Nasal polyps - Treating nasal polyps

Nasal polyps can often be effectively treated with steroid medication. Surgery may be recommended for larger polyps, and for those that do not respond to medication.

Steroid sprays and drops

If you have one or more small polyps, your GP may prescribe nose drops or a nasal spray that contains steroid medicine (corticosteroids). This can reduce inflammation in your nose and shrink your polyps.

A type of spray called mometasone is usually recommended because it causes fewer side effects than other steroid sprays. The recommended dose is usually two sprays into each nostril once a day.

Most people do not experience any side effects after using mometasone. However, where side effects do occur, the most commonly reported ones are:

It can take up to five weeks of using a nasal spray before the symptoms of nasal polyps improve. If you still have symptoms after this time, you should see your GP or the specialist in charge of your care. You may require additional treatment.

If your symptoms improve, you will still need to continue using the spray long-term to reduce the chances of them returning quickly.

Steroid tablets

If you have large polyps, or if your symptoms are particularly troublesome, a short course of steroid tablets (oral corticosteroids) may be prescribed for you. They may either be prescribed for use alone or in combination with a nasal spray.

A type of steroid medication called prednisolone is usually recommended. It is likely you will be prescribed no more than 7-10 days worth of prednisolone. This is because using the medication for longer than this increases your risk of developing side effects, such as:

weakening of your bones (osteoporosis)
high blood pressure
diabetes
weight gain

If your symptoms do not improve after three weeks, you may need surgery to remove the polyps.

Surgery

Surgery to remove nasal polyps may be recommended if:

your symptoms do not respond to steroid treatment
you have recurrence of nasal polyps despite treatment with steroids
you have developed a more serious secondary condition due to the polyps, such as obstructive sleep apnoea (OSA)

If surgery is recommended to remove nasal polyps, endoscopic sinus surgery is usually used. It is carried out under general anaesthetic, usually as a day procedure.

The surgeon will pass an endoscope (a tube with a video camera at one end) into your nostrils to allow them to see inside your nose and sinuses.

Surgical instruments, such as a micro-debrider (a tiny motorised revolving saw) will be used to remove the polyps. This technique means that it is not necessary to make any cuts to your face.

Following surgery, you will be observed for about six hours. If a dressing has been used, it will be removed from your nose after a few hours. If there is no bleeding you will be discharged and allowed home to continue your recovery.

You will usually be advised to rest for two weeks after surgery, and to avoid crowds to prevent catching an infection. Your surgeon will be able to give you more detailed information and advice.

Infection at the site of the surgery and persistent nosebleeds are the most common complications of endoscopic sinus surgery.

An infection can usually be successfully treated with antibiotics. If you have persistent nosebleeds, you should contact your surgical team because you may need to go back to hospital for further treatment.

Endoscopic sinus surgery has a good track record of success with around 90% of people reporting a marked improvement in their symptoms. However, in around 8% of cases, the polyps grow back after 2-3 years.