Nasal polyps are treated with a combination of steroid sprays, saline rinses, and, when those aren’t enough, surgery or biologic injections. Most people start with medical therapy, and many can manage their symptoms without an operation. But polyps are persistent: even after surgical removal, the five-year recurrence rate is about 30%, climbing to 66% at ten years. Effective treatment usually means ongoing management, not a one-time fix.
Steroid Nasal Sprays: The Starting Point
Corticosteroid nasal sprays are the first treatment most people will try. These sprays reduce inflammation in the nasal lining, which can shrink polyps and open up your airway. Mometasone is the most commonly prescribed option and is FDA-approved specifically for nasal polyps. The standard dose is two sprays in each nostril twice daily, though some people respond to a once-daily regimen at half that amount.
Don’t expect overnight results. Clinical trials for polyp treatment ran over four months, and that’s a realistic timeframe for judging whether sprays are working for you. Consistency matters more than anything: skipping doses lets inflammation creep back. Many people use steroid sprays indefinitely to keep polyps from regrowing, even after other treatments have reduced their size.
If sprays alone aren’t cutting it, your doctor may prescribe a short course of oral steroids to rapidly shrink larger polyps. These are effective but come with side effects (weight gain, mood changes, bone thinning) that make them unsuitable for long-term use. Oral steroids are best thought of as a reset button, not a maintenance plan.
Saline Rinses for Daily Relief
Rinsing your nasal passages with saltwater won’t shrink polyps directly, but it clears mucus, reduces irritation, and helps steroid sprays reach the tissue they’re targeting. Most people use a squeeze bottle or neti pot with a premixed saline packet. Seawater-based solutions offer a slight edge over plain saline because their mineral content (bicarbonates, potassium, calcium, magnesium) helps thin mucus, supports tissue healing, and limits local inflammation. The bicarbonates in particular reduce mucus thickness, making it easier to breathe.
Rinsing once or twice a day is a reasonable routine. Do it before using your steroid spray so the medication lands on cleaner tissue. Use distilled, sterile, or previously boiled water to avoid introducing bacteria into your sinuses.
When Surgery Makes Sense
If medications haven’t adequately controlled your symptoms after several months, functional endoscopic sinus surgery (FESS) is the next step. A surgeon uses a thin camera and small instruments inserted through your nostrils to remove polyps and widen the sinus openings. There are no external incisions.
Recovery is faster than most people expect. You can typically return to work or school within a week, and most people resume their normal routine within two weeks. Full recovery takes a few months. During the healing period, you’ll need to avoid blowing your nose for at least seven days, skip strenuous exercise until cleared, rinse with saline regularly, and sneeze with your mouth open to avoid pressure buildup. Expect some bloody discharge for a few weeks. A follow-up visit a few weeks after surgery lets your doctor clear out dried mucus and blood.
Surgery is effective at restoring breathing and smell, but it doesn’t cure the underlying inflammation that caused polyps in the first place. That’s why recurrence rates are significant. Continuing steroid sprays after surgery is essential for slowing regrowth.
Biologic Injections for Severe Cases
Three biologic medications are now FDA-approved for nasal polyps that haven’t responded to standard treatment: dupilumab, mepolizumab, and omalizumab. These are injections (given every two to four weeks) that target specific immune pathways driving the inflammation behind polyp growth.
Biologics aren’t a first-line option. They’re approved as add-on treatments for adults whose polyps remain inadequately controlled despite other therapies. Guidelines from European specialists suggest biologics are appropriate for people with bilateral polyps who’ve already had sinus surgery and meet at least three of these five criteria: lab evidence of a specific type of inflammation (called type 2), need for oral steroid courses more than twice a year, significantly impaired quality of life, major loss of smell, or a coexisting asthma diagnosis requiring inhaled steroids. If you haven’t had surgery yet, the bar is higher: you’d typically need to meet four of those five criteria.
For people who qualify, biologics can dramatically reduce polyp size, restore smell, and cut the need for repeat surgeries. The tradeoff is cost (these medications are expensive, even with insurance) and the commitment to ongoing injections.
Aspirin Desensitization for a Specific Subtype
Some people with nasal polyps also have asthma and a sensitivity to aspirin or ibuprofen, a combination known as aspirin-exacerbated respiratory disease (AERD) or Samter’s triad. For this group, aspirin desensitization therapy can be uniquely effective.
The process involves taking gradually increasing doses of aspirin under medical supervision until your body tolerates it, then continuing a daily maintenance dose. Research shows that daily aspirin slows polyp regrowth and reduces the need for repeat surgeries, but the dose matters. A study of patients taking just 100 mg daily found no improvement, with polyps recurring in all patients within a year. In contrast, patients taking 300 mg daily had far better outcomes: none required repeat surgery over a median follow-up of about two years. Higher doses didn’t appear to offer additional benefit beyond that threshold, and about half of patients on larger doses were able to reduce to 650 mg daily without losing effectiveness.
Managing Polyps Long-Term
The reality of nasal polyps is that they tend to come back. With roughly a one-in-three chance of recurrence within five years and a two-in-three chance within ten, treatment is less about eliminating polyps forever and more about keeping them small enough that they don’t interfere with your breathing, sleep, or sense of smell.
The most successful long-term approach combines several layers: daily saline rinses to keep passages clear, consistent use of steroid sprays to suppress inflammation, and periodic check-ins with an ENT specialist to catch regrowth early. If you have allergies, managing those aggressively (with antihistamines or allergy immunotherapy) can reduce one of the triggers that feeds polyp growth. Avoiding known irritants like cigarette smoke and strong chemical fumes also helps.
People who’ve had one surgery and find polyps returning may benefit from biologics rather than repeated operations. That conversation is worth having with your specialist, particularly if you also have asthma or frequent sinus infections, since those factors tend to predict a more stubborn course.