Treatment

Chronic sinusitis, with or without polyps, is a challenging condition to clear up completely.

You'll work with your health care team to develop the appropriate long-term treatment plan to manage your symptoms and to treat factors, such as allergies, that may contribute to chronic swelling (inflammation).

The treatment goal for nasal polyps is to reduce their size or eliminate them. Medications are usually the first approach. Surgery may sometimes be needed, but it may not provide a permanent solution because polyps tend to recur.

Medications

Nasal polyp treatment usually starts with drugs, which can make even large polyps shrink or disappear. Drug treatments may include:

• Nasal corticosteroids. Your doctor is likely to prescribe a corticosteroid nasal spray to reduce swelling and irritation. This treatment may shrink the polyps or eliminate them completely.

  Nasal corticosteroids include fluticasone (Flonase Allergy Relief, Flovent HFA, Xhance), budesonide (Rhinocort), mometasone (Nasonex, Asmanex HFA), triamcinolone (Nasacort Allergy 24HR), beclomethasone (Beconase AQ, Qvar Redihaler, Qnasl) and ciclesonide (Omnaris, Alvesco, Zetonna).

• Oral and injectable corticosteroids. If a nasal corticosteroid isn't effective, your doctor may prescribe an oral corticosteroid, such as prednisone, either alone or in combination with a nasal spray.

  Because oral corticosteroids can cause serious side effects, you usually take them only for a limited period.

  Injectable corticosteroids may be used if nasal polyps are severe.

• Medication to treat nasal polyps and chronic sinusitis. If you have nasal polyps and chronic sinusitis, your doctor may give you an injection of a medication called dupilumab (Dupixent) to treat your condition. This medication may reduce the size of the nasal polyps and lessen congestion.

• Other medications. Your doctor may prescribe drugs to treat conditions that contribute to long-term swelling in your sinuses or nasal passages. These may include antihistamines to treat allergies and antibiotics to treat a chronic or recurring infection.

  Aspirin desensitization, under the care of an allergy specialist with experience in desensitization, may benefit some patients with nasal polyps and aspirin sensitivity. The treatment involves gradually increasing the amount of aspirin you take while under a doctor's care in a hospital or clinic to help your body tolerate taking aspirin long term.

Surgery

If drug treatment doesn't shrink or eliminate nasal polyps, you may need endoscopic surgery to remove polyps and to correct problems with your sinuses that make them prone to inflammation and the development of polyps.

In endoscopic surgery, the surgeon inserts a small tube with a lighted magnifying lens or tiny camera (endoscope) into your nostrils and guides it into your sinus cavities. He or she uses tiny instruments to remove polyps and other substances that block the flow of fluids from your sinuses.

Your surgeon may also enlarge the openings leading from your sinuses to your nasal passages. Endoscopic surgery is usually performed as an outpatient procedure.

After surgery, you'll likely use a corticosteroid nasal spray to help prevent the recurrence of nasal polyps. Your doctor may also recommend the use of a saltwater (saline) rinse to promote healing after surgery.

Potential future treatments

Researchers are studying the role of biologic drugs, including medications that treat severe asthma, in helping reduce nasal polyps and relieve symptoms. Biologics work by targeting specific cells or proteins to reduce irritation and swelling. Early research suggests that the drugs may become options for people whose nasal polyps don't respond to corticosteroids or surgery.