Can chronic nasal polyp inflammation be controlled?

Question

Hi doctor,

I have suffered from recurrent nasal polyps since I was about 20 years old. The polyps were regularly operated on every two to three years. All of these surgeries give temporary relief, and after that period, all the symptoms recur. The steroids are helping too, but the effect does not last long.

Now I am 32, and I want to know why I suffer from recurrent polyps and if there are any other ways to treat the problem, since I have had five to six surgeries already.

Is there any way to control the inflammation in case of chronic nasal polyp disease?
Is there a biological treatment for such patients, or is there no alternative to repeated surgeries?

All these procedures, which did not bring a good result for a long time, became psychologically and physically exhausting for me. Constant congestion, lack of sleep, and planning my days around a non-functional organ make me tired. It also influences me at work and in social situations much more than many can imagine.

I will be grateful for your consultation.

Answer 1

Hi,

Welcome to icliniq.com.

After reviewing your query, I am truly sorry to know about the problems that you are facing.

The problem of nasal polyps tends to recur since while surgery removes existing nasal polyps, it does not treat the inflammatory process that causes the formation of polyps. People who suffer from CRSwNP experience inflammation in their sinuses, which results in the development of new polyps, even after surgical removal. The fact that you underwent many operations does not indicate failure of treatment; rather, it is a signal of persistence of the underlying inflammatory process.

While steroids do help with temporary relief of symptoms due to reduction in inflammation, the condition recurs when they are no longer used. Moreover, repeated use of oral steroids is associated with certain side effects.

In view of your numerous operations and continuing symptoms, it would be helpful to speak with an ENT specialist regarding biologic medications like dupilumab. These medications reduce inflammation, shrink nasal polyps, restore a sense of smell, reduce steroid intake, and reduce the number of surgical interventions in well-selected patients.

However, the main aim of treatment is to achieve long-term disease control and not just depend on repeat surgeries. Treatment can be composed of:

Regular nasal irrigation using a saline solution.
Steroid nasal spray or sinus irrigation using a steroid, especially post-sinus surgery.
Assessment and treatment of any associated disorders, like allergies and asthma, if applicable.
Biologics treatment in patients with severe or recurrent disease, if the patient meets the criteria.
Only surgery if symptoms are still poorly controlled despite having optimal medical treatment, or if there is considerable blockage.

The disturbed sleep, nasal obstruction, loss of sense of smell, and problems with concentration that you mentioned are common complications of sinus disease and may significantly affect your quality of life. Luckily, many patients suffering from severe nasal polyps respond positively when the treatment approach centers on managing inflammation rather than removing the polyps repetitively.

Hopefully, this will help clear up your confusion.

Good luck to you, and I wish you all the best.

Thank you.