Nasal polyps are soft, non-cancerous growths that develop on the lining of the nasal passages or sinuses, often resembling small, peeled grapes. They typically arise from chronic inflammation and are often associated with conditions like chronic rhinosinusitis. If these growths become large or numerous, they can block the nasal passages, leading to symptoms such as congestion, reduced sense of smell, and facial pressure. Many effective non-surgical treatments exist to shrink or manage nasal polyps. This article outlines the medical and self-care strategies available to manage these growths and control the underlying inflammation.
Prescription Treatments for Reducing Polyps
Medical treatment is the first and most effective approach for managing nasal polyps, aiming to shrink the growths and reduce inflammation. The first line of defense is typically topical nasal corticosteroids, delivered directly to the nasal lining via a spray or rinse. These sprays work by suppressing pro-inflammatory substances and inhibiting inflammatory cells in the nasal tissue. Consistent, long-term use of these high-dose topical sprays reduces polyp size and improves symptoms like congestion and loss of smell.
For severe cases where nasal passages are too blocked for a topical spray to be effective, a short course of systemic (oral) corticosteroids may be prescribed. Medications such as prednisone are powerful anti-inflammatory agents that can quickly shrink polyps and restore the sense of smell. However, due to the risk of side effects like insomnia, weight gain, and long-term issues, oral steroids are reserved for temporary use or as a bridge to other therapies, often limited to a few courses per year.
A newer class of advanced treatments involves biological therapies, or “biologics,” administered via injection. These are reserved for patients with severe, recurring polyps that have not responded adequately to standard treatments. Biologics work by targeting specific components of the Type 2 inflammatory pathway, which underlies the majority of nasal polyps. Monoclonal antibodies like dupilumab, mepolizumab, and omalizumab target key inflammatory mediators such as interleukin-4, interleukin-13, interleukin-5, or immunoglobulin E (IgE). By blocking these specific signals, biologics significantly reduce polyp size, improve nasal function, and decrease the need for oral steroid use.
Self-Care Techniques for Symptom Management
While prescription treatments target the polyps, simple daily self-care techniques can manage symptoms and improve overall nasal hygiene. The most commonly recommended technique is saline nasal irrigation, which involves flushing the nasal passages with a saltwater solution using a neti pot or squeeze bottle. This process washes away thick mucus, allergens, and irritants, helping to reduce local inflammation and improve the effectiveness of nasal sprays.
It is crucial to use only distilled, sterile, or previously boiled and cooled tap water for nasal irrigation. Using unsterilized tap water carries a risk of introducing harmful organisms, such as the Naegleria fowleri amoeba, into the nasal passages. Saline solution can be purchased pre-mixed or made at home using non-iodized salt and baking soda to ensure the solution is isotonic and less irritating.
Other home-based methods focus on keeping the nasal environment moist, which helps thin mucus and ease congestion. Using a humidifier, particularly at night, adds moisture to the air and helps soothe dry, irritated nasal tissues. Steam inhalation, suching as taking a steamy shower, can also temporarily loosen mucus and clear the airways. Over-the-counter decongestant sprays offer temporary relief but must be limited to a few days to avoid “rebound congestion.”
Managing Chronic Inflammation and Triggers
Since nasal polyps manifest as chronic inflammation, long-term management relies on identifying and controlling the underlying triggers. One of the first steps involves allergy testing to pinpoint environmental factors, such as pollen, dust mites, or pet dander, that perpetuate the inflammatory cycle. Effective management of co-existing conditions, like asthma, is also important, as the two conditions often share a common inflammatory pathway.
For some individuals, inflammation is triggered by aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs), a condition known as Aspirin-Exacerbated Respiratory Disease (AERD). Managing this requires strict avoidance of these medications or, in some cases, undergoing an aspirin desensitization protocol under medical supervision. Patients should also avoid known environmental irritants, including tobacco smoke, chemical fumes, and intense odors, which directly irritate the nasal lining.
Dietary adjustments can support the management of systemic inflammation. Consuming foods rich in anti-inflammatory properties, such as fruits, vegetables, and sources of omega-3 fatty acids, supports overall health. Attention to a healthy lifestyle, including regular exercise and sufficient sleep, contributes to a robust immune response and helps reduce the severity of chronic inflammatory conditions.
Indicators That Surgery May Be Necessary
While non-surgical treatments are effective for most people, surgery becomes the recommended course of action in specific circumstances. Endoscopic sinus surgery is reserved for patients whose symptoms remain severe and uncontrolled despite maximum medical therapy, including topical corticosteroids, oral steroids, and potentially biologics.
Indicators that a specialist might recommend surgery include total nasal obstruction that prevents normal breathing and sleep, or a persistent loss of the sense of smell (anosmia). Surgery is also considered when polyps cause severe complications, such as structural deformities or vision changes. Furthermore, surgical removal may be necessary to restore normal sinus drainage and clear the airway if polyps cause recurrent, severe sinus infections or contribute to obstructive sleep apnea.