How to Treat Nasal Polyps

Nasal polyps are noncancerous, soft, painless growths that develop on the lining of the nasal passages or sinuses. When they become enlarged—often referred to clinically as “hypertrophic” or “large” nasal polyps—they can significantly obstruct airflow, impair sinus drainage, and contribute to chronic symptoms such as nasal congestion, reduced sense of smell (hyposmia or anosmia), postnasal drip, facial pressure, and recurrent sinus infections.

Management of enlarged nasal polyps follows a stepwise, evidence-based approach. First-line therapy typically involves intranasal corticosteroid sprays—such as mometasone, fluticasone, or budesonide—to reduce inflammation and shrink polyp size. For patients with more extensive disease or inadequate response to topical treatment, a short course (7–10 days) of oral corticosteroids—like prednisone—may be prescribed to achieve rapid reduction in polyp burden and symptom relief.

In cases of persistent or recurrent polyps despite maximal medical therapy, endoscopic sinus surgery is indicated. Functional endoscopic sinus surgery (FESS) removes polyps and opens blocked sinus ostia while preserving healthy mucosa. Postoperative care is critical: ongoing intranasal corticosteroids, saline irrigation, and sometimes steroid-eluting sinus spacers or short-term oral steroids help prevent recurrence. Emerging biologic therapies—including dupilumab, omalizumab, and benralizumab—are now approved for severe, refractory chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in patients with type 2 inflammation confirmed by eosinophilia or elevated IgE.

Long-term control requires addressing underlying drivers: comorbid asthma, aspirin-exacerbated respiratory disease (AERD), allergic rhinitis, and cystic fibrosis must be evaluated and managed concurrently. Regular follow-up with an otolaryngologist or rhinology specialist ensures timely intervention and optimizes outcomes.