Nasal Polyps Treatment: Medication, Surgery, and More

Nasal polyps are inflammatory, soft, teardrop-shaped growths that line the inside of the nose or sinuses on both sides. Not all people with polyps can be cured of them.

For example, people who are diagnosed with chronic rhinosinusitis with nasal polyps (chronic inflammation of the nose and sinus cavities accompanied by nasal polyps), may deal with polyps for years.

“The word ‘chronic’ explains the nature of the disease,” says Alexander Schneider, MD, a board-certified otolaryngologist at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois. “For many patients, it’s a chronic condition that will require multiple forms of treatments across time.” Fortunately, there are several treatments that may help a person manage symptoms and lower the odds of polyps returning — no matter what the cause.

“Polyps look the same, so they have to be classified by a pathologist before you can start treatment,” says Chester F. Griffiths, MD, the director of the eye, ear and skull base center and head and neck surgery and endoscopic skull base surgery at Pacific Neuroscience Institute in Santa Monica, California. Treatment may vary according to the type of nasal polyps you have.

An ear, nose, and throat (ENT) doctor can answer any questions you have and help you decide which treatment options are right for you.

Medication

Several medication options are available to treat nasal polyps.

Nasal Corticosteroids

• budesonide (Rhinocort)
• beclomethasone (Beconase AQ, Qnasl)
• ciclesonide (Omnaris, Zetonna)
• fluticasone (Flonase Allergy Relief, Xhance)
• mometasone (Nasonex 24hr Allergy)

Nasal sprays often require daily administration to be effective, which can be a drawback, Schneider says. How long and how often you take nasal corticosteroids, as well as the dosage, will depend on the severity of your symptoms and whether you take other medications, he says.

Oral Corticosteroids

“Oral steroids are typically very effective in shrinking polyps and improving symptoms,” Schneider says. “However, the effects can be short-lived, and steroids have serious side effects, particularly when used long-term.”

• Fluid retention
• High blood pressure
• Mood swings
• Weight gain
• Upset stomach

• Glaucoma
• Cataracts
• Rounding of the face (also known as “moon face”)
• High blood sugar, which can lead to or worsen diabetes
• Increased risk of infections
• Osteoporosis and fractures
• Thin skin, bruising, and slower wound healing
• Severe fatigue, loss of appetite, nausea, and muscle weakness

Be sure to discuss these side effects with your doctor when deciding whether oral corticosteroids are the right option for you.

Biologic Medications

The newest treatment option for polyps is biologic medication. Biologics are antibodies that target inflammatory signal pathways and chemicals that contribute to the development of nasal polyps, and they are usually given via injection, Schneider says.

• dupilumab (Dupixent), which is by far the most widely used, Dr. Griffiths says
• mepolizumab (Nucala)
• omalizumab (Xolair)

“These biologics have been a game changer in the last five years in treating patients whose polyps have had a significant impact on their health,” Griffiths says.

Surgery

Your doctor may recommend surgery if other treatments haven’t been effective or if you have related diseases, such as asthma or eczema. “These patients may require surgery to open up the sinus cavities so the lining can be treated with topical steroids and prevent the side effects of oral steroids,” says Kathleen Kelly, MD, a clinical assistant professor at the Ohio State University Wexner Medical Center in Columbus.

• Functional Endoscopic Sinus Surgery (FESS) FESS is a minimally invasive procedure in which surgeons insert nasal endoscopes through the nose to magnify and see the sinus tissues. Specialized instruments are then used to remove the nasal polyps and open the sinuses without cutting the skin.

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• Polypectomy This minimally invasive procedure involves a surgeon using very small tools to grab and remove nasal polyps.

Lifestyle Changes

Good hygiene, for example, is essential for keeping the nose and sinuses clear of bacteria and viruses that can cause inflammation of the nasal passages. “I use the analogy of brushing your teeth to prevent a cavity,” Griffiths says. “If you don’t brush your teeth, you will develop cavities.”

• Wash your hands regularly and thoroughly.
• Use an over-the-counter saline (saltwater) spray or nasal wash to rinse allergens and other irritants out of your nasal passages.
• Avoid potential irritants like dust, chemical fumes, smoke, or tobacco.
• Use a humidifier, a machine that adds moisture to the air in your home, to help prevent nasal congestion and irritation.

The Takeaway

• Nasal polyps are small growths that appear inside your nose and sinuses and cause congestion, loss of smell and taste, postnasal drip, and more.
• For many people, the condition and treatment can be lifelong.
• Treatment options include nasal corticosteroid (“steroid”) sprays, oral corticosteroids, sinus surgery, or biologic medications combined with lifestyle changes.