Nasal Polyp Treatment Without Surgery

Nasal polyps are soft growths that can occur on the inside of the nasal canal or sinuses. Small nasal polyps can be harmless, but if a nasal polyp blocks the sinuses or airway, it can lead to infections, difficulty breathing, and other symptoms. Treatment is recommended in these cases.

While surgery to treat nasal polyps is an option, there are several treatments to consider before surgery. Corticosteroids are generally considered the gold standard pharmacological treatment for nasal polyps, and can be delivered by spray, oral medication, or injection.

Learn more about nonsurgical nasal polyp treatment, including prednisone for nasal polyps.

Nasal Sprays for Polyps

Nasal corticosteroid sprays are usually the first-line treatment for nasal polyps. They work through a topical mechanism, meaning the medication is absorbed by the skin. Steroid sprays can help shrink polyps and reduce symptoms of nasal polyps.

Examples of corticosteroid nasal sprays for polyps include:

• Flonase (fluticasone propionate)
• Nasonex (mometasone furoate)
• XHANCE (fluticasone propionate)

Nasal sprays are typically used long term, because if the spray is discontinued then the polyps may return. Studies show that long-term use is very safe.

Oral Steroids

Short courses of oral corticosteroids, such as prednisone, may also be given to treat nasal polyps. Evidence shows that this can improve symptoms, such as returning sense of smell and improving nasal air flow, and can also reduce the size of nasal polyps.

However, polyps and symptoms may return after just three to six months of a short course. With that in mind, it's important to consider the significant risk of side effects with systemic (throughout the body) oral steroids, which are in pill form.

These side effects can include:

• Insomnia
• Facial swelling or "moon face"
• Weight gain
• Gastrointestinal disturbances
• Acne
• Mood swings
• Abnormal hair growth

Due to the risk of side effects, systemic oral steroids are usually a second-line treatment reserved for when nasal sprays are ineffective. Healthcare providers are encouraged to prescribe prednisone for nasal polyps cautiously. They should give you full informed consent on the benefits and potential side effects of their recommendations before prescribing.

One study examined the effectiveness and safety of short-term oral corticosteroids for people with chronic rhinosinusitis with nasal polyps. Similar results in reducing nasal polyp size and symptoms were found across dosages.

However, they noted that people receiving more than 50 milligrams per day of prednisone reported more insomnia and gastrointestinal symptoms. As such, prednisone doses of less than 50 milligrams per day are recommended.

Steroid Injections

Nasal polyps may also be treated by injecting corticosteroids directly into the polyp itself. It's believed that in steroid injection, a higher dose of steroid can be delivered, while limiting the side effects found with oral steroids.

A 2020 review found that treatment with intrapolyp steroid injection decreased the total number of polyps and symptoms. Dosages ranged from 10 milligrams to 40 milligrams of triamcinolone acetonide, which is a type of synthetic corticosteroid used to treat skin conditions.

Other studies have compared intrapolyp steroid injection to oral short-term steroid treatment and found that steroid injections were similarly effective as oral steroids in reducing polyps and symptoms.

The evidence implies that steroid injection is a similarly effective but safer treatment option than oral steroids for some people with nasal polyps. The exception is very extensive or bulky nasal polyps that might be better treated with surgery.

Other Nonsurgical Treatments for Nasal Polyps

There are additional nonsurgical treatments for nasal polyps that don't include steroids. These include:

• Antibiotics: Though rare, antibiotics may be prescribed to treat nasal polyps. If they are prescribed, it's usually because there is an additional concern of bacterial infection.
• Leukotriene inhibitors: Montelukast, a type of leukotriene inhibitor often used to treat asthma, has shown some benefit in treating nasal polyps, particularly for people with aspirin sensitivity.
• Biologics: Dupilumab, a new type of biologic monoclonal antibody, was approved by the Food and Drug Administration (FDA) in 2019 to treat chronic rhinosinusitis with moderate to severe nasal polyps. It is given as a biweekly injection.

When Surgery May Be Needed

An endoscopic surgery to remove nasal polyps (called a nasal polypectomy) may be recommended if nonsurgical treatments are ineffective or if the nasal polyps are very large. This typically is an outpatient procedure, meaning you can go home the same day as long as you have no complications.

During the procedure, your surgeon will insert a thin tube into your nasal passage. The tube has a light on the end as well as surgical instruments to help your surgeon cut out the polyps.

Surgery to remove nasal polyps can treat symptoms and help you breathe more easily. However, keep in mind that unless the underlying cause (such as with chronic sinus infections or aspirin sensitivity) is under control, then nasal polyps can recur.

Summary

Corticosteroids are the gold standard for treating nasal polyps. They are effective at reducing polyp size and alleviating symptoms. There are different methods of delivery, including topical, oral, and injection. In some cases in which the nasal polyps are particularly large or not responding to medication, surgery may be recommended.

A Word From Verywell

It's understandable to want to avoid surgery for nasal polyps. Depending on the size and symptoms of your nasal polyps, it's likely that your healthcare provider will recommend medical treatment options first before surgery. There are benefits and drawbacks to each type of treatment, but together you and your healthcare provider will decide what is right for you.