Chronic Rhinosinusitis with Nasal Polyps: When First-Line Intranasal Therapy Has Not Controlled Polyp Burden
Clinical Scenario
This protocol addresses chronic rhinosinusitis with nasal polyps in the nasal cavity. The presence of nasal polyps is a key phenotypic distinction that guides treatment selection and escalation decisions.
First-Line Treatment — Inadequate Response
A course of intranasal corticosteroid spray (mometasone furoate or fluticasone furoate) combined with nasal saline irrigation has been completed but has not achieved the expected clinical goals: adequate reduction of nasal blockage, rhinorrhea, and nasal polyp size. This failure to reach those targets triggers escalation to the next treatment step.
Next-Line Approach
When topical therapy alone has not adequately controlled polyp burden, a short course of an oral corticosteroid (prednisone) may be introduced to achieve more substantial polyp reduction — the complete protocol details are in the structured regimen below.
Treatment Goals
Reduction in nasal polyp size and rapid symptomatic relief, including improved sense of smell.
References
DOI: 10.1503/cmaj.241101
- The phenotypic distinction of whether or not the patient has polyps can guide treatment.
- Short bursts of oral steroids such as prednisone can reduce the size of known nasal polyps and provide rapid symptomatic relief, including improved sense of smell.
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