Steroid sprays and drops
If you have one or more small polyps, your GP may prescribe a nasal spray or nose drops that contain steroid medicine (topical corticosteroids). These can help reduce the inflammation in your nose and shrink your polyps.
A type of spray called mometasone is usually recommended because it is known to cause fewer side effects than other steroid sprays. The recommended dose is usually two sprays into each nostril once a day.
Most people do not have any side effects after using mometasone. However, where side effects occur, the most commonly reported ones are:
It can take five weeks of using a nasal spray before the symptoms of nasal polyps get better. If you still have symptoms after this time, see your GP or the specialist in charge of your care. You may require additional treatment.
Steroid tablets
If you have large polyps or if your symptoms are particularly troublesome, your doctor may prescribe a short course of steroid tablets (oral corticosteroids), either alone or in combination with a nasal spray.
A type of steroid medication called prednisolone is usually recommended. It is likely that you will be prescribed no more than three weeks 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 to have surgery to remove the polyps.
Surgery
Surgery to remove nasal polyps may be recommended if:
- your symptoms don't respond to treatment with steroids
- you have repeated episodes of nasal polyps despite treatment with steroids
- you have developed a more serious secondary condition due to the polyps, such as obstructive sleep apnoea or double vision
Endoscopic sinus surgery
A type surgery called endoscopic sinus surgery is usually recommended to remove nasal polyps.
The procedure is usually carried out under local anaesthetic (painkilling medication) so that the tissue of the nose is numb throughout the procedure.
The surgeon will use an endoscope (a thin, flexible tube with a video camera at one end) to see inside your nose and sinuses. They will make small cuts to your face and insert surgical instruments to open the sinus cavities and remove the polyps. Alternatively, some surgeons now use a laser to burn away the polyps.
Once the surgery is complete, a dressing is placed inside your nostrils to stem any bleeding. The dressing can be removed one to two days after surgery. Most people can return home on the same day as the surgery, but it may take one to two weeks before you can start doing your normal daily activities again.
Your surgeon can give you more detailed information and advice.
The most common complications of endoscopic sinus surgery are:
- infection at the site of the surgery
- persistent nosebleeds
An infection can usually be successfully treated with antibiotics. If you have persistent nosebleeds, 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 two to three years.
Polypectomy
If you have smaller polyps that are near the opening of your nostrils and are easily accessible, an alternative surgical technique called a polypectomy may be recommended.
A polypectomy involves holding your nose open with a small surgical clamp and cutting away the polyps with a loop of wire or forceps. A dressing is then applied to stem any bleeding.
A polypectomy is usually carried out under general anaesthetic, which means that you will be asleep during the procedure and will not feel any pain. You should be able to leave hospital after you have recovered from the effects of the anaesthetic.
It is common for dry blood that develops inside your nose after surgery to cause an obstruction. However, this should clear within a few weeks.
You may have nosebleeds for the first few days after surgery. It is also common for small amounts of blood to come out of your nose when you blow it. This can occur for around a month after surgery. Avoid smoking for the first two weeks after surgery because it will irritate your nose.
As with endoscopic sinus surgery, an infection is the most common complication after a polypectomy.
The results of a polypectomy are similar to those of endoscopic sinus surgery. However, the chance of the polyps growing back after a polypectomy is much higher (it's estimated that they will return in about a third of people).
