Chronic sinusitis, with or without polyps, is hard to clear up. Treatment depends on the cause of the swelling and irritation. The goal is to lessen symptoms and improve life.
Medicines
Treatments might include:
- Nasal steroids. These nasal sprays include fluticasone (Flonase Allergy Relief, Xhance), budesonide (Rhinocort), mometasone (Nasonex 24hr Allergy), triamcinolone (Nasacort Allergy 24HR), beclomethasone (Beconase AQ, Qnasl) and ciclesonide (Omnaris, Zetonna).
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Steroids taken by mouth. Some nasal polyps can block nasal sprays. If so, taking steroids in pill form such as prednisone might help. Steroids taken by mouth also might be given to shrink polyps before surgery.
The pills can be taken alone or with a nasal spray. Because oral steroids can cause serious side effects, health care providers generally prescribe them only for a short time.
Steroids given as shots may be used if nasal polyps are severe.
- Biologic medicines. Biologics work by aiming at certain cells or proteins to lessen irritation and swelling. These might be used for people whose nasal polyps keep coming back. In the United States, dupilumab (Dupixent), mepolizumab (Nucala) and omalizumab (Xolair) have been approved for treatment of chronic sinusitis with nasal polyps.
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Other medicines. Other prescription medicines can treat conditions that lead to long-term swelling and inflammation in the nose. These might include medicines to treat allergies, also known as antihistamines, and antibiotics to treat infection.
A treatment known as aspirin desensitization might help people with nasal polyps and asthma who react badly to aspirin. An allergy specialist oversees the treatment. The treatment involves taking a little more aspirin bit by bit to help the body get used to taking aspirin.
Surgery to remove the polyps might come before aspirin desensitization. Desensitization might be followed by daily aspirin therapy.
Surgery
If medicine doesn't shrink or get rid of nasal polyps, endoscopic surgery can remove polyps and correct problems with the sinuses that lead to polyps.
In endoscopic surgery, a surgeon puts a small tube with a lighted lens or tiny camera, also known as an endoscope, through the nostrils into the sinuses. A surgeon then uses tiny tools to remove polyps.
A surgeon can also make the openings to the sinuses larger. This can be done during endoscopic surgery. Or there's a procedure called balloon ostial dilation. This procedure doesn't involve removing tissue from inside the nose.
After surgery, a corticosteroid nasal spray might help keep nasal polyps from coming back. A saltwater rinse can promote healing after surgery.