Should I change steroid sprays regularly for nasal polyps?

Question

Hello doctor,

I have had nasal polyps for years and use steroid nasal sprays daily, but congestion and loss of smell keep coming back. Sometimes the sprays help, and sometimes they do not seem to help at all. I am tired of breathing through my mouth and waking up exhausted every day. Not being able to smell food or smoke also makes me anxious. My questions are:

Does someone at 41 with nasal polyps need to change steroid sprays regularly?
Can the nose become less responsive to one spray over time?
When are biologic treatments or surgery considered instead of just rotating nasal sprays?
How do doctors decide when symptoms are severe enough for advanced treatment options?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Steroid nasal sprays usually do not stop working because the nose becomes used to them. Persistent symptoms are more often due to worsening inflammation, large nasal polyps blocking the medication from reaching the sinuses, or a disease that has become too severe for sprays alone.

A change in sprays is not always necessary, although physicians can decide to use a new steroid spray or steroid rinse in case one leads to irritation or does not work effectively. The right spray application and saline rinses can help to make the spray more effective.

Given that you still suffer from severe congestion, anosmia, breathing through your mouth, and lack of sleep despite taking treatment on a daily basis, you should see an ENT (ear, nose, and throat) specialist. They will advise on imaging tests and other tests such as nasal endoscopy.

Surgery is considered when symptoms remain severe despite medical therapy, especially with ongoing blockage, loss of smell, recurrent infections, or major quality-of-life problems. Biologic medications such as Dupilumab may be considered for severe or recurrent nasal polyps, particularly if symptoms return after surgery or require repeated steroid treatment.

I hope it helps.

For further queries, you can consult me.

Thank you.