Medical treatment of nasal polyps

Polyps are a multifactorial disease that affect the nasal lining and sinus mucosa, and in about one-third of the patients are associated with asthma. Polyps may occur in other respiratory diseases such as cystic fibrosis, primary ciliary dyskinesia and immune deficiencies. Allergy does not predispose to polyp formation, although mast cell reactions appear to be important. This explains why corticosteroids are effective in controlling some cases and helping to prevent recurrence in some others. Polyp formation in the sinuses is due to three factors: (1) the balance between the inflammatory response and the local homoeostatic mechanisms; (2) the relatively poor blood supply of the sinuses; and (3) the complex anatomy of the ethmoids and middle meatus which aggravates the existing oedema. Half the cases resolve on inhaled corticosteroids. Surgery should be tailored to the patient's needs, but on principle the simplest, least invasive operation should be tried first. If the patients are still symptomatic or recurrence is a problem, surgery may be followed by corticosteroids. If inhaled corticosteroids do not control the symptoms, then oral therapy may be required.