Fast Five Quiz: Nasal Polyp Practice Essentials

Arlen D. Meyers, MD, MBA

Disclosures

May 14, 2020

The management of nasal polyps should be based on the causative factors. Unfortunately, most cases of nasal polyps have an unclear etiology. Even if a patient has allergies, no clinical evidence shows that the management of allergies reduces or eliminates polyps. The underlying etiology in most cases is inflammatory, so medical management is aimed at nonspecific treatment of the inflammatory disorder.

Oral corticosteroids are an effective medical treatment for nasal polyps. The nonspecific anti-inflammatory agents quickly and substantially reduce the size of inflammatory polyps and improve symptoms. Patients whose polyps respond to oral corticosteroids may be re-treated safely three to four times a year, especially if they are not candidates for surgery. The mechanism of action of corticosteroids is unclear. One study showed that corticosteroids induce apoptosis in inflammatory cells in human nasal polyps in vitro.

Intranasal steroid sprays may reduce or retard the growth of small nasal polyps, but they are relatively ineffective in large nasal polyps. Intranasal corticosteroid sprays reduce the growth of small intranasal polyps and are most effective in the postoperative period to prevent or retard regrowth of the polyps. Corticosteroids have also proven to be effective when administered intramuscularly or injected into the polyps.

In June 2019, the US Food and Drug Administration approved dupilumab for treatment in adults with inadequately controlled, severe chronic rhinosinusitis with nasal polyps. Dupilumab is a humanized monoclonal antibody that inhibits interleukin (IL)-4 and IL-13 signaling by specifically binding to the IL-4 receptor-alpha subunit shared by the IL-4 and IL-13 receptor complexes. Approval was supported by phase 3 clinical trials that demonstrated significant improvement in nasal congestion/obstruction, the nasal polyp score, sinus opacification, and sense of smell when dupilumab was added to standard-of-care mometasone furoate nasal spray.

Antifungal agents have no role in the management of nasal polyposis, but these agents may be useful in cases of allergic fungal sinusitis with polyposis.

Other agents with a possible role in management of nasal polyposis are macrolide antibiotics, topical diuretic therapy, and intranasal lysine acetylsalicylate.

Read more about the treatment of nasal polyps.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Pediatric Nasal Polyps and Nonsurgical Treatment of Nasal Polyps.

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