Current management options for nasal polyps

Nasal polyps are soft, painless, benign growths in the nose that are sometimes seen by primary care providers, but mainly need to be confirmed and managed by an otolaryngologist. This blog is about treatment for these.

Observation and follow-up are chosen by many patients who have these, since most treatments listed below are still “treatments”. Meaning, some people who have had therapy for polyps and under close care choose to take holidays from medicine. Also, as you will read below, only two of the options below are not based on corticosteroid use.

The mainstay and “FDA-approved” medicine for nasal polyps are called nasal steroid sprays. There are many examples, but a common example is fluticasone (Flonase ®). These are now over-the-counter and typically are used once a day, two sprays each side.

A newer delivery model for this drug has come out, and the proprietary name is Xhance ®. It seems to be superior to conventional delivery methods, but might not be covered by all insurance plans.

Using budesonide within sinus rinse is a very common way for otolaryngologists to treat polyps. It seems that nearly all otolaryngologists write and speak about this option. Some pharmacists are puzzled when a script comes over for this, but properly educating them and patients on the use of this have led to many happy patients who are without disease.

Short bursts (less than two weeks) of oral corticosteroids are commonly used, both when polyps are first diagnosed and sometimes once or twice a year. Common types are prednisone and methylprednisolone (aka Medrol dose pack). These carry risks that have been written in blog of August 2019.

There is a procedure in the office available, where we can place a stent in the sinuses that slowly releases mometasone, a steroid, into the sinuses (Sinuva ®). This is reserved for those who have already had sinus surgery.

Next medical treatment is fairly new, and is a “biological” called dupilumab (Dupixent ®). It is basically an antibody against nasal polyps that is injected into the skin (anywhere, but usually a shoulder). It is very expensive at the moment.

Of course, surgery is performed for polyps, which has been written about in the December 2018 Hudson ENT blog, for example.

More treatments will be available as time goes on, and many journals are filled with the biological processes that are behind (and within) the formation of nasal polyps.

Do you or a loved one suffer from nasal polyps? Come to the experts at hudsonENT and give us a call at 845-758-1456.