Treatments: Nasal Polyps (Chronic Rhinosinusitis With Nasal Polyps)

This page describes the step-by-step treatments used to shrink nasal polyps, ease symptoms and keep polyps from coming back.

Nasal polyps that come with long-lasting sinus inflammation are called chronic rhinosinusitis with nasal polyps. This page describes the treatments used to shrink polyps, ease symptoms and keep polyps from coming back. The condition itself is described on the nasal polyps conditions page.

Treatment usually follows a step-by-step plan. Most people start with sprays and rinses and move on to stronger options only if symptoms are not well controlled. Many people use more than one treatment at the same time, and treatment is usually long-term because polyps tend to return if therapy stops.

Saltwater (Saline) Rinses

Rinsing the nose with saltwater is one of the simplest and safest treatments and is often the foundation that other treatments build on. See nasal saline rinses and the nasal saline irrigation technique.

• It flushes out mucus, crusting and irritants, and helps soothe the nasal lining.

• Larger-volume rinses (for example, a squeeze bottle or neti pot) tend to work better than a simple saline spray.

• Rinses are generally used daily and can be continued long-term.

• The rinse is mixed with distilled, sterile, or previously boiled and cooled water, never straight tap water, and the rinse device is cleaned regularly.

Steroid Nasal Sprays and Steroid Rinses

Steroids (corticosteroids) are the main medicines used to control the inflammation that drives polyps. When delivered directly into the nose, very little is absorbed into the rest of the body, so they are considered safe for long-term daily use.

• Steroid nasal sprays are a first-line treatment and are usually taken every day, often indefinitely, to shrink polyps and keep symptoms down.

• A newer "exhalation delivery" spray device can push the medicine higher and deeper into the nose, where polyps often sit, and may be used when a standard spray is not enough.

• Some people add steroid rinses or drops, which mix a steroid into a saltwater rinse to coat more of the nasal and sinus lining. This is often used after sinus surgery or for stubborn symptoms.

• The most common side effect is mild nasal irritation or occasional nosebleeds. Benefits build over weeks, so consistent daily use matters.

Oral Steroids (Steroid Pills)

A short course of steroid pills (such as prednisone) can quickly shrink polyps and open the nose.

• They are typically used for short bursts, for example during a flare or severe symptoms, or sometimes before surgery.

• Because longer or repeated use can cause side effects, such as mood changes, trouble sleeping, raised blood sugar, bone thinning and weight gain, their use is kept as limited as possible.

• Needing steroid pills more than about once a year (especially with asthma) is often a sign that a longer-term treatment, such as surgery or a biologic, may be considered.

Endoscopic Sinus Surgery

When sprays, rinses and steroid courses do not control symptoms, surgery is often the next step. In endoscopic sinus surgery, a thin camera and small instruments are passed through the nostrils, with no cuts on the face, to remove polyps and open blocked sinuses.

• Surgery does not cure the underlying inflammation; it removes polyps and creates open, accessible sinuses.

• Opening the sinuses lets steroid sprays and rinses reach the lining more effectively afterward.

• Steroid sprays and saline rinses are continued after surgery to help keep polyps from growing back.

• Polyps commonly return over time, and some people need repeat (revision) surgery, which is why ongoing medical treatment after surgery is so important.

Recovery is described on the sinus surgery recovery page, and preparation in the sinus surgery packet.

Steroid-Eluting Implants

During or after sinus surgery, a small, dissolvable steroid-eluting implant (sometimes called a stent or spacer) may be placed into the sinus.

• The implant slowly releases a steroid directly onto the healing sinus lining over several weeks and then dissolves on its own, so it does not need to be removed.

• It helps reduce swelling and scarring, improves healing, and can lower the chance of polyps regrowing and the need for more steroid pills or procedures.

• Because the medicine is released right where it is needed, very little reaches the rest of the body.

Biologic Medicines

Biologics are newer injectable medicines that target specific parts of the immune system responsible for the inflammation behind polyps. They are generally reserved for people whose polyps are not controlled by sprays, rinses and surgery, or who cannot have surgery, and they are especially useful for those who also have conditions such as asthma.

• Dupilumab, mepolizumab and omalizumab are approved for nasal polyps. They can shrink polyps, improve sense of smell and congestion, boost quality of life, and reduce the need for steroid pills and repeat surgery.

• Among them, dupilumab has shown the strongest and most consistent benefits across studies, though the choice depends on a person's other conditions, preferences and insurance coverage.

• They are given as an injection on a regular schedule (some can be given at home). Because they treat ongoing inflammation rather than curing it, treatment is usually long-term.

• Side effects are generally mild but can include injection-site reactions; dupilumab can sometimes cause eye irritation (conjunctivitis), and omalizumab carries a small risk of a serious allergic reaction.

• Biologics are expensive and often require insurance approval, so they are typically used after other treatments have been tried.

Aspirin Desensitization for Aspirin-Exacerbated Respiratory Disease

Some people have a specific pattern called aspirin-exacerbated respiratory disease (AERD, sometimes called N-ERD): nasal polyps, asthma, and breathing reactions (such as congestion, wheezing or trouble breathing) after taking aspirin or similar pain relievers (NSAIDs like ibuprofen). Polyps in this group tend to be aggressive and to come back quickly after surgery.

• Aspirin desensitization can help control polyp regrowth and sinus symptoms in these patients. It is usually done after sinus surgery.

• The procedure takes place under close medical supervision over one to three days, with gradually increasing doses of aspirin while breathing and symptoms are watched carefully. Reactions are expected and are treated as they occur.

• After desensitization, a daily aspirin dose is taken indefinitely to keep the benefit. Doses used for polyp control are often higher than a typical "baby aspirin."

• The benefit lasts only as long as aspirin is taken every day. Missing doses for more than about two days can cause the tolerance to be lost, and the desensitization may need to be repeated.

• Stomach irritation or bleeding is a possible side effect of daily aspirin, so this approach is monitored carefully by the care team.

Recurrence and Long-Term Maintenance

Nasal polyps are a chronic condition. Even after successful treatment or surgery, polyps often come back; a large share of people have polyps return in the years after surgery, and some need repeat procedures.

• Treatment is almost always long-term. Daily steroid nasal sprays and saline rinses are the backbone of maintenance and are usually continued even after symptoms improve.

• Stopping maintenance treatment is one of the most common reasons polyps and symptoms return.

• Regular follow-up visits allow the nose to be checked, regrowth to be caught early and treatment to be adjusted.

• People with asthma or aspirin-exacerbated respiratory disease are at higher risk of recurrence and often benefit from more intensive, ongoing therapy such as biologics or aspirin desensitization.

The Bigger Picture

There is no one-size-fits-all approach. The combination of rinses, sprays, surgery, implants, biologics or aspirin desensitization depends on how severe the polyps are, what other conditions a person has, how they respond to each step, and personal preferences. The shared goals are to control symptoms, protect the sense of smell, reduce the need for steroid pills and keep polyps from returning. Related topics include sinus infection treatments and loss of smell treatments.