In brief
Nasal polyposis is a form of chronic rhinosinusitis in which inflammation, usually type 2, forms polyps that block the nose and paranasal sinuses. It is often associated with asthma; treatment includes endoscopic surgery and, where indicated, biologic drugs.
Nasal polyposis is a form of chronic rhinosinusitis (CRSwNP, chronic rhinosinusitis with nasal polyps) in which inflammation of the lining of the nose and paranasal sinuses leads to the formation of polyps: benign growths that block the nasal cavities and sinuses.
In most European patients the underlying cause is type 2 inflammation, the same mechanism shared by asthma, allergies and other inflammatory diseases. This is why nasal polyps are often associated with asthma and, in some patients, with intolerance to aspirin and NSAIDs (N-ERD).
Symptoms
- persistent nasal blockage and mouth breathing;
- reduced or lost sense of smell and taste;
- nasal discharge at the front or at the back of the nose (post-nasal drip);
- facial pressure and snoring;
- worsening of asthma, where present.
Diagnosis
Diagnosis is based on an ENT consultation with nasal endoscopy, which shows the polyps and their extent (Nasal Polyp Score). A CT scan of the paranasal sinuses defines the extent of the disease and is used to plan any surgery.
The assessment is completed by the quality-of-life questionnaire SNOT-22, smell tests and, where indicated, blood tests (eosinophils, total IgE) and allergy and respiratory assessment.
Treatment options
Treatment is tailored to each patient, and the options are not mutually exclusive: they are often combined over time.
- Topical medical treatment: saline nasal irrigation and nasal corticosteroid sprays, the basis of treatment for all patients.
- Courses of oral steroids: useful during flare-ups, but to be limited because of side effects with repeated use.
- Endoscopic surgery (ESS/FESS): removes the polyps and opens the sinuses, improving breathing and the effectiveness of topical treatment.
- Biologic drugs: for patients with severe disease not controlled by previous treatments.
Biologic drugs
Biologic drugs are monoclonal antibodies that selectively block the mechanisms of type 2 inflammation. They are given by subcutaneous injection, which patients can usually self-administer at home after the first doses.
Dr Puya Dehgani-Mobaraki is an authorised prescriber of biologic drugs for nasal polyps and was a member of the Italian Academy of Rhinology working group that drafted the diagnostic and therapeutic care pathway (PDTA) for type 2 chronic rhinosinusitis.
Who may be a candidate
In Italy, biologics for nasal polyps are reimbursed by the National Health Service for adult patients with severe nasal polyps not adequately controlled despite corticosteroid treatment and/or surgery, according to criteria set by the Italian Medicines Agency (AIFA). They are prescribed through a treatment plan issued by authorised centres and specialists.
The choice between surgery, a biologic or a combination of the two is made together with the patient, taking into account disease severity, previous operations, sense of smell, quality of life, asthma and other associated conditions.
For initial guidance you can use the tool below. The SNOT-22 score can be calculated with the online questionnaire (in Italian).
Self-check: could I be a candidate for a biologic drug?
A guidance tool for patients with nasal polyps. Enter the data you know (many can be found in your consultation and test reports). The calculation runs only in your browser: no data are saved or sent.
Criteria taken from the Italian Medicines Agency (AIFA) treatment plans for severe nasal polyps (NPS ≥ 5, SNOT-22 ≥ 50, age ≥ 18, failure of systemic steroids and/or surgery) and from the EPOS/EUFOREA 2023 recommendations (at least 3 of 5 criteria after surgery). The tool is for guidance only: assessing the indication, choosing the drug and prescribing it are the specialist’s responsibility. Reimbursement criteria in other countries may differ.
Main biologic drugs for nasal polyps
| Active substance | Target | Status for nasal polyps | Dosing frequency |
|---|---|---|---|
| Dupilumab | IL-4Rα receptor (blocks IL-4 and IL-13) | Approved in the EU and reimbursed in Italy | Every 2 weeks |
| Omalizumab | IgE | Approved in the EU and reimbursed in Italy | Every 2 or 4 weeks, depending on weight and IgE |
| Mepolizumab | IL-5 | Approved in the EU and reimbursed in Italy | Every 4 weeks |
| Tezepelumab | TSLP | Approved in the EU (October 2025) | Every 4 weeks |
| Depemokimab | IL-5 (long-acting) | Approved in the EU (February 2026) | Every 6 months |
| Benralizumab | IL-5Rα receptor | Not approved for nasal polyps | — |
Table updated September 2026. Availability and reimbursement in Italy of the most recently approved drugs may vary and are checked case by case at the time of prescription. The choice of drug and dose are decided exclusively by the specialist.
Monitoring
During treatment the response is assessed at regular intervals with nasal endoscopy and polyp score, the SNOT-22 questionnaire, smell tests, symptom trends, steroid use and asthma control. Depending on the results, treatment is continued, changed or stopped.
📋 NPS, SNOT-22, Lund-Mackay and the other scores used to assess nasal polyps are explained on the page Questionnaires and rating scales (in Italian).
Frequently asked questions
Does a biologic replace surgery?
Not necessarily. In some patients it makes it possible to avoid or postpone further surgery; in others surgery remains the best choice, alone or combined with a biologic.
Do I have to take the biologic for ever?
Treatment is long-term and is reviewed periodically. Its duration depends on the individual patient’s response.
Can people with asthma have a biologic for nasal polyps?
Yes: many of these drugs act on both asthma and nasal polyps. In these cases treatment is coordinated with the respiratory physician.
Will my sense of smell come back?
Improving the sense of smell is one of the aims of treatment and is common, but the degree of improvement varies from person to person.
The information on this page is for general education and does not replace a medical consultation.