Past research suggests nasal polyps affect up to 4 percent of the population. And while anyone can get nasal polyps, they’re most common in people with asthma, allergies, repeat infections, and chronic rhinosinusitis (long-term inflammation of the nasal passages), per the Cleveland Clinic. Not all patients can be cured of nasal polyps. People who are diagnosed with chronic rhinosinusitis with nasal polyps (chronic inflammation of the nose and sinus cavities accompanied by nasal polyps), for example, may deal with polyps over the long-term. “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 manage symptoms and lower the odds of polyps returning — no matter what the cause. Read on to learn more about nasal polyp treatment options. An ear, nose, and throat (ENT) doctor can answer any additional questions and help you decide which treatment options are right for you.
How Nasal Polyps Are Diagnosed
To diagnose nasal polyps, your doctor will ask about your health history to find out if you have conditions associated with nasal polyps, such as allergies, infections, or asthma, according to the Cleveland Clinic. Then, they’ll use a nasal endoscope (a small thin telescope with a camera on the end) to see inside your nose and confirm the presence of polyps, per Johns Hopkins Medicine. They will also likely take a small sample (a biopsy) to determine what type of polyps you have. “Polyps look the same, so they have to be classified by a pathologist before you can start treatment,” says Chester F. Griffiths, MD, a fellow of the American College of Surgeons and chief of endoscopic sinonasal and skull-base surgery at Pacific Neuroscience Institute in Santa Monica, California. Treatment may vary depending on which type of nasal polyps you have. Nasal polyps most commonly appear in people with chronic rhinosinusitis (CRS). In fact, about 20 percent of patients with CRS have nasal polyps, a condition known as chronic rhinosinusitis with nasal polyps (CRSwNP), according to the American Academy of Allergy, Asthma, and Immunology (AAAAI). The exact cause is unknown, but biopsies reveal that polyps in patients with CRSwNP contain higher levels of an allergic type of cells known as eosinophils, notes the AAAAI. Bacterial infections — especially by bacteria called Staphylococcus aureus — may also play a role. What if you only have polyps or symptoms on one side of your nose or sinuses? “That’s a unique situation, and that would require a biopsy because it could be a tumor,” Dr. Griffiths says. Or, you may have a deviated septum (when one nasal air passage is smaller than the other) or sinus mucocele (a pocket of trapped mucus within the sinus), he notes. In any case, it’s important to get single-sided symptoms checked out by a doctor.
Nasal Polyps Treatment Options
Nasal Corticosteroids
Nasal corticosteroid (“steroid”) sprays, such as fluticasone (Flonase Allergy Relief, Flovent HFA, Xhance), are typically the first-line treatment for nasal polyps, per Johns Hopkins Medicine. Corticosteroid nasal sprays combat the inflammation associated with polyps, Dr. Schneider says. Nasal corticosteroids reduce swelling and irritation and may shrink the polyps or get rid of them completely, according to the Mayo Clinic. Nasal sprays often require daily administration to be effective, “which is 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
If a nasal corticosteroid doesn’t work, your doctor may recommend an oral corticosteroid, such as prednisone, according to the Mayo Clinic. This treatment may be taken alone or in combination with a nasal spray. “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.” According to the Mayo Clinic, the short-term side effects of oral corticosteroids may include:
Fluid retentionHigh blood pressureMood swingsWeight gainUpset stomach
Meanwhile, long-term use may cause the following side effects:
GlaucomaCataractsHigh blood sugarIncreased risk of infectionsOsteoporosis and fracturesThin skin, bruising, and slower wound healingSevere 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.
Functional Endoscopic Sinus Surgery
If you have chronic sinus inflammation or a single polyp, your doctor may recommend functional endoscopic sinus surgery (FESS), according to the Cleveland Clinic. FESS is a minimally invasive procedure in which surgeons insert nasal endoscopes through the nose to magnify and see the sinus tissues, per Johns Hopkins Medicine. Specialized instruments are then used to remove the nasal polyps and open the sinuses without cutting the skin. Your doctor may also recommend FESS 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 avoid the side effects of oral steroids,” says Kathleen Kelly, MD, a board-certified otolaryngologist and a clinical assistant professor at the Ohio State University Wexner Medical Center in Columbus. Research on FESS for CRSwNP nasal polyps is mixed. Surgery is effective at providing short-term relief, according to a past meta-analysis. Long-term rates of recurrence are high, yet still have shown improved symptoms and lower polyp scores (rating of their amount, size, and severity), per a study published in June 2019 in Clinical and Translational Allergy. It’s best to discuss with your PCP and ENT provider the benefits versus risk of a surgical or medical (medication-based) approach. Nasal polyps can recur after surgery, especially if you don’t take postoperative medications as recommended, Schneider says. To prevent nasal polyps from returning, your doctor will likely prescribe a corticosteroid nasal spray, according to Johns Hopkins Medicine.
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. According to the AAAAI, biologics are used to treat moderate to severe asthma, but they can also be used to treat CRSwNP. There are a couple of different biologics, but dupilumab (Dupixent) is by far the most widely used, Griffiths says. It’s also the first medication approved to treat uncontrolled CRSwNP by the U.S. Food and Drug Administration (FDA). Biologics block the body from producing eosinophils, a pro-inflammatory white blood cell that’s elevated in people with nasal polyps. As a result, they treat both asthma and sinus polyps and reduce the need for oral steroids, Griffiths says. “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,” he says.
Lifestyle Changes for the Treatment of Nasal Polyps
Aside from medications and surgery, there are regular habits that can help manage nasal polyps and prevent recurrence. 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.” Good hygiene includes washing your hands regularly and thoroughly, and using an over-the-counter saline (saltwater) spray or nasal wash to rinse allergens and other irritants out of your nasal passages, per the Mayo Clinic. Staying on top of any allergy and asthma medications can also help prevent swelling and irritation in your nose and sinuses that may lead to polyps.
Summary
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.
