Background: Nasal polyps are a common disease with in the majority of cases unknown origin. Both the medical and surgical treatment of nasal polyps present a challenge in Otorhinolaryngology. Methods: We developed a four-stage grading system for nasal polyps based on the endoscopic aspect of more than 300 patients. In a study of 37 patients, treated by systemically (Methylprednisolon 64 mg p. o., decreasing amounts for the first 11 days) and locally (Budesonid 400 µg intranasal) applied steroids for 90 days, this staging-system was tested. Results: The mean stage of polyps decreased significantly (p < ) from at day 0 to at day 7 and further to and to at day 28 and day 90 respectively. The mean nasal symptom score decreased equally from on day 1 to and to on day 7 and day 28 respectively. To summarize, we observed a significant (p < ) decrease in polyp stages of 75 % respectively a significant (p < ) reduction of symptom scores of 93 %. Conclusions: Thus, we present a suitable new grading system for nasal polyps which we applied directly to assess the efficacy of combined local and systemic steroid therapy. It was shown that this treatment can reduce polyps and prevent their recurrence over the observed time.