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The web site for people with sinus problems

What can be done, before surgery, to reduce or eliminate the polyps? 

So you have polyps and want to know how to shrink them, to avoid surgery.  Well, the treatment for polyps depends on what is causing them, so its very important to get a thorough evaluation of the polyps in order to “go for” the best treatment.    We can’t give you medical recommendations here and now, because we don’t know whats causing the polyps in your particular case, but there are some  general treatments that may be common to all types of polyps so  we’ll go over some of the treatments that your doctor may prescribe for you.  Specifically, we’ll talk about steroid sprays and steroid pills.

Steroid Sprays
Who gets them?
Steroid sprays are typically prescribed for most types of nasal polyps.  They are commonly used for mild polyps that are caused by allergic rhinitis (say, for instance, polyps caused by allergies to cats, dust, molds, pollens, trees, grasses, and/or molds).    They are also used for patients with medium and large polyps.  Generally speaking, steroid sprays are helpful to shrink polyps or may just slow the natural growth of polyps.   More on treatment of polyps later in the text.

How do they work?
How are they best given?
Are there any problems with them? We'll talk more on this later. This section is under development.

Oral steroid pills.

When treating patients for nasal and sinus polyps, sometimes a physician will prescribe steroid pills which (for most people) will cause a dramatic shrinkage of the polyps.  However, the effect is usually temporary.  The polyps usually return within a few days or a couple of weeks after stopping the steroid pills.   I use a graphic analogy with patients to get the point across, which is the grape-raisin anology.   When grapes are dehydrated to form raisins, all of the protein and “meat” of the grape remains, but the water is removed.  Similarly, when large polyps are treated with oral steroids, the fluid in the polyp is dramatically reduced, but the inflammatory cells and tissue remains, and within a few days after stopping the steroids, the water returns to the polyps and they often return to about their original size, if nothing else is done to treat the polyps. 
Who gets them
How do they work?
How are they best given?
Are there any problems with them?

So, we are back to the topic of “Chronic sinusitis with polyps”.  We now know that a polyp is inflamed, edematous or swollen nasal or sinus tissue that often causes symptoms by obstructing airflow and / or obstructing air to the olfactory area (causing decreased sense of smell and complaints of poor ability to taste).

But what is “chronic sinusitis”.   Well sinusitis is, simply put, an “itis” or inflammation, of the sinuses.  The sinuses are air filled spaces between, below, above, and behind the eyes (see drawing/photo of sinuses).   The sinuses are lined with mucosa, a very thin, moist, pink lining usually less than about 1mm thick.  If the mucosa becomes inflamed (“itis”), the condition is called “sinusitis”.   There are many, many possible causes for inflammation of the sinuses, some of them very common, some not common, and some incredibly rare.   So you see “sinusitis” is a sort of generic term for inflammation that could be caused by many different things.   Kind of like saying you have “car trouble”.   The mechanic you go to will try to find out what sort of “car trouble” you are having:  an electrical/ignition  problem, fuel problem, a timing problem, an exhaust problem in order to classify the type of car problem and focus on solutions.

Doctors dealing with sinusitis also try to classify the type of problem in order to identify the best solution for that particular type of sinusitis.   Of course, classifying the different types of sinusitis is also important for scientists and clinicians to be able to study the disease (and agree on which type of sinusitis anyone is researching or talking about).   It turns our that there are several different ways to classify sinusitis.  You can classify it by how long its been there (acute or chronic), whether its infectious or not, what type of infectioun it is (viral, bacterial, fungal).  Doctors  can also classify sinusitis by what the doctors sees on examination (with or without polyps), or what the pathologist sees when he or she examines sinus tissue (from surgery) under the microscope. 

 The   first types of classificationof sinusitis, and perhaps the easiest,  is by timing:  that is, how long has this problem lasted?  If the sinusitis has been less than 4 weeks, it is called acute sinusitis.  If its been more than 12 weeks, its called chronic sinusitis, and if its been between 4 and 12 weeks, its called subacute sinusitis.  For the most part, patients with acute sinusitis, sometimes referred to as a routine sinus infection, get better.  Either on their own or with antibiotics, most all of them improve.  However, a small percentage of patients with an acute infection will not completely improve and symptoms will smolder (or be quite evident) for more than 3 months, again fitting the category of what we’d call “chronic sinusitis”, just by its timing.   If you have acute sinusitis once a year, you probably just get it treated (or it gets better on its own), and it doesn’t bother you enough to spend the time to read this book.   Good for you!   But other folks get acute sinus infections one time after another, perhaps every 6-8 weeks.  They are frequently calling their doctor for medications, get better with treatment, then have a recurrence of the infection after several weeks.   Doctors refer to this type of infection as “recurrent acute sinusitis”,  because it completely resolves between the acute infections, then recurs.

Some patients with sinus infections never completely improve between these infections and after treatment.  The symptoms may improve to some degree with antibiotics or other treatment, but the nasal and sinus symptoms don’t completely resolve.   Doctors classify these patients as having chronic sinusitis when the symptoms last more than 12 weeks.  Sometimes there are low grade, smoldering symptoms most of the time, then there is a sudden  or acute flare up of symptoms, which may get treated and improve, but the patient still has the low grade symptoms afterwards.  These patients are described as having a type of sinusitis called “acute exacerbations of chronic sinusitis”.  So now we have described at least one type of classification for sinusitis (acute versus chronic).  This will help us complete our definition of chronic sinusitis with polyps: 

So chronic sinusitis with polyps is a condition of inflammation of the sinuses which lasts more than 12 weeks and is associated with nasal polyps. 

Great, we have described the first type of chronic sinus problems that require sinus surgery, chronic sinusitis with nasal polyps.  It gets easier from here, in some respects, because the next type is chronic sinusitis without polyps.