A 38-year-old man presents with bilateral nasal obstruction and rhinorrhea for 6 months. Nasal endoscopy reveals multiple pale, smooth, gelatinous masses in both nasal cavities consistent with nasal polyps. CT paranasal sinuses shows no evidence of sinusitis. What is the drug of choice for medical management of this condition?

Explanation

## Medical Management of Nasal Polyps **Key Point:** Intranasal corticosteroids are the first-line and gold standard medical treatment for nasal polyps, regardless of etiology (allergic, chronic rhinosinusitis-associated, or idiopathic). ### Mechanism of Action Intranasal corticosteroids (e.g., mometasone, fluticasone, budesonide) reduce polyp size by: - Suppressing local inflammation and eosinophilic infiltration - Reducing mucus secretion - Decreasing vascular permeability - Inhibiting mast cell degranulation ### Efficacy & Duration - Symptom improvement: 2–4 weeks - Polyp size reduction: 4–12 weeks - Sustained benefit with long-term use (6–12 months) - Can delay or prevent need for surgical intervention **High-Yield:** Mometasone furoate and fluticasone propionate are preferred agents due to: - High topical potency - Low systemic bioavailability - Excellent safety profile even with prolonged use ### Treatment Algorithm ```mermaid flowchart TD A[Nasal Polyps Diagnosed]:::outcome --> B[Intranasal Corticosteroid]:::action B --> C{Response at 12 weeks?}:::decision C -->|Yes| D[Continue long-term]:::action C -->|No| E[Consider Surgery]:::action E --> F[Functional Endoscopic Sinus Surgery]:::action ``` ### Adjunctive Measures - Saline irrigation (supportive) - Antihistamines if allergic component present - Treat underlying allergic rhinitis or asthma **Clinical Pearl:** Patients with aspirin sensitivity or asthma-associated nasal polyps (Samter triad) may have more aggressive disease and may require earlier surgical intervention despite medical therapy.