Nasal polyps are non-cancerous, teardrop-shaped growths that develop in the lining of the nasal passages or sinuses, usually resulting from chronic inflammation. As they grow, polyps cause persistent symptoms, including nasal congestion, a runny nose, facial pressure, and a significant reduction in the sense of smell. While surgery is an option, long-term care primarily involves medical strategies aimed at shrinking these growths and managing the underlying inflammatory process. This approach is often successful in restoring breathing and improving quality of life without an operation.
Prescription Medications to Shrink Polyps
The most common and effective non-surgical approach involves prescription anti-inflammatory medications. Topical nasal corticosteroids are the first-line treatment, delivered as sprays directly into the nasal cavity. Medications like fluticasone or mometasone work by delivering an anti-inflammatory agent directly to the nasal lining to decrease swelling and reduce polyp size. These topical sprays are minimally absorbed, making them a safe option for long-term daily use to prevent recurrence.
For individuals experiencing severe obstruction where sprays cannot effectively reach the polyps, a short course of oral corticosteroids, such as prednisone, may be prescribed. This treatment provides a rapid, non-specific anti-inflammatory response that can quickly shrink large polyps and restore the sense of smell and nasal airflow. Because of potential side effects, including insomnia, weight gain, and effects on bone density, oral steroids are limited to a short duration. Polyps frequently regrow and symptoms often return after the course is completed, necessitating a maintenance plan.
Biologic therapies are injectable medications used for people with severe or recurrent disease that has not responded well to topical steroids. These drugs are monoclonal antibodies designed to target specific inflammatory pathways associated with Type 2 inflammation. Approved biologics like dupilumab, mepolizumab, and omalizumab inhibit molecules such as IL-4, IL-5, or IgE, which drive chronic inflammation.
These treatments can significantly reduce polyp size, improve nasal function, and decrease the need for oral steroid courses or surgery. They are typically administered via injection every two to four weeks, often self-administered at home after initial instruction. Biologic therapy offers sustained control for patients whose condition is rooted in chronic, severe inflammation.
Treating Underlying Causes of Inflammation
Successful long-term management depends on addressing the root causes of inflammation. The most common underlying condition is chronic rhinosinusitis, which is persistent inflammation of the sinuses lasting more than twelve weeks. Controlling this inflammation is fundamental to preventing polyp growth and recurrence.
Asthma and allergies must be managed effectively, as they often coexist with polyps. Allergens such as pollen, dust mites, or pet dander can trigger a cycle of inflammation that encourages polyp formation. Identifying specific triggers through allergy testing allows for targeted management, which may include prescribed antihistamines or long-term strategies like immunotherapy (allergy shots).
Chronic inflammation may be compounded by a bacterial or fungal infection, requiring antibiotics or antifungals to clear the affected sinus cavities. Aspirin-Exacerbated Respiratory Disease (AERD) involves a sensitivity to aspirin and other NSAIDs. For AERD patients, a specialized medical regimen called aspirin desensitization may be recommended to reduce inflammation and slow polyp regrowth.
At-Home Management and Lifestyle Adjustments
Beyond prescription medications, several steps can be taken at home to manage symptoms and support the health of the nasal lining. Regular nasal saline irrigation is essential. This process involves flushing the nasal passages with a sterile, lukewarm saline solution using a neti pot or a specialized squeeze bottle device.
Saline rinsing helps remove thick mucus, environmental irritants, and allergens from the nasal and sinus cavities, which reduces local inflammation. It also moistens the nasal lining, improving the function of the cilia that clear mucus. It is crucial to use only distilled, sterile, or previously boiled and cooled water for irrigation to prevent harmful organisms from entering the sinuses.
Maintaining adequate moisture in the nasal passages helps alleviate congestion and dryness. Using a cool-mist humidifier, especially in the bedroom, keeps the nasal lining moist, thins mucus secretions, and encourages better drainage. Inhaling steam from a hot shower or a bowl of hot water can provide temporary relief from congestion.
Avoiding airborne irritants can exacerbate nasal inflammation. Exposure to cigarette smoke, harsh chemical fumes, dust, and known allergens can trigger the swelling that contributes to polyp formation. Minimizing contact with these substances helps reduce the inflammatory burden on the nasal mucosa.
Monitoring and Consulting a Specialist
Managing nasal polyps requires consistent monitoring and partnership with a healthcare specialist. Patients should schedule regular follow-up appointments to track polyp size and monitor symptoms like sense of smell. Persistent or worsening symptoms, despite adherence to the treatment plan, indicate that a specialist consultation is needed.
An otolaryngologist (ENT doctor) or an allergist/immunologist is best equipped to manage this condition. These specialists perform a nasal endoscopy, a procedure using a camera to visualize the polyps and surrounding tissue, aiding in diagnosis and treatment planning. They may also order imaging studies, such as a CT scan, to determine the extent of the polyps within the deeper sinus cavities.
While the goal is to avoid surgery, recognizing when non-surgical treatment is insufficient is important for preventing complications. Severe, persistent pain, changes in vision, or double vision are rare but serious signs that warrant immediate medical attention. Successful non-surgical management depends on accurately diagnosing the underlying cause and maintaining a consistent medical and lifestyle plan prescribed by a specialist.