Chronic rhinosinusitis with nasal polyps

For patients with chronic rhinosinusitis with evidence of nasal polyps on investigation or examination, if symptoms do not respond after at least 1 month of initial therapy, refer to an ear, nose and throat surgeon for further investigation (including a nasal endoscopy) and management. Nasal endoscopy of a patient with chronic rhinosinusitis will have at least one objective finding, such as polyps, oedema, obstruction at the middle meatus, or mucopurulent discharge from the middle meatus.

The presence of nasal polyps should always prompt testing for cystic fibrosis in children, and for coexisting asthma and aspirin sensitivity (aspirin-exacerbated respiratory disease) in adults. Some adults with chronic rhinosinusitis and aspirin sensitivity may benefit from aspirin desensitisation under specialist supervision.

If symptoms do not respond after at least 1 month of initial therapy, or if the nose is too blocked to be able to use a nasal spray effectively, use a course of oral corticosteroid to reduce the size of polyps (‘medical polypectomy’). Medical polypectomy can be trialled while awaiting specialist referral. Use:

If medical polypectomy is ineffective or if symptoms recur, surgical polypectomy may be required.

Recurrence of nasal polyps after surgery is common so intranasal corticosteroid therapy must be continued long term after surgery to prevent or delay recurrence.

Some biological drugs (eg dupilumab, omalizumab, mepolizumab) are used by specialists for the treatment of chronic rhinosinusitis with nasal polyps.