It is of value to look separately at the effect on rhinitis symptoms associated with polyposis and the effect on the size of nasal polyps per se.

Topical corticosteroid sprays have a documented effect on bilateral Nasal Polyps and also on symptoms associated with NP such as nasal blockage, secretion and sneezing but the effect on the sense of smell is not high. There is strong evidence for effect on polyp size and nasal symptoms associated with nasal polyposis.

For individual symptoms blockage responds best to corticosteroids but improvement in sense of smell is not so obvious. Nasal drops are more effective than nasal spray and have a significant positive effect on smell. Nevertheless, corticoids are not well accepted and higher dosages are required to achieve small effects. Moreover, the question of “how corticosteroids reach the sinuses” is unanswered. The indication for topical steroids in ARS has not been accepted by EMA (European Medicines Agency).