Nasal polyps are the common end-point of a number of conditions characterised by
inflammation and are rarely 'curable' in its true sense. After consideration of the underlying aetiology and confirmation of the diagnosis, they are normally managed by a combination of medical and surgical interventions. Of these, topical
corticosteroids have proved to be the medical treatment of choice. The objectives of the medical management are to eliminate or reduce the size of
polyps, re-establish nasal airway and nasal breathing, improve or restore the sense of smell, and prevent recurrence of
nasal polyps. The mechanism of action of
corticosteroids may be by a multifactorial effect on various aspects of the inflammatory reaction, the effect being initiated by their binding to a specific cytoplasmic
glucocorticoid receptor. At a cellular level, there is a reduction in the number of antigen-presenting cells, in the number and activation of T cells, in the number of mast cells, and in the number and activation of eosinophils. When
polyps are large (grade 3) topical medication is difficult to instil in a very blocked nose and surgery or short term systemic
corticosteroids may be required. Topical
corticosteroids are of use in the primary treatment of
nasal polyps when they are of a small or medium size (grades 1 and 2) and in the maintenance of any therapeutic improvement. The efficacy of topical
corticosteroids such as
betamethasone sodium phosphate nose drops,
beclomethasone dipropionate,
fluticasone propionate and
budesonide nasal sprays in reducing
polyp size and
rhinitis symptoms has been demonstrated in several randomised, placebo-controlled trials.
Beclomethasone dipropionate,
flunisolide and
budesonide sprays have also been shown to delay the recurrence of
polyps after surgery. Placebo-controlled studies of agents that have shown a significant clinical effect in the management of nasal polyposis are reviewed.