Treatments and drugsBy Mayo Clinic staff
CLICK TO ENLARGE
|Endoscopic sinus surgery|
Chronic sinusitis, with or without polyps, is a challenging condition to clear up completely. You'll work with your health care team to develop the best long-term treatment plan to manage your symptoms and to treat factors, such as allergies, that may contribute to chronic inflammation.
The treatment goal for nasal polyps is to reduce their size or eliminate them. Medications are usually the first approach. Surgery may sometimes be needed, but it may not provide a permanent solution because polyps tend to recur.
Nasal polyp treatment usually starts with drugs, which can make even large polyps shrink or disappear. Drug treatments may include:
- Nasal corticosteroids. Your doctor is likely to prescribe a corticosteroid nasal spray to reduce inflammation. This treatment may shrink the polyps or eliminate them completely. Nasal corticosteroids include fluticasone (Flonase, Veramyst), budesonide (Rhinocort), flunisolide, mometasone (Nasonex), triamcinolone (Nasacort) and beclomethasone (Beconase AQ).
- Oral and injectable corticosteroids. If a nasal corticosteroid isn't effective, your doctor may prescribe an oral corticosteroid, such as prednisone, either alone or in combination with a nasal spray. Because oral corticosteroids can cause serious side effects, you usually take them only for a brief period. If your polyps don't respond to nasal and oral corticosteroids, your doctor may recommend injecting a corticosteroid directly into your polyps.
- Other medications. Your doctor may prescribe drugs to treat conditions that contribute to chronic inflammation in your sinuses or nasal passages. These may include antihistamines to treat allergies and antibiotics to treat a chronic or recurring infection.
If drug treatment doesn't shrink or eliminate nasal polyps, your doctor may recommend surgery. The type of surgery depends on the size, number and location of your polyps and the extent of inflammation. Surgery options for nasal polyps include:
- Polypectomy. Small or isolated polyps can often be completely removed using a small mechanical suction device or a microdebrider — an instrument that cuts and extracts soft tissue. This procedure, called a polypectomy, is performed on an outpatient basis.
- Endoscopic sinus surgery. You may need surgery to remove polyps and to correct problems with your sinuses that make them prone to inflammation and polyp development. The surgeon inserts an endoscope, a small tube with a magnifying lens or tiny camera, into your nostrils and guides it into your sinus cavities. He or she uses tiny instruments to remove polyps and other obstructions that block the flow of fluids from your sinuses. Your surgeon may also enlarge the openings leading from your sinuses to your nasal passages. Endoscopic surgery is usually performed as an outpatient procedure.
After surgery, you'll likely use a corticosteroid nasal spray to help prevent the recurrence of nasal polyps. Your doctor may also recommend the use of a saltwater (saline) rinse to promote healing after surgery.
- Fried MP. Nasal polyps. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec08/ch091/ch091d.html. Accessed Nov. 12, 2010.
- Levine M. Nasal polyps. American rhinologic society. http://www.american-rhinologic.org/patientinfo.nasalpolyps.phtml. Accessed Nov. 10, 2010.
- Hamilos DL. Clinical manifestations, pathophysiology and diagnosis of chronic rhinosinusitis. http://www.uptodate.com/home/index.html. Accessed Nov. 10, 2010.
- Scadding GK, et al. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clinical and Experimental Allergy. 2007;38:260.
- Antunes MB, et al. The role of local steroid injection for nasal polyposis. Current Asthma and Allergy Reports. 2010;10:175.
- Dykewicz MS, et al. Rhinitis and sinusitis. Journal of Allergy and Clinical Immunology. 2010;125(Suppl 2):S103.
- Wood AJ, et al. Pathogenesis and treatment of chronic rhinosinusitis. Postgraduate Medical Journal. 2010;86:359.
- Hamilos DL. Medical management of chronic rhinosinusitis. http://www.uptodate.com/home/index.html. Accessed Nov. 10, 2010.
- Tosun F, et al. Impact of endoscopic sinus surgery on sleep quality in patients with chronic nasal obstruction due to nasal polyposis. The Journal of Craniofacial Surgery. 2009;20:446.
- Citardi MJ. An introduction to nasal endoscopy. American Rhinologic Society. http://www.american-rhinologic.org/patientinfo.introendoscopy.phtml. Accessed Nov. 10, 2010.
- Dutton JM. Endoscopic sinus surgery. American Rhinologic Society. http://www.american-rhinologic.org/patientinfo.sinussurgery.phtml. Accessed Nov. 19, 2010.
- Li JT (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 23, 2010.
- Rabago D, et al. Nasal irrigation for chronic sinus symptoms in patients with allergic rhinitis, asthma, and nasal polyposis: A hypothesis generating study. Wisconsin Medical Journal. 2008;107:69.