Nasal polyps are soft, noncancerous growths that develop in the lining of your sinuses or nasal passages, and the good news is that several effective treatments exist, from daily nasal rinses to prescription sprays, biologic injections, and surgery. The right approach depends on polyp size, how much they affect your breathing and smell, and whether they keep coming back. Most people start with the least invasive options and escalate only if needed.
How Polyps Are Diagnosed
If you’re dealing with persistent nasal congestion, reduced sense of smell, postnasal drip, or facial pressure that won’t resolve, a doctor will typically start with a physical exam and your symptom history. The key diagnostic tool is nasal endoscopy, where a thin tube with a tiny camera is guided into your nose to get a direct look at the tissue. This takes only a few minutes and is done in the office.
If polyps are found, a CT scan may follow. Imaging reveals polyps deep in the sinuses that the camera can’t reach and helps rule out other causes of obstruction, like structural problems or, rarely, tumors. Together, these two tools give a clear picture of how many polyps you have, how large they are, and which sinuses are involved.
Saline Rinses: The Simplest Starting Point
High-volume saline irrigation is one of the most accessible and cost-effective things you can do. Rinsing your nasal passages with a squeeze bottle or neti pot flushes out mucus, allergens, and inflammatory debris that contribute to swelling. Twice a day is a common recommendation, though no studies have pinpointed an exact optimal frequency.
Use isotonic saline, which you can buy premixed or make at home with non-iodized salt and baking soda. The water matters: use distilled or bottled water. If you use tap water, boil it for at least five minutes and let it cool first. This eliminates the small but real risk of introducing harmful organisms into your sinuses. Saline rinses won’t shrink polyps on their own, but they reduce symptoms and help prescription sprays reach the tissue more effectively.
Steroid Sprays and Drops
Corticosteroid nasal sprays are the standard first-line medical treatment. These sprays deliver anti-inflammatory medication directly to the nasal lining, reducing swelling and, over time, shrinking polyps. You won’t feel results overnight. Most people need several weeks of consistent daily use before noticing meaningful improvement.
For larger or more stubborn polyps, steroid nasal drops can be more effective than sprays because the liquid reaches deeper into the sinus cavities. In clinical trials, steroid drops used twice daily for 12 weeks significantly reduced polyp size compared to placebo. Drops are typically prescribed when sprays alone aren’t enough. A short course of oral steroids may also be used to rapidly shrink polyps before transitioning to a spray or drops for long-term maintenance, though oral steroids carry more side effects and aren’t meant for extended use.
Biologic Injections for Severe Cases
When steroid sprays, drops, and even oral steroids fail to control polyps, biologic medications are a newer and increasingly important option. These are injectable drugs that target specific molecules driving the inflammation behind polyp growth. Three biologics are currently used for nasal polyps, each working through a different mechanism.
Dupilumab blocks a receptor involved in two key inflammatory signals and is particularly useful for people who also have asthma, since it addresses both nasal and lower airway symptoms. Omalizumab targets an antibody called IgE and tends to work best in people with significant allergies. Mepolizumab targets a protein that activates eosinophils, a type of white blood cell that drives inflammation in many polyp patients, and may be the better fit when eosinophil counts are high but allergy markers are normal.
Your doctor chooses among these based on blood work and your specific pattern of inflammation. Biologics are given as injections every two to four weeks and can dramatically reduce polyp size and improve breathing and smell. They’re expensive and typically reserved for people whose polyps haven’t responded to other treatments or who want to avoid repeated surgeries.
When Surgery Makes Sense
Endoscopic sinus surgery becomes the recommendation when medications can’t adequately control your symptoms. The procedure is done through the nostrils with a camera and small instruments, so there are no external incisions. The surgeon removes polyps and opens up blocked sinus passages to restore drainage and airflow.
Results can be substantial. In studies tracking patient outcomes, 83% of people reported improved nasal breathing after surgery, 80% saw improvement in bad smell or taste issues, and about 64% regained some or all of their lost sense of smell. Most patients go home the same day or stay overnight. Recovery involves about a week of antibiotics, and steroid sprays are typically restarted about two weeks after the procedure to help prevent regrowth.
Follow-up visits are scheduled at roughly one week, two weeks, one month, and six months after surgery. During these visits, your doctor checks healing and cleans out any crusting or scar tissue forming in the surgical area.
The Recurrence Problem
The most frustrating aspect of nasal polyps is that they tend to come back. Five-year recurrence rates after surgery sit around 35%, and about 18% of patients eventually need a second procedure. Recurrence rates across studies range anywhere from 5% to 60%, depending on the severity of inflammation, whether asthma is present, and how consistently people use their maintenance medications after surgery.
This is precisely why surgery alone is rarely the complete answer. Ongoing treatment with steroid sprays, saline rinses, or biologics after surgery significantly improves the odds of staying polyp-free longer. Skipping your post-surgical maintenance routine is one of the most common reasons polyps return.
Steroid-Releasing Sinus Implants
A middle ground between sprays and surgery exists in the form of bioabsorbable steroid-releasing implants. These are small devices placed directly into the sinus opening during an in-office procedure under local anesthesia. They slowly release anti-inflammatory medication over weeks to months while physically holding the sinus passage open.
In a multicenter study of patients with recurrent polyps, these implants cut the average polyp grade nearly in half within one month, and the improvement held steady through six months. The implant gradually dissolves on its own. This option is especially relevant for people whose polyps have returned after surgery but who want to avoid or delay another full procedure.
The Aspirin Sensitivity Connection
A subset of polyp patients has a condition sometimes called Samter’s Triad: the combination of nasal polyps, asthma, and a sensitivity to aspirin or similar anti-inflammatory drugs. If you’ve noticed that aspirin or ibuprofen triggers breathing difficulty, facial flushing, or worsening congestion, this pattern may apply to you.
For these patients, a supervised aspirin desensitization protocol can help. The process involves taking gradually increasing doses of aspirin under medical observation until you can tolerate a full dose, then continuing daily aspirin long-term. Research shows this approach doesn’t shrink existing polyps but is effective at slowing or preventing regrowth after they’ve been removed. The daily aspirin reduces the production of inflammatory chemicals that fuel polyp formation in aspirin-sensitive people.
What Happens If You Do Nothing
Small polyps that aren’t causing symptoms don’t always require treatment. But larger or growing polyps left untreated can progressively block your nasal passages, leading to chronic mouth breathing, persistent sinus infections, and worsening or complete loss of smell. People with nasal polyps also experience more sleep disruption and have higher rates of obstructive sleep apnea. The ongoing inflammation and obstruction create a cycle where infections worsen swelling, which worsens obstruction, which leads to more infections.
If you have asthma alongside nasal polyps, uncontrolled upper airway inflammation can make your asthma harder to manage. Treating the polyps often leads to better breathing overall, not just through the nose.