Nasal polyps are removed through endoscopic sinus surgery, steroid medications that shrink them, or newer biologic drugs that target the inflammation driving their growth. The right approach depends on polyp size, how much they affect your breathing, and whether they’ve come back after previous treatment. Most people start with medications before considering surgery.
Steroid Treatment: The First Step
Corticosteroid nasal sprays are the standard starting treatment for nasal polyps. These sprays reduce the inflammation that causes polyps to swell, and over weeks of consistent use, they can shrink small to moderate polyps enough to restore airflow and improve your sense of smell. For larger polyps or more severe symptoms, a short course of oral steroids can produce faster, more dramatic shrinkage. The effects of oral steroids are temporary, though, and repeated courses carry real side effects like bone thinning and blood sugar changes, so doctors use them sparingly.
Steroid sprays work best as ongoing maintenance. Even after polyps shrink, stopping the spray often lets them grow back. Think of it less as a cure and more as keeping the inflammation in check over the long term.
Biologic Medications for Stubborn Polyps
Three biologic drugs are now FDA-approved specifically for nasal polyps that don’t respond well to steroids: dupilumab, mepolizumab, and omalizumab. Each works by blocking a different part of the immune overreaction (called type 2 inflammation) that drives polyp growth. All three have been shown to reduce polyp size in clinical trials.
Among them, dupilumab has performed best across multiple measures. It was the most effective at shrinking polyps, improving how the sinuses look on imaging scans, and restoring the sense of smell, which is one of the most frustrating symptoms for people with polyps. These biologics are given as injections, typically every two to four weeks, and are generally reserved for people with recurrent or severe polyps who haven’t gotten adequate relief from steroids alone.
Saline Rinses as Supportive Care
Saline nasal irrigation won’t remove polyps on its own, but it plays a meaningful role alongside other treatments. Rinsing flushes out mucus, allergens, and inflammatory debris from the nasal passages, which can reduce congestion and help medicated sprays reach the tissue more effectively. If you use an isotonic saline solution (the same salt concentration as your body), it’s well tolerated for daily use. Hypertonic solutions, with a higher salt concentration, can draw out more fluid from swollen tissue but should stay below 3% concentration. Above roughly 2.7%, hypertonic rinses can irritate the lining of the nose, cause significant pain, and actually impair the tiny hair-like structures that keep mucus moving.
Squeeze bottles and neti pots both work. The key is using distilled, sterile, or previously boiled water to avoid introducing bacteria into the sinuses.
How Endoscopic Surgery Works
When medications can’t adequately control polyps, or when polyps are large enough to completely block the sinuses, surgery becomes the next option. The procedure is called functional endoscopic sinus surgery. A surgeon inserts a thin, rigid tube with a camera and light on the end into your nostril, then uses specialized instruments alongside it to carefully remove polyps, swollen tissue, and scar tissue that’s blocking sinus drainage.
Everything is done through the nostrils with no external incisions, and the camera gives the surgeon a magnified, real-time view of the tissue. The goal isn’t just removing visible polyps but opening the sinus passages so air and mucus can flow normally and medicated sprays can reach deeper tissue after surgery.
What Recovery Looks Like
Plan to be out of work for at least a week. Fatigue is the most common complaint in the days following surgery, and if your job involves physical labor, you may need longer. Your doctor may pack your nose with gauze, which stays in place until your first follow-up visit, usually within the first week. Don’t try to remove packing yourself.
Expect congestion, bloody drainage, and some facial pressure during the first week or two. The full healing process for the tissue inside your nose typically takes four to six weeks. During that window, you’ll have follow-up appointments where your doctor cleans the surgical area to prevent scar tissue from forming in ways that block the sinuses again. Most surgeons also have you start saline rinses within the first few days to keep the healing tissue moist and clear of crusting.
Surgical Risks
Endoscopic sinus surgery is generally safe, but the sinuses sit next to some important structures. Significant bleeding can occur, and in rare cases it’s enough to require stopping the procedure early. Because the sinuses border the eye sockets, there’s a small risk of injury to the eye muscles (which can cause double vision) or, extremely rarely, to the optic nerve. The sinuses also sit just below the brain, creating a rare possibility of a spinal fluid leak. These serious complications are uncommon, and the overall safety profile of the surgery has improved substantially with modern camera-guided techniques.
Recurrence After Removal
This is the part most people don’t expect: nasal polyps have a high rate of coming back. About 30% of patients experience recurrence within five years of surgery, and that number climbs to roughly 66% at ten years. The surgery removes the polyps themselves but doesn’t change the underlying inflammatory tendency that created them. People with asthma, aspirin sensitivity, or allergies tend to have higher recurrence rates.
This is why post-surgical treatment matters as much as the surgery itself. Continuing steroid sprays after surgery, using saline rinses, and managing any underlying allergies or asthma all reduce the chances of regrowth. For people who’ve already had polyps return after one or more surgeries, biologics can be a particularly valuable addition, potentially delaying or preventing the need for repeat operations.
Choosing the Right Approach
Most treatment follows a predictable ladder. Small polyps causing mild symptoms usually start with steroid sprays and saline rinses. If symptoms persist, a short oral steroid course can test whether the polyps are responsive to anti-inflammatory treatment. Polyps that keep growing despite medical therapy, or that are large enough to cause significant obstruction or smell loss, are candidates for surgery. And for people with recurrent polyps despite surgery and steroids, biologics offer a newer option that targets the root inflammatory process rather than just managing symptoms.
The combination of surgery followed by long-term medical maintenance tends to produce the best outcomes. Surgery clears the blockage and opens the sinuses, while ongoing medication works to prevent the inflammation from rebuilding what the surgeon removed.