Nasal polyps - Treatment 

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:

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.

Page last reviewed: 13/03/2013

Next review due: 13/03/2015

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Comments

The 7 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Nasal said on 15 October 2014

This is my third polypectomy in 14 years, last one being endoscopic sinus surgery this week..2000, 2007 and 2014. Was very nervous but Surgical team at Royal Berks NHS ENT were very competent, with wealth of surgical expertise and after care. I will be using saline sprays that are available over-the-counter for first five days followed by NeilMed nasal rinse twice daily. ENT specialist also suggested use of Budesonide nasal wash or metered spray over 3 moths period to manage the regrowth of polys we are currently discussing the dosage and method (wash or metred spray). Budesonide is believed to be beneficial and safe to use (short term) for the management of chronic rhinosinusitis (a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen — for at least eight weeks, despite treatment attempts) and recurring allergic polyp growth. I have both of these, had pre op-treatment of Flixonase nasule drops and Prednisolone and hopefully we will mange it better this time. Luckily for me, most of RBS ENT team were the same over the 14 year period.

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bungedup said on 02 October 2014

A couple of things that have worked for me, having had 3 polypectomies already:
(1) Every 5 or 6 months, my nose gets really congested. My doctor prescribes a short course of Prednisolone (I think that's right) which, although they make you feel a bit odd, settles everything down and enables continued control using Nasonex.
(2) My doctor also recommends increasing the dose of Nasonex (i.e. more doses during the day), short term, to regain control over enlarged polyps. It takes a while, but it does seem to work sometimes. If this fails there is also recourse to (1) above.

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fkrbtch said on 10 September 2014

I have had 3 operations to remove nasal polyps, the first being in 1999 and the last in 2012. In the post op appointment 6-8 weeks after the latest op, (with someone whom I had not seen before), I was told things look good, they will as you know grow back, but we hope not to see you for another 10 years, well just over 2 years later they are back. It is frustrating to find myself in that group of 8% that have this problem of the rapid return of polyps. I have never been told that there are things to avoid to stop their quick return. A quick look on the web and I found people advising to avoid alcohol, bread, dairy products, if this is true why haven't consultants been informing patients of the issues with these products?

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Pippinkid said on 05 May 2012

I've suffered Glue Ear since I was born. I had 3 grommet op's before the age of 11 and I had my 4th grommet op at the age of 31 (5 years ago). During my last op, the surgeon said they couldn't do many more grommet op's due to scarring and if I kept having trouble, they would look at the tube between my nose and ear, as it may not be working properly. He also said that he would check for polyps whilst I was asleep. It turned out, at the time, I didn't have any polyps.

Three years later, I was diagnosed with Polyps in both nostrils and a CT Scan showed my entire face was full of gunge - apparently I also have sinusitus. The Specialist simply sent me away with a weeks course of Nose Drops, followed by a nasal spray - Flixonase - that I was told to use everyday, basically, for the rest of my life. No check ups on progress. September this year, I'd of been on the sprays for 2 years and my 'face' is no better. If anything, it's worse - I seem to get tired really quickly!? When I went to my Doctors Surgery, I was basically told that they wouldn't remove the polyps as they're likely to grow back and that people have them worse than me.

I'm seriously thinking of pushing to have them removed and my face drained but after watching various relevant video's on YouTube, it's putting me off a little.

I've read your comments above and would be interested in hearing more to help me decide - do I or don't I......

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mega9999 said on 19 November 2011

I already had 2 operations (1 under NHS and 1 in BUPA) to remove the ployps under under general anaesthetic and polyps are back. Seen the consultant and another operation is required but I am not willing to go through another operation under general anaesthetic as I never recover from the operation and the infaction is starts.

I read about laser suregry and have seen video on youtube. Also, here it is mentioned that some surgeons now use a laser to burn away the polyps. I think this would be a better option for me as there would be no bleeding but can not find which hospital under NHS does this.

I spoke to my GP and Hospital consultant but they don't know.

Does anyone know which Hospital under NHS offers this laser surgery for Polyps removal?

Also, I would be interested to know from other people who had this done and where?

thanks.

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Sir Syrup said on 28 May 2011

I tried the nasal sprays and in my view they are impotent and little more than a placebo. I had an Op in December 2010. They removed a blockage in my nose and hey I had a nostril back and removed diseased polyp type growth in the sinus behind my right eye. "weeding the garden" the surgeon called it. It was great I could breath properly and also stopped snoring. Trouble is after three months the symptoms returned and at the time of writing I am feeling very sick indeed with a continuous headache and daily discharge on the same side. So be warned these things can come back with a vengence and once you are discharged from the hospital you are back to square one.

Feel like I need a pressure hose in my skull, trouble is the waiting times are increasing and from GP to initial consultation it is going to be close to three months and then I guess another 3 - 6 to get the op done.

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kevhull said on 27 December 2010

I've recently had my second Nasal Polyp operation on 2 Dec. 2010. The first operation on my Nasal Polyps was Five years ago. They started giving me problems again just over a year ago, so following some advice given me by a specialist I decided to go down the surgical route once more rather than rely on sprays -which to tell the truth weren't helping any more by this stage.

Following this surgery, the Surgeon informed me that my polyps definitely needed doing. So now I'm taking a six week course of Flixinase Drops and then continuing with Nasonex Spray -as advised by the hospital.
Nasal Douching is necessary (for a while at least) but in the long term I feel that the repeated Surgery was the right decision for me.

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Recurring polyps

If you have recurring nasal polyps, or if you have a condition such as asthmahay fever or a long-term sinus infection that makes it likely that you will develop polyps, you may need to use a daily steroid nasal spray to help prevent your nose becoming inflamed.

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