From the Guidelines
Conservative treatment for nasal polyps primarily involves intranasal corticosteroids as first-line therapy, with medications such as fluticasone propionate or mometasone furoate commonly prescribed. For more severe cases, a short course of oral corticosteroids like prednisone may be used to reduce polyp size, followed by maintenance therapy with intranasal steroids 1.
Key Components of Conservative Treatment:
- Intranasal corticosteroids:
- Fluticasone propionate (2 sprays per nostril daily)
- Mometasone furoate (2 sprays per nostril daily)
- Budesonide (1-2 sprays per nostril twice daily)
- Oral corticosteroids for severe cases:
- Prednisone (20-40mg daily for 5-7 days)
- Saline nasal irrigation:
- Using a neti pot or squeeze bottle with sterile saline solution twice daily
- Leukotriene modifiers for concurrent asthma or aspirin sensitivity:
- Montelukast (10mg daily)
- Allergen avoidance and management of underlying conditions like allergic rhinitis or asthma
These treatments aim to reduce inflammation, improve nasal breathing and drainage, and potentially avoid the need for surgical intervention 1. It's essential to note that while these treatments are effective, the management of nasal polyps should be tailored to the individual patient's needs and underlying conditions 1.
Additional Considerations:
- Antibiotics are only indicated if there's evidence of bacterial infection.
- Management of underlying conditions such as allergic rhinitis or asthma is crucial.
- The use of systemic corticosteroids should be limited due to potential side effects, but they can be beneficial in reducing polyp size and improving symptoms in the short term 1.
Overall, conservative management of nasal polyps focuses on controlling symptoms, reducing polyp size, and improving quality of life, with intranasal corticosteroids as the cornerstone of treatment 1.
From the Research
Conservative Treatment for Nasal Polyps
The conservative treatment for nasal polyps typically involves the use of topical corticosteroids, which have been shown to be effective in reducing polyp size and improving symptoms such as nasal congestion and loss of smell.
- Topical corticosteroids, such as fluticasone propionate 2, 3 and mometasone furoate 4, 5, are commonly used in the treatment of nasal polyps.
- These medications can be administered as nasal sprays or drops, and have been shown to be effective in reducing polyp size and improving symptoms in patients with nasal polyps.
- The efficacy of topical corticosteroids in reducing polyp size and improving symptoms has been demonstrated in several randomized, placebo-controlled trials 2, 3, 6, 4.
- In addition to reducing polyp size and improving symptoms, topical corticosteroids may also delay the recurrence of polyps after surgery 6.
- Mometasone furoate nasal spray has been shown to be safe and effective in reducing polyp grade and improving congestion/obstruction, loss of smell, anterior rhinorrhea, and postnasal drip in patients with nasal polyps 4, 5.
Mechanism of Action
The mechanism of action of topical corticosteroids in the treatment of nasal polyps is thought to involve a multifactorial effect on various aspects of the inflammatory reaction, including a reduction in the number of antigen-presenting cells, T cells, mast cells, and eosinophils 6.
Treatment Outcomes
The treatment outcomes for patients with nasal polyps who receive topical corticosteroids can vary, but many patients experience significant improvements in symptoms and reductions in polyp size 2, 3, 4, 5.
- A systematic review and meta-analysis of mometasone furoate nasal spray found that it significantly improved nasal symptoms and reduced nasal polyp size in patients with nasal polyps 5.
- Another study found that fluticasone propionate nasal drops were effective in reducing polyp size and improving symptoms in patients with bilateral nasal polyposis 2.