Biologic Treatments Offer New Hope for Chronic Nasal Polyps

Understanding Nasal Polyps

Nasal polyps are noncancerous growths that develop in the lining of the sinuses or nasal passages. They typically appear as teardrop-shaped swellings that hang down from the sinus passages into the nasal cavity.

Nasal polyps often occur in people with chronic inflammation conditions like asthma, cystic fibrosis, and chronic sinusitis. They may affect adults and children, but are more common in middle-aged and older adults.

The exact cause of nasal polyps is unknown, but they tend to form in people with chronic inflammation. This inflammation causes fluid to accumulate in the sinuses and nasal tissues, resulting in edema or swelling. Over time, the swollen tissue can form into polyps.

Common symptoms of nasal polyps include:

• Chronic congestion or stuffiness
• Runny nose
• Postnasal drip
• Loss of smell and taste
• Facial pain or pressure
• Snoring
• Difficulty breathing through the nose

If left untreated, nasal polyps can completely block the nasal passages and sinuses, causing even more severe symptoms.

Medical Treatments for Nasal Polyps

The most common medical treatments for nasal polyps include:

Nasal Steroid Sprays

Corticosteroid nasal sprays are the first line treatment for nasal polyps. The steroids work by reducing inflammation, which helps shrink polyps over time. They may take several weeks to start working but can significantly open nasal passages once effective.

Some common prescription steroid sprays include fluticasone (Flonase), triamcinolone (Nasacort), mometasone (Nasonex), and budesonide (Rhinocort). Using nasal saline spray along with steroids may help enhance results.

Oral Steroids

Oral corticosteroids like prednisone are sometimes prescribed for short-term treatment of severe nasal polyps. A course of oral steroids, such as prednisone, taken for 1-2 weeks can rapidly shrink polyps and open nasal passages.

However, oral steroids can have significant side effects with long-term use, including weak bones, weight gain, and high blood pressure. Therefore, an oral steroid burst is only used for severe blockage until other treatments start working.

Biologics

Biologic drugs that inhibit specific parts of the inflammatory response are emerging as new therapy options for chronic nasal polyps. Currently, the anti-IgE antibody omalizumab (Xolair) and anti-IL5 antibodies mepolizumab (Nucala) and reslizumab (Cinqair) have been studied in patients with nasal polyps.

These biologic agents target different inflammatory proteins involved in certain disease pathways. Early research indicates they may be beneficial in reducing nasal polyp size and recurrence after surgery in select patients.

Biologics are given by injection or IV infusion. Potential side effects may include increased infection risk, fever, headache, and injection site reaction. More research is still needed to confirm long-term efficacy and safety.

Other Medications

Oral steroids and nasal steroid sprays are the mainstays of medical treatment for nasal polyps. Some other medications that may be helpful include:

• Antihistamines - Help reduce sneezing and runny nose symptoms.
• Decongestants - Temporarily open nasal passages.
• Nasal anticholinergics - Block specific receptors to reduce nasal leakage and congestion.
• Leukotriene inhibitors - Reduce inflammation by blocking leukotrienes.

Discuss all medications with your doctor, as improper or overuse of decongestants and antihistamines can actually worsen congestion.

Nasal Polyp Surgery

If medications are not effective at shrinking nasal polyps, surgery may be recommended. There are several different nasal polyp surgery techniques:

Polypectomy

Polypectomy is a procedure to directly remove nasal polyps. It is often done using small surgical instruments with the patient under local or general anesthesia.

This procedure removes accessible polyps but has a high recurrence rate since it does not treat the underlying inflammation that causes them to regrow.

Functional Endoscopic Sinus Surgery (FESS)

FESS is the most common and effective surgery for nasal polyps. It uses an endoscope (small camera) inserted into the nostril to visualize the nasal passages and sinuses.

The surgeon then carefully removes polyps as well as small bone and tissue fragments to widely open the sinus drainage pathways. This both removes current polyps and improves long term drainage to reduce recurrence.

FESS is done under general anesthesia as an outpatient procedure. Patients normally recover in 1-2 weeks.

Balloon Sinuplasty

Balloon sinuplasty uses a small inflated balloon to gently remodel the sinus opening instead of removing tissue. This minimally invasive option may be used alone or with polyp removal and other techniques.

It can help improve drainage but does not remove polyps. Balloon sinuplasty has a quicker recovery than FESS but a higher recurrence risk.

Home Remedies and Lifestyle Changes

Medical therapy and surgery are the most proven options for treating nasal polyps. However, certain at-home treatments and lifestyle changes may help provide additional symptom relief:

• Use nasal saline rinses to help clear mucus and soothe inflammation.
• Take over-the-counter medications like antihistamines, decongestants, and nasal steroids.
• Avoid irritants like cigarette smoke, chemicals, and air pollutants.
• Use a humidifier to add moisture to overly dry indoor air.
• Drink plenty of fluids to thin mucus.
• Get regular gentle exercise to support the immune system.
• Consider antioxidants and herbal supplements (discuss with your doctor first).

Avoid overusing decongestant nasal sprays, as this can increase congestion. See your doctor if at-home treatments are not relieving symptoms.

Outlook for Nasal Polyps

Nasal polyps are common noncancerous growths affecting the nasal passages and sinuses. They frequently recur after treatment but rarely become cancerous.

With proper continuing treatment, most people with nasal polyps can achieve good symptom control and quality of life. The combination of nasal steroid sprays, biologics, surgery, and lifestyle changes offers effective long-term management for chronic nasal polyps.

Work closely with your ENT doctor to determine the right treatment plan for your individual case. Report any new or worsening symptoms promptly, as early treatment leads to better outcomes.

Though challenging to manage, nasal polyps can often be reduced to minimize disruptive symptoms using todays advancing treatment options.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.