What is the treatment for nasal polyps?

From the Guidelines

The treatment for nasal polyps typically begins with corticosteroids to reduce inflammation, with short courses of systemic corticosteroids (7-21 days) combined with local corticosteroids being a widely used treatment. This approach is supported by the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 1, which highlights the effectiveness of systemic corticosteroids in reducing the inflammatory response and the size of nasal polyps.

Key Treatment Options

• Intranasal steroid sprays like fluticasone (Flonase), mometasone (Nasonex), or budesonide (Rhinocort) are used daily as first-line therapy.
• For more severe cases, oral corticosteroids such as prednisone (typically 20-40mg daily for 5-7 days) may be prescribed for short courses to rapidly shrink polyps.
• Saline nasal irrigation with devices like neti pots helps clear mucus and improve medication delivery.
• For patients with allergies contributing to polyp formation, antihistamines or leukotriene modifiers may be added.
• Antibiotics are only used if there's a bacterial infection.
• Newer biological therapies like dupilumab (Dupixent) target specific inflammatory pathways and are effective for severe cases, especially those with concurrent asthma or aspirin sensitivity.

Surgical Intervention

If medications fail, endoscopic sinus surgery may be necessary to physically remove polyps and improve sinus drainage, though polyps often recur even after surgery. The use of corticosteroid-eluting sinus implants in the ethmoid has been considered an option for patients with recurrent polyposis after sinus surgery, as it reduces the need for surgery and nasal polyp score, as noted in the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 1.

Treatment Approach

The treatment approach targets the underlying inflammation causing polyps, as they develop from chronically inflamed sinus tissue due to allergies, infections, or immune disorders. The goal is to reduce morbidity, mortality, and improve quality of life for patients with nasal polyps. Studies such as those referenced in the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 1 support the use of corticosteroids and other treatments to manage nasal polyps effectively.

From the Research

Treatment Options for Nasal Polyps

• The primary treatment for nasal polyps involves the use of topical corticosteroids, which have been shown to reduce polyp size and improve symptoms 2, 3, 4, 5.
• Topical corticosteroids such as fluticasone propionate, beclomethasone dipropionate, and budesonide have been demonstrated to be effective in reducing polyp size and improving symptoms 2, 3, 4.
• The use of topical corticosteroids can be used as long-term therapy, either alone or in combination with systemic corticosteroids and/or surgery 3, 4.
• In cases where polyps are large, surgery or short-term systemic corticosteroids may be required, while topical corticosteroids are effective for small to medium-sized polyps 4.

Medical Management of Nasal Polyps

• The objectives of medical management are to eliminate or reduce the size of polyps, re-establish nasal breathing, improve or restore the sense of smell, and prevent recurrence of nasal polyps 3, 4.
• Topical corticosteroids have a multifactorial effect on the inflammatory reaction, reducing the number of antigen-presenting cells, T cells, mast cells, and eosinophils 4.
• The efficacy of topical corticosteroids in reducing polyp size and improving symptoms has been demonstrated in several randomized, placebo-controlled trials 2, 3, 4, 5.

Surgical Intervention and Biologics

• Surgical intervention may be beneficial for chronic rhinosinusitis with nasal polyps (CRSwNP), but there are no evidence-based criteria to indicate when maximum medical treatment has failed 6.
• Biologics such as dupilumab, omalizumab, mepolizumab, and reslizumab may be used in the treatment of CRSwNP, particularly in patients with concomitant uncontrolled asthma 6.
• The use of biologics in the treatment of nasal polyps is still evolving, and further research is needed to determine their effectiveness and optimal use 6.