Nasal polyps are soft, non-cancerous, teardrop-shaped growths that develop on the lining of the nasal passages or sinuses. They are most commonly linked to long-term swelling, which is often a result of conditions like chronic rhinosinusitis. When inflammation persists, it causes the tissues to become waterlogged, eventually leading to the formation of polyps that can obstruct the nasal passages. This guide outlines the medical and lifestyle strategies available for reducing the size of nasal polyps and managing the associated symptoms.
Non-Invasive Daily Management Strategies
Implementing routine non-invasive strategies helps manage the underlying inflammation and clear the nasal environment. One of the most effective non-prescription methods is high-volume saline nasal irrigation, typically administered using a neti pot or a sinus rinse bottle. This process involves flushing the nasal passages with a large volume of sterile saline solution, which mechanically washes away mucus, irritants, allergens, and inflammatory mediators from the nasal and sinus cavities.
Consistent daily irrigation, often using a hypertonic solution, helps to improve the function of the cilia—the tiny, hair-like structures responsible for moving mucus out of the sinuses. Better ciliary function and clearance of thick secretions can reduce the congestion and pressure that polyps often cause.
Reducing exposure to environmental triggers that exacerbate inflammation is also important. Substances like tobacco smoke, dust, industrial pollutants, and strong chemical odors can irritate the nasal lining and fuel the inflammatory cycle. Using a high-quality air filter in the home and maintaining proper indoor humidity levels can also help soothe irritated nasal tissues. Avoiding known allergens, such as using allergen-proof bedding or limiting outdoor exposure during high-pollen seasons, helps to reduce the overall inflammatory burden.
Prescription Medications for Polyp Reduction
The primary medical approach for actively shrinking nasal polyps centers on the use of corticosteroids. Topical nasal steroids, delivered via a spray or rinse, are typically the first line of prescription treatment recommended for polyp reduction. Medications such as fluticasone, mometasone, and budesonide work by delivering a high concentration of anti-inflammatory medicine directly to the nasal lining.
Consistent daily application of these topical steroids can reduce the swelling of the polyp tissue over time, leading to shrinkage and improved nasal breathing. Because the medication is delivered locally, the risk of systemic side effects is significantly lower than with oral steroids, making them safe and effective for long-term use.
For patients experiencing severe symptoms or large polyps that significantly obstruct breathing, a short course of oral corticosteroids, such as prednisone, may be prescribed. These short-term bursts provide a systemic, high-dose anti-inflammatory effect that can rapidly shrink polyps within days to weeks. Oral steroids are reserved for temporary use to gain rapid control over symptoms or to shrink polyps immediately before a planned surgery, due to the potential for serious side effects.
In cases of severe or recurrent nasal polyps that do not respond sufficiently to standard steroid therapy, newer biologic therapies may be considered. These injectable medications are targeted treatments that work by interrupting specific inflammatory pathways, often those related to Type 2 inflammation. For example, Dupilumab is a biologic approved for chronic rhinosinusitis with nasal polyps, which blocks the signaling of interleukins 4 and 13—key drivers of this chronic inflammation. Biologics can significantly reduce polyp size, improve the sense of smell, and decrease the need for repeated courses of oral steroids or surgery.
Addressing Underlying Inflammatory Conditions
Effective, long-term management of nasal polyps requires addressing the chronic diseases that cause them. Nasal polyps are a hallmark of chronic rhinosinusitis (CRS), a persistent inflammatory condition that needs continuous maintenance treatment. Even after polyps are reduced or removed, ongoing use of topical nasal steroids and saline irrigation is necessary to suppress the underlying inflammation and prevent regrowth.
A significant number of polyp cases are linked to underlying allergies. Identifying and managing these allergies through testing and treatment, such as immunotherapy (allergy shots or drops), can reduce the overall inflammatory burden that fuels polyp formation. While antihistamines and decongestants can provide temporary symptom relief, they do not address the chronic inflammation.
Polyps are often associated with other severe inflammatory co-morbidities, particularly severe asthma and Aspirin-Exacerbated Respiratory Disease (AERD). AERD is a condition characterized by the triad of nasal polyps, asthma, and a sensitivity reaction to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Treatment for AERD often involves aspirin desensitization (AD) following surgery, where the patient is medically guided to take increasing doses of aspirin daily to modify the inflammatory response, which helps slow the rate of polyp recurrence.
Surgical Options for Complete Removal
When medical treatments fail to adequately shrink polyps or control symptoms, surgical removal becomes the necessary next step. The goal of surgery is to remove the visible polyps, improve the drainage pathways of the sinuses, and create a clear space for topical medications to be delivered effectively. The most common procedure is Endoscopic Sinus Surgery (ESS), which is performed entirely through the nostrils using a thin tube equipped with a camera and light.
During ESS, the surgeon carefully removes the polyps and widens the natural openings and drainage pathways of the sinuses. This improves airflow and allows the subsequent use of medicated rinses and sprays to reach the previously obstructed areas, reducing the chance of recurrence. ESS provides immediate, significant relief from obstruction and congestion.
Surgery is a tool for immediate physical removal and structural improvement, but it is not a cure for the underlying chronic inflammatory disease. The long-term success of the surgery depends heavily on consistent post-operative medical management. Patients must continue rigorous use of saline rinses and topical nasal steroids for an extended period to suppress the inflammation and keep the sinuses open, which minimizes the likelihood of polyps returning.