Nasal polyps are soft, non-cancerous growths that develop within the lining of the nasal passages or sinuses. These growths are a common manifestation of chronic inflammation. When they become large or numerous, nasal polyps can obstruct normal airflow and drainage, leading to persistent nasal congestion, reduced sense of smell, and recurring sinus infections. Managing these growths is essential for improving daily comfort and long-term respiratory health.
What Nasal Polyps Are and Common Causes
Nasal polyps form as a result of prolonged swelling and irritation within the nasal and sinus membranes, a condition known as chronic rhinosinusitis. This persistent inflammation causes the tissue lining to become saturated with fluid, eventually forming the drooping, fleshy masses of the polyp. The precise mechanism that triggers this overgrowth is not fully understood, but it is strongly linked to underlying systemic conditions.
The presence of polyps is frequently associated with an inflammatory response driven by a type of immune cell called eosinophils. Common conditions that predispose a person to polyp formation include asthma and chronic rhinosinusitis that lasts for more than 12 weeks. Other significant risk factors involve certain immune responses, such as aspirin-exacerbated respiratory disease (Samter’s Triad) and allergic fungal sinusitis.
Non-Surgical Treatments to Shrink Polyps
The initial and most common approach to shrinking nasal polyps involves targeted anti-inflammatory medications. Topical corticosteroid nasal sprays are considered the mainstay of first-line treatment for reducing the size of existing polyps and alleviating related symptoms. These sprays work by delivering a potent anti-inflammatory agent directly to the nasal lining, which helps to reduce the swelling that contributes to polyp formation. Using a nasal steroid spray consistently helps to decrease the polyp burden.
Regular nasal saline irrigation or rinsing is another effective non-surgical intervention. Using a saline solution helps to mechanically flush out mucus, allergens, and inflammatory particles from the nasal and sinus cavities. This practice clears the nasal passages and enhances the effectiveness of subsequently applied steroid sprays by ensuring the medication can reach the inflamed tissues more effectively.
For individuals experiencing severe flare-ups, a healthcare provider may prescribe a short course of oral corticosteroids, such as prednisone. Oral steroids provide a strong, systemic anti-inflammatory effect that can rapidly shrink polyps and temporarily restore nasal breathing and the sense of smell. However, due to the potential for side effects with long-term use, short courses are primarily used to manage acute symptoms before returning to a maintenance regimen with topical sprays.
When Advanced Interventions Are Necessary
When first-line therapies fail to control symptoms or shrink polyps adequately, more advanced interventions become necessary. Endoscopic Sinus Surgery (ESS) is a procedure used to remove large or obstructive polyps and to widen the drainage pathways of the sinuses. During ESS, a surgeon uses a thin, lighted tube with a camera, called an endoscope, to navigate the nasal passages and excise the growths.
The goal of this surgical removal is to clear the obstruction and create larger openings that allow topical medications to better penetrate the sinuses. Although highly effective for immediate relief, surgery does not address the underlying chronic inflammation, meaning polyps have a high potential for recurrence. ESS is viewed as a way to facilitate better medical management rather than a standalone cure.
Biologic medications represent a significant advance for individuals with severe, refractory chronic rhinosinusitis with nasal polyps. These injectable drugs, which include options like dupilumab, mepolizumab, and omalizumab, are designed to target specific inflammatory pathways within the immune system. By selectively blocking these molecules, biologics can reduce polyp size, improve nasal congestion and sense of smell, and decrease the need for systemic steroids or repeat surgery. These therapies are reserved for patients whose disease remains uncontrolled despite maximum medical therapy and/or surgery.
Long-Term Management and Preventing Recurrence
Preventing the return of nasal polyps requires a dedicated, long-term maintenance strategy, as recurrence rates can be high even following successful treatment. Consistent use of intranasal corticosteroids remains the cornerstone of post-treatment prevention because they continuously suppress the inflammatory environment that causes polyps to grow. These sprays or rinses must be used daily, even when symptoms are absent, to maintain their anti-inflammatory effect.
Regular nasal saline rinsing should also be maintained to keep the nasal passages clear and reduce the buildup of irritants. Managing underlying conditions is an important component of long-term control, including diligent treatment of asthma, allergies, or aspirin sensitivity.
Environmental controls are another practical step in reducing recurrence risk. Avoiding exposure to known irritants, such as tobacco smoke, strong fumes, and industrial pollutants, helps keep the nasal lining less inflamed. Using a humidifier to maintain moisture in the air can also minimize irritation and reduce the chance of recurrent swelling.