I’m 36, female, with year-long nasal polyps. Is surgery helpful?

Question

Hello doctor,

I am a 36-year-old woman who has been struggling with nasal blockage and facial pressure for over a year. My ENT diagnosed me with nasal polyps and chronic rhinosinusitis. I constantly feel congested and have almost completely lost my sense of smell and taste.

Despite completing two courses of antibiotics and using nasal steroid sprays, my symptoms have shown little improvement. A recent CT scan of my sinuses revealed extensive mucosal thickening and polypoid changes in both the ethmoid and maxillary sinuses. Blood tests showed an eosinophil count of eight percent and a total IgE level of 320 IU/mL.

I also experience postnasal drip and a dull ache around my eyes and forehead, which tends to worsen in the mornings. Although I do not have asthma, I have had frequent sinus infections, at least five in the past year. My ENT has suggested either starting oral corticosteroids or considering surgery.

I am concerned about the potential side effects of steroids and whether surgery would provide lasting relief. Is there a more effective way to manage these symptoms or prevent the regrowth of polyps? Could allergy testing or biologic therapies be beneficial in my case?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

According to your medical history and your concerns regarding nasal polyps and chronic rhinosinusitis, a nasal polyp is a projection of hypertrophied, edematous mucous membrane consisting of loose fibro-edematous tissue covered by columnar ciliated epithelium. The etiology of nasal polyps is complex; they may arise from chronic inflammation of the nasal mucosa, ciliary motility disorders, or may be associated with other systemic conditions.

Nasal polyps typically present with symptoms such as nasal obstruction, partial or complete loss of the sense of smell, headaches due to associated sinusitis, sneezing, and watery nasal discharge if allergy is involved.

Treatment usually begins conservatively with antihistamines to control allergies, oral corticosteroids, nasal decongestants, and steroid nasal sprays. If symptoms persist despite medical management, surgery becomes the next option.

As you mentioned, you have already tried antibiotics, nasal steroid sprays, and oral steroids, but your symptoms persist. Your otolaryngologist has now recommended another course of oral steroids or surgery.

Long-term use of steroids can lead to various side effects, so at this stage, surgery appears to be the most appropriate option. Do not worry, nasal polyp surgery is generally safe and not considered high-risk.

If you have any follow-up questions or other health concerns, please feel free to ask. I am happy to help.

Thank you, and best wishes.