From the Guidelines
Nasal polyp treatment in kids should start with intranasal corticosteroid sprays, and for severe cases, a short course of oral corticosteroids may be prescribed. The first-line treatment for nasal polyps in children is intranasal corticosteroid sprays, such as fluticasone propionate or mometasone furoate, which reduce inflammation and can shrink polyps over time 1. For more severe cases, a short course of oral steroids like prednisone (1 mg/kg/day for 5-7 days, maximum 40 mg) may be prescribed to rapidly reduce polyp size, followed by maintenance therapy with nasal steroids 1. Some key points to consider in the treatment of nasal polyps in children include:
- The use of saline nasal irrigation to clear mucus and improve medication delivery
- The potential addition of antihistamines or leukotriene modifiers if allergies contribute to polyp formation
- The need for specialized treatment approaches for children with cystic fibrosis or aspirin-exacerbated respiratory disease
- The reservation of surgery, such as endoscopic sinus surgery, for cases that do not respond to medical therapy after 3-6 months of consistent treatment 1. It is essential to balance treating the condition while minimizing medication exposure in developing children, as nasal polyps result from chronic inflammation of the nasal and sinus mucosa, often associated with allergies, asthma, or other inflammatory conditions. Intranasal corticosteroids are typically the most effective medication class for controlling symptoms of allergic rhinitis, which is often associated with nasal polyps, and they should be used at the lowest effective dose in children 1. A short course of oral corticosteroids may be appropriate for the treatment of very severe or intractable nasal symptoms or to treat significant nasal polyposis, but single administration of parenteral corticosteroids is discouraged, and recurrent administration of parenteral corticosteroids is contraindicated due to the greater potential for long-term corticosteroid side effects 1.
From the Research
Nasal Polyp Treatment in Kids
- The treatment of nasal polyps in children typically involves medical management, with the goal of reducing inflammation and eliminating or reducing the size of polyps 2.
- Topical corticosteroids, such as mometasone furoate nasal spray, have been shown to be effective in reducing polyp size and improving nasal symptoms in children with nasal polyps 3, 4.
- In some cases, surgical intervention may be necessary, particularly for children with antral choanal polyps or those with recurrent polyps and significant sinusitis 5.
- The use of oral corticosteroids and other medications, such as antileukotrienes and antihistamines, may also be considered in the treatment of nasal polyps in children, although their effectiveness and safety may vary 6.
Treatment Options
- Topical corticosteroids:
- Mometasone furoate nasal spray: effective in reducing polyp size and improving nasal symptoms in children with nasal polyps 3, 4.
- Beclomethasone dipropionate nasal spray and betamethasone nasal drops: effective in reducing polyp size and rhinitis symptoms in adults with nasal polyps, but may also be used in children 2.
- Surgical intervention:
- May be necessary for children with antral choanal polyps or those with recurrent polyps and significant sinusitis 5.
- Other medications:
- Oral corticosteroids: may be used to reduce inflammation and improve symptoms, but their use should be limited due to potential side effects 6.
- Antileukotrienes and antihistamines: may be used to improve symptoms, but their effectiveness and safety in children with nasal polyps are not well established 6.
Safety and Efficacy
- Mometasone furoate nasal spray has been shown to be safe and effective in children with nasal polyps, with no significant differences in adverse events compared to placebo 3.
- Topical corticosteroids, such as beclomethasone dipropionate nasal spray and betamethasone nasal drops, have been shown to be effective in reducing polyp size and rhinitis symptoms in adults with nasal polyps, and may also be used in children 2.
- Surgical intervention is generally safe, but may be associated with complications such as epistaxis and intranasal synechia 5.