Nasal polyps are soft, non-cancerous growths that develop on the lining of the nose or sinuses, often resembling small, peeled grapes or teardrops. They form due to chronic inflammation associated with conditions such as asthma, allergies, or recurring sinus infections. Small polyps may not cause noticeable symptoms. However, larger polyps or clusters can block the nasal passages and sinuses, requiring treatment to relieve persistent nasal congestion, difficulty breathing, and loss of smell or taste.
Treating Polyps Without Surgery
Medical management is the first approach used to shrink or eliminate nasal polyps before surgical intervention. The primary goal of these non-surgical treatments is to reduce the inflammation driving polyp formation. This approach is effective for many patients and can often resolve symptoms without an operation.
The most common first-line treatment involves topical corticosteroid sprays, such as fluticasone propionate or mometasone furoate. These sprays deliver potent anti-inflammatory medication directly to the mucosa, helping to decrease swelling and shrink the polyps over time. Since the medication is absorbed locally, long-term use is considered safe and is often continued for maintenance.
For more severe cases, a short course of oral corticosteroids, such as prednisone, may be prescribed for typically five to ten days. Systemic steroids are powerful anti-inflammatory agents that rapidly shrink polyps and improve symptoms. However, due to the risk of side effects, oral steroids are not a long-term solution, and polyps frequently return once the course is finished.
Saline nasal irrigation is an effective technique that supports medical treatment. Using a sterile saline solution to flush the nasal and sinus cavities helps clear thick mucus, remove irritants, and reduce inflammation. This physical cleansing enhances the effectiveness of medicated sprays.
Newer biological therapies represent an advancement for patients with severe, chronic nasal polyps that do not respond well to standard steroid treatments. These injectable medications, such as dupilumab, target specific inflammatory pathways to reduce the underlying Type 2 inflammation. Biologics can significantly reduce polyp size and decrease the need for surgery.
Surgical Removal Procedures
When comprehensive medical therapy fails to control symptoms or polyps cause significant obstruction, surgical removal becomes the necessary next step. The standard procedure is Functional Endoscopic Sinus Surgery (FESS). FESS is a minimally invasive technique performed entirely through the nostrils, requiring no external incisions.
The procedure is typically done under general anesthesia. The surgeon uses an endoscope, a thin tube equipped with a camera and light, to visualize the nasal and sinus cavities. Specialized micro-instruments are inserted alongside the endoscope to carefully remove the polyps and any diseased tissue. The primary goal of FESS is to enlarge the natural drainage pathways of the sinuses.
Widening the sinus openings restores proper ventilation and drainage, which is crucial for long-term sinus health. This improved access also allows post-operative topical medications to reach the deeper sinus cavities more effectively. The procedure usually takes about an hour, and patients often return home the same day.
Post-operative care focuses on managing the surgical site. Patients may wake up with temporary packing inside the nose to control initial bleeding. Minor bleeding, congestion, and discharge are common for one to three weeks as the sinuses heal. Patients are instructed to avoid strenuous activity for about ten days.
Preventing Polyps from Returning
Surgical removal provides immediate relief, but it does not cure the underlying chronic inflammation that causes nasal polyps. Recurrence is common, with many patients experiencing a return of polyps within a decade of surgery. Therefore, long-term maintenance is necessary to sustain the benefits of treatment.
The cornerstone of recurrence prevention is the continued use of topical anti-inflammatory therapy. Patients are advised to maintain a routine of high-volume saline rinses combined with prescribed topical steroids. This daily regimen regularly cleanses the sinuses, controls inflammation, and discourages the formation of new growths.
Regular follow-up appointments with a specialist are important for monitoring the sinus passages and detecting early signs of polyp regrowth. This allows for conservative treatment, such as adjusting the topical regimen or a short course of oral steroids, before polyps cause debilitating symptoms again.
For individuals who experience severe or rapid recurrence, the long-term use of biologic therapies may be integrated into the maintenance plan. These specialized injections help manage chronic inflammation, slowing or preventing the return of polyps and reducing the need for repeat surgeries. Managing associated conditions like asthma and allergies also minimizes the triggers that drive inflammation.