symptoms or when polyps cause significant obstruction, surgery becomes a viable option. Surgical intervention aims to physically remove the polyps and correct any anatomical issues contributing to the disease. Pre-operative preparation typically involves a nasal endoscopy to visualize the extent of the polyps and a Computed Tomography (CT) scan to map the anatomy of the sinuses.
A simple polypectomy is a procedure used to remove isolated polyps, often performed through the nostril. This procedure is generally less extensive and focuses only on removing the visible growths. The most common and comprehensive surgical approach, however, is Functional Endoscopic Sinus Surgery (FESS).
FESS is a minimally invasive technique where the surgeon uses an endoscope to navigate the nasal passages. The primary goal of FESS is not just polyp removal but also restoring normal sinus function by opening the natural drainage pathways. During the procedure, small amounts of bone or diseased tissue may be removed to widen the sinus openings. This improves ventilation and allows topical medications to reach the affected areas more effectively. Temporary nasal packing may be used immediately following the surgery to control bleeding.
Long-Term Management and Follow-Up
Removing or shrinking nasal polyps does not eliminate the underlying inflammatory tendency, leading to a high potential for recurrence. Therefore, long-term management focuses on preventing the regrowth of these tissues and maintaining the results achieved through initial treatment.
Continued use of topical therapies is fundamental to this strategy, even after successful surgery or medical shrinking. Daily nasal saline rinses help keep the nasal lining clear of irritants and mucus, while intranasal corticosteroid sprays maintain an anti-inflammatory environment in the sinuses. Managing co-existing inflammatory conditions, particularly asthma and allergies, is also essential for reducing the overall inflammatory burden.
Regular surveillance with the healthcare provider is another component of long-term care. Follow-up appointments, often including an endoscopic check, allow for the early detection of newly forming polyps. Identifying recurrence early permits a prompt return to intensified medical therapy, potentially avoiding the need for further surgery. In cases of severe Type 2 inflammation, biologic agents may be continued long-term to keep the disease under control.