## Management of Uncomplicated Nasal Polyps **Key Point:** In patients with uncomplicated nasal polyps (no asthma, no cystic fibrosis, no severe symptoms), medical management with topical nasal corticosteroids is the first-line approach. Surgery is reserved for cases that fail medical therapy or cause significant functional impairment. ### Rationale for Topical Corticosteroids **High-Yield:** Topical nasal corticosteroids (fluticasone, mometasone, budesonide) are the gold standard initial treatment because they: - Reduce polyp size and symptoms in 50–70% of patients - Have minimal systemic absorption - Can be used long-term without significant side effects - Delay recurrence post-operatively ### Why Surgery Is Not First-Line Here Endoscopic sinus surgery (ESS) is indicated when: 1. Medical therapy fails after 6–8 weeks of adequate topical corticosteroid use 2. Polyps cause significant obstruction affecting quality of life despite medical therapy 3. Recurrent polyps after previous surgery In this case, the patient has not yet received a trial of topical therapy, so surgery would be premature. ### Systemic Corticosteroids **Clinical Pearl:** Oral corticosteroids are reserved for: - Acute exacerbations with severe obstruction - Polyps associated with asthma exacerbations - Bridge therapy before surgery in selected cases They are NOT first-line monotherapy because of systemic side effects and lack of sustained benefit. ### Pulmonology Referral While asthma screening is reasonable in patients with polyps, the absence of respiratory symptoms does not mandate pulmonology referral before initiating nasal treatment. Asthma workup can proceed in parallel if clinically indicated. **Mnemonic:** **STOP** — Start Topical, Observe for 4–6 weeks, Plan surgery if Persistent symptoms. 
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