Much like many things in rhinology, we always try medical management first. And medical management usually consists of treating the polyps with steroids. So not all polyps respond to steroids, but a lot of them do. And this can take the form of topical steroids or oral steroids for short durations. Typically I'll have a patient come in and we'll examine, and if we see polyps and they're big enough and obstructing enough of the nasal cavity of the nasal sinuses and causing symptoms, we can start with topical nasal steroids. This can come in the form of a nasal spray. There's some newer sprays, which have been shown to be very highly effective to treating nasal polyps. And when this fails, we can try oral steroids, in the right patient, of course, because they can have plenty of side effects that we need to be careful with. Sometimes patients don't respond to steroids and don't respond to topical or oral steroids, and we have to move on to the next step. Sometimes that'll involve allergy testing. We can see if allergies might be behind the cause of someone's polyps, and obviously if the allergies are an issue, we can have that addressed. But in the end, if we can't figure out a good medical management for polyps and they continue to be a problem, surgical intervention is required. And this can happen in the operating room where we take the patient for endoscopic sinus surgery. And we remove all the polyps, open up all the sinuses where the polyps seem to be involved, and give the patient a fresh start. More recently, some newer medications have come out in the form of injectable medications that can be given to lessen that type of inflammation which can lead to polyp. That type two inflammation we talked about earlier. And that can be a very effective tool. But typically we reserve something like that for patients who have had difficulty with polyps that aren't able to be treated with medical management and aren't able to be treated with surgery enough that will give them a long lasting results. And that's when we really turn to these newer medications called the biologics.
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