Is endoscopic sinus surgery for nasal polyps safe at 42?

Hello,

Welcome to icliniq.com.

I can understand your concern.

The most common reason for the symptoms you are facing is due to severe allergic rhinitis, which has led to sinusitis-induced polyposis.

Before we jump to the treatment, I have tried to explain the cascade of events in a very simple manner below, even though it is not as simple as it looks.

Exposure to dust (or any irritative substance that your body is hypersensitive to) will initiate reflexes such as sneezing to remove the offending agent. If this fails, mucosal cells in your nose start to hyperfunction, producing loads of mucus to trap dust (owing to its sticky nature). This mucus has nowhere to go other than either being blown out of the nose or pushed into the throat, owing to mucociliary activity, thereby entering into a new zone. The throat initially reacts by activating cough impulses to push out the mucus, but if that fails, a local inflammation around the throat starts, which often leads to symptoms such as a feeling of a lump in the throat and repeated feeling to clear the throat.

A chronic long-standing inflammation around the nose leads to involvement of the eustachian tubes, which ventilate air and equalise pressure between the nose and the ear. Inflamed tubes do not function well, and this leads to a resultant negative pressure in the ear, causing ringing sensations, muffled noise, and sometimes decreased hearing as well.

Long-standing inflammation in the nose also blocks the outflow tract of the sinuses, leading to secretions getting collected, which then get infected and cause a pressure headache around your eyes, forehead, and cheeks.

Once the inflammation reaches its peak, you will start developing edematous sinus mucosa, which will prolapse directly into your nasal cavity (what we call polyps), obstructing the nasal passages and causing loss of smell as well.

I know the problem has been there for a long time, but I am not sure if you have followed any specific treatment chart, which is usually recommended before we consider any patient for surgery. This treatment chart is custom-made according to your symptoms and follows the guidelines to treat both allergies with sinus sinus-induced polyps.

If you have Aspirin sensitivity or asthma with polyposis, it is Samter's triad. You need to strictly avoid Aspirin at all costs or take a substitute if you are supposed to take it compulsorily.

The following aspects can be considered to manage allergies with polyposis. I have discussed the surgery as well below.

1. Wear an N95 mask at all times, and do not allow any dust or irritating substances from entering your nose. This is the most important thing you should be following; failing which, no treatment will bring any relief.

2. Take one tablet (or its equivalent) of Sinarest (a combination of Paracetamol, Chlorpheniramine maleate, and Phenylephrine), one tablet two times a day after food, 12 hours apart, for 15 days.

3. Tablet Allegra M (a combination of Fexofenadine and Montelukast) (or its equivalent), one tablet two times a day after food, 12 hours apart, for 15 days.

4. Take Zerodol TH ( a combination of Aceclofenac and Thiocolchicoside) four mg (milligrams )(or its equivalent) one tablet two times a day after food for five days.

5. Take Clarithromycin 500 mg one tablet two times a day after food, 12 hours apart, for 15 days.

6. Duonase nasal spray (or its equivalent) two puffs, two times a day in both nostrils for three months (do not inhale while you spray the drug).

7. Take Mucomix (Acetylcysteine) 600 mg (or its equivalent) one tablet two times a day, 12 hours apart after food for one week.

8. Steam inhalations three to four times a day.

9. Salt water gargles eight to ten times a day for one month.

10. Do not smoke or consume alcohol, as it slows down mucociliary clearance mechanisms.

All precautionary measures have to be followed strictly for maximum relief; otherwise, medications would not be useful in the long term.

Surgery can be considered (if the above medications and precautionary measures do not give any relief), but there is a catch to it. The symptoms might come back sometimes, even on a higher scale, after a brief relief following surgery, if the precautionary measures post-surgery are not followed. Ideally speaking, in a nutshell, I again emphasize preventing any irritative substance from entering the nose and throat, thereby triggering an allergic cascade of events and reproducing the symptoms you have mentioned above.

More than the post-surgery complications that are of concern, it is the recurrence (even after a good, complete surgery) that is bothersome.

There is nothing that you need to worry about; once you follow the advice mentioned above, your symptoms should improve with time.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.