How should I manage a patient with nasal polyps who is experiencing obstructive symptoms?

Management of a patient with nasal polyps experiencing obstructive symptoms should begin with a thorough clinical assessment to confirm the diagnosis and evaluate the severity of obstruction and associated symptoms ¹. Initial treatment typically involves the use of topical nasal corticosteroids, which help reduce polyp size and inflammation, thereby improving nasal airflow and symptoms ¹. For patients with more severe or persistent symptoms, a short course of oral corticosteroids may be considered to achieve more rapid reduction in polyp size and symptom relief (Martinez-Devesa and Patiar, 2011). This approach is supported by evidence showing oral steroids can effectively reduce nasal polyps and improve obstructive symptoms (Martinez-Devesa and Patiar, 2011).

If symptoms persist despite medical therapy, or if there is significant anatomical obstruction, referral to an ear, nose, and throat (ENT) specialist is recommended for further evaluation and consideration of surgical options such as endoscopic sinus surgery ¹. Surgery aims to remove polyps and restore nasal patency but should be combined with ongoing medical management to reduce recurrence risk (Thomas et al., 2008).

Additionally, it is important to assess for and manage any underlying inflammatory conditions such as allergic or vasomotor rhinitis, which may contribute to nasal obstruction and polyp formation ¹. Emerging research highlights the role of eosinophilic inflammation in nasal polyp pathogenesis, suggesting that targeted therapies addressing eosinophil subpopulations may become relevant in future management strategies (Simmalee et al., 2025).

In summary, management involves initial medical therapy with topical corticosteroids, consideration of oral steroids for severe cases, assessment and treatment of underlying rhinitis, and referral for specialist evaluation if obstruction persists or worsens ¹. Surgical intervention is reserved for refractory cases, with ongoing medical treatment to prevent recurrence (Thomas et al., 2008; Martinez-Devesa and Patiar, 2011).