How to manage nasal polyp with sinus pressure at 38?

Question

Hello doctor,

I have been having constant nasal congestion, postnasal drip, and loss of smell for over six months now. A scan showed nasal polyps. I am 38 and also struggling with sinus pressure during my periods and early pregnancy symptoms. I am worried about taking steroids or needing surgery while planning conception.

Can these polyps be related to allergies or hormonal changes? Will nasal polyp surgery affect anesthesia safety during pregnancy? Are there non-hormonal treatments for chronic sinus issues?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Corticosteroids are commonly used to reduce inflammation and the size of nasal polyps, but their use during pregnancy warrants careful consideration.
Nasal corticosteroids (like Mometasone, Fluticasone, and Budesonide): These are generally considered relatively safe when used at recommended doses during pregnancy. They are classified as category B by the FDA (Food and Drug Administration), meaning animal studies have not shown risk to the fetus, and there are no well-controlled studies in pregnant women.
Systemic steroids (oral or injectable): Carry a higher risk of adverse effects, such as gestational diabetes, hypertension, or fetal growth restriction, especially with prolonged or high-dose use. They are typically reserved for severe cases when other treatments have failed.

Recommendations:

Nasal sprays with corticosteroids are usually the first line and are preferred due to minimal systemic absorption.
Use the lowest effective dose to minimize any potential risks.
Consult your healthcare provider before initiating or continuing steroid therapy during pregnancy. Your doctor will weigh the severity of your symptoms, the impact on your quality of life, and potential risks.

Additional management strategies:

Saline nasal irrigation: Safe and effective for symptom relief.
Allergy control: Avoid triggers and consider allergy testing if relevant.
Monitoring: Regular follow-up to assess symptom control and any side effects.
While nasal corticosteroids are generally safe during pregnancy when used appropriately, it is essential to have personalized medical advice.
Never start or adjust medication without consulting your obstetrician and ENT (ear, nose, and throat) specialist.

Hormonal fluctuations, such as those during pregnancy, can influence nasal tissue swelling and may exacerbate nasal congestion, but they are less directly linked to polyp formation. However, hormonal changes can impact nasal mucosal edema and symptoms.

Nasal polyp surgery (like a functional endoscopic sinus surgery) is generally safe but involves anesthesia, which carries some considerations during pregnancy. It is usually preferable to delay elective procedures until after pregnancy if symptoms are manageable, but if your symptoms are severe and impacting your quality of life, your ENT specialist and obstetrician can collaborate to assess risks and timing.

I hope this has helped you.

Please feel free to reach out to me again if you have further queries.

Thank you.