Nasal polyps treatment: medical management

Abstract

The objectives of medical management of nasal polyposis are 1) to eliminate nasal polyps and rhinitis symptoms, 2) to reestablish nasal breathing and olfaction, and 3) to prevent recurrence of nasal polyps. Although antibiotics are used for infectious complications of nasal polyposis, only glucocorticosteroids (steroids) have a proven effect on the symptoms and signs of nasal polyps. Topically applied steroids is the therapeutic modality that has been best studied in controlled trials. It reduces rhinitis symptoms, improves nasal breathing, reduces the size of polyps and the recurrence rate, but it has a negligible effect on the sense of smell and on any sinus pathology. Topical steroids can, as long-term therapy, be used alone in mild cases, or combined with systemic steroids/surgery in severe cases. Systemic steroids, which are less well studied, have an effect on all types of symptoms and pathology, including the sense of smell. This type of treatment, which can serve a "medical polypectomy," is only used for short-term improvement due to the risk of adverse effects. Individualized management of nasal polyposis may use long-term topical steroids, short-term systemic steroids, as well as surgery, in various combinations. Exactly how these therapies, which differ in their control of various symptoms, are optimally combined is not yet well established.