Management of a patient with nasal polyps experiencing obstructive symptoms should begin with a thorough clinical assessment to confirm the diagnosis and evaluate the severity of obstruction and associated symptoms NICE NG202. Initial treatment typically involves the use of topical nasal corticosteroids, which help reduce polyp size and inflammation, thereby improving nasal airflow and symptoms NICE NG202. For patients with more severe or persistent symptoms, a short course of oral corticosteroids may be considered to achieve more rapid reduction in polyp size and symptom relief Martinez-Devesa 2011. This approach is supported by evidence showing oral steroids can effectively reduce nasal polyps and improve obstructive symptoms Martinez-Devesa 2011.
If symptoms persist despite medical therapy, or if there is significant anatomical obstruction, referral to an ear, nose, and throat (ENT) specialist is recommended for further evaluation and consideration of surgical options such as endoscopic sinus surgery NICE NG202. Surgery aims to remove polyps and restore nasal patency but should be combined with ongoing medical management to reduce recurrence risk Thomas et al. 2008.
Additionally, it is important to assess for and manage any underlying inflammatory conditions such as allergic or vasomotor rhinitis, which may contribute to nasal obstruction and polyp formation NICE NG202. Emerging research highlights the role of eosinophilic inflammation in nasal polyp pathogenesis, suggesting that targeted therapies addressing eosinophil subpopulations may become relevant in future management strategies Simmalee et al. 2025.
In summary, management involves initial medical therapy with topical corticosteroids, consideration of oral steroids for severe cases, assessment and treatment of underlying rhinitis, and referral for specialist evaluation if obstruction persists or worsens NICE NG202. Surgical intervention is reserved for refractory cases, with ongoing medical treatment to prevent recurrence Thomas et al. 2008Martinez-Devesa 2011.
Key References
- NG202 - Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s
- (Thomas et al., 2008): EPOS Primary Care Guidelines: European Position Paper on the Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps 2007 - a summary.
- (Martinez-Devesa and Patiar, 2011): Oral steroids for nasal polyps.
- (Simmalee et al., 2025): Inflammatory and homeostatic roles of eosinophil subpopulations in chronic rhinosinusitis with nasal polyp pathogenesis.