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Is surgery necessary for a nasal polyp?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At June 30, 2018
Reviewed AtJuly 16, 2023

Patient's Query

Hi doctor,

I visited an ENT two weeks ago for a check-up after noticing my tinnitus which I have had for more than a decade was slightly worse in one ear. He did an audiogram and balance tests and said my hearing was fine and not affected by the tinnitus, and that the cause was extra-cranial. He suggested taking Betahistine and Loratadine. During the examination, he also looked at my nose and saw a polyp in my left nostril. He then scheduled me for a nasal endoscopy. The endoscopy confirmed the polyp in the left nostril or sinus as well as a deviated septum and enlarged turbinate. I was then referred for an X-ray and CT scan. I will attach the CT scan report. According to the ENT, it is a case of a unilateral polyp and because of its size, it is a surgical case that will not respond to the nasal steroid spray he prescribed after the first visit. He asked if I had any pain or other symptoms and I said no, I have had no snoring, no sleep apnoea, and no pain, only the odd post-nasal drip which I have always had since childhood. Since I have (controlled) hypertension and type 2 diabetes he said the surgery was a risk but he recommended it, but I needed to discuss it with my GP and endocrinologist because of the risks involved. My main worry was that the polyp could be something malignant, but he seems to have ruled this out based on the endoscope and CT imaging. My feeling is that if I am not having any symptoms, and due to the risks of surgery and the likelihood the polyp will return after surgery, it is not a good option for me right now. I am basically looking for a second opinion, taking into account the CT scan results, is surgery definitely indicated now or can a waiting approach be taken? The tinnitus issue sort of fell by the wayside the Betahistine and Loratadine caused headaches. So I have not been taking them. All focus for now seems to be on this polyp issue. Currently, I am taking Nebilet, Dexilant, Glucophage, Victoza, Allopurinol, and Exforge HCT.

Answered by Dr. Mehak Agarwal

Hi,

Welcome to icliniq.com.

I have seen your CT scan reports (attachment removed to protect patient identity). I will want to see CT scan films myself. The typed report says that there are extensive polyps for which medical management might not be enough but I want to see films myself in all the cuts (axial, coronal). You have mentioned that you do not have any symptoms like a headache, nose block, snoring, sneezing, but tinnitus can also be due to polyps. Extensive polyposis can block eustachian tube and can cause a ringing sensation in ears (left ear). As of now you send me CT scan films and also you start taking steroid nasal spray twice daily (one puff each nostril) for six weeks (local steroid spray does not have any side effects, so you need not bother about that).

Patient's Query

Thank you doctor,

Yes, I have not had any symptoms like pain or anything out of the ordinary. I have always had the odd case of post nasal drip on and off since being a child. I am hoping this can be managed with the spray and if there is an infection maybe antibiotics? I have attached the scan.

Answered by Dr. Mehak Agarwal

Hi,

Welcome back to icliniq.com.

Postnasal drip is due to sinusitis. I have seen your CT scan. You have extensive sinusitis but I think nasal sprays will subside sinusitis. You start taking the nasal spray and continue for two months. Also, you have severe deviated septum to the left which is impinging on left inferior turbinate but if you do not have any symptoms then let's manage it conservatively.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mehak Agarwal
Dr. Mehak Agarwal

Otolaryngology (E.N.T)

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