What are The Best Treatment for Nasal Polyps 2020 ?


INCS are an effective treatment for Nasal Polyps ( Nose polyps ) but are limited in their efficacy by inconsistent nasal distribution, especially in the presence of severe nasomucosal edema or large nasal polyps. Conven¬tional nasal sprays deliver less than 5% of metered INCS into the middle meatus, the critical area of the nose for drainage of the maxillary, anterior ethmoid, and frontal sinuses. Several different delivery strategies, such as nebulization or irrigation, are used to overcome this maldistribution. For example, an appropriately powered randomized clinical trial of topical budesonide saline irrigation versus INCS nasal sprays shows no difference in outcome for the patient-based quality of life score or objective (endoscopy and CT scores) assessments. 

However, a 2019 Food and Drug Administration (FDA)-approved device for intranasal fluticasone, which is breath-assisted, is now indicated for the treatment of Nasal Polyps (Xhance; Optinose, Yardley, Pa). It significantly reduces nasal polyps size by improving the delivery of the CS into the OMC. Ideally, a study including a conventional INCS spray treatment group to directly compare both treatments would enhance confidence in the results of this study. Xhance is not approved to treat Nasal Polyps. However, ongoing phase III clinical trials are in progress for this phenotype.

Another new device is the mometasone drug-eluting stent (Sinuva; Intersect ENT, Menlo Park, Calif) that can be inserted in an outpatient setting. This is FDA approved for recurrent Nasal Polyps. It slowly releases mometasone over a 3-month period but ultimately has to be removed. Some subjects cannot tolerate the device due to increased nasal crusting, mucus production, and a perceived bad odor. A similar CS eluting stent (Propel; Intersect ENT) is also FDA approved and can be used after surgical polypectomy and ethmoidectomy. Propel is not approved for outpatient use.

Long-term topical decongestants combined with INCS for Nasal Polyps is another treatment modality that requires an additional study. Nasal congestion is usually the most bothersome symptom with any upper airway disease. Two studies indicate that several weeks of continuous topical oxymetazoline does not cause “rebound phenomenon” when concomitantly used with INCS. Topical decongestants may enhance the delivery of INCS in the presence of nasal mucosal edema and improve the quality of life and sleep. Oral CS, used for 3 to 7 days, is another option to reduce severe mucosal edema and large nasal polyps and enhance subsequent INCS efficacy.

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