How can a nasal spray efficiently relieve sinusitis and nasal polyps?

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Before I go to answer your questions, you need to understand the physiological and pathology of the problem in concern. Having understood that the treatment and mechanism of action of medications become much easier to understand.

The nasal cavity performs various functions, one of which is to filter the air that we breathe. Other functions include humidification, a pathway for olfaction (smell), etc. The exposure to dust (or any irritative substance that your body is hyper-sensitive to) will initially initiate reflexes such as sneezing to remove the offending agent. If this fails, mucosal cells in your nose start to hyperfunction, producing loads of mucus that trap dust (owing to its sticky nature). This mucus has nowhere to go other than either being blown out of the nose or getting pushed into the throat owing to mucociliary activity, thereby entering into a new zone. The throat initially reacts by activating cough impulses to push out the mucus, but if that fails, a local inflammation around the throat starts, which often leads to symptoms such as the feeling of a lump in the throat and the feeling of clearing the throat.

Chronic, long-standing inflammation around the nose leads to edema of the nasal and sinus mucosal lining, now causing the thickened mucosa to out-pouch from its primary area, and such outpouching prolapsed mucosa is called a polyp. These polyps increase in size, occupying the nasal cavity and causing nasal obstruction and a lack of smell and taste. Chronic inflammation also involves the eustachian tubes, which ventilate air and equalize pressure between the nose and the ear. Inflamed tubes do not function well, and this leads to negative pressure in the ear, causing ringing sensations, muffled noise, and sometimes decreased hearing.

Now, answers to your questions.

Will the spray be effective enough to reduce the polyps and give relief?

It depends on the extension and degree of inflammation in the nose. If the polyps have grown to an extent causing almost near obliteration and obstruction of the nasal cavity, steroid nasal sprays have very little or no role to play, as they will not able to reach the target areas. Mere topical application will not fetch the desired outcomes.

How does the nasal spray work?

The process of allergy is mediated by several chemical substances released by the body, depending on the load of exposure. There are several chemical substances known to participate in this cascade. However, the major problem is created by histamine and leukotrienes. Nasal sprays are available with steroids (fluticasone propionate, Furoate, or Mometasone) and anti-histamines (Azelastine), which primarily work on reducing the inflammatory activity by antagonizing the formation and action of the problem chemical 'histamine.' Using nasal decongestants containing Oxymetazoline or Xylometazoline is not advocated in the long term as these medications are known to cause rebound congestion, also called rhinitis medicamentosa (an inflammation of the nasal mucosa caused by the overuse of nasal sprays).

As per guidelines, ideally speaking,

An ENT (ear-nose-throat) doctor has to evaluate the patient and assess the degree of the problem. If there is an extensive disease, a course of tapering steroids should be given, and later, steroid-added alkaline nasal rinses should be started. A non-contrast computed tomography (NCCT) nose and PNS X-ray (Para-nasal sinus) should be done in all patients. Surgery should be considered to remove the residual polyps (after medical treatment) and to correct any bony deviations, if any, to regulate the appropriate delivery of medications for the long term. Not adhering to instructions and getting exposed to trigger factors will certainly lead to the recurrence of polyps even after surgery, and this is why good care has to be kept.

Always remember there is no head-on medication or surgical procedure to remove the allergy. Whatever medications are given in the appropriate situation is only to temporarily cease or reduce the symptoms.

I hope this information helps provide some insight into your symptoms.

Please do not hesitate to reach out if you have any further questions or concerns.

Thank you.