Dr. Akshay. B. K.
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 37-year-old and have a history of PMH - chronic rhinitis with polyposis. I have suffered from the mentioned disease for 12 years, which is controlled with Mometasone and occasionally Fluticasone drops. I also take an antihistamine regularly, which helps even though my IgE allergy testing was negative. I had two questions: when I previously saw an ENT a year ago, they discovered grade 1 polyps and performed a sinus CT scan, which revealed minor inflammation that they did not consider severe enough to warrant surgery. The specialist reported there were no polyps during the follow-up nasendoscopy.I had been taking the steroid drops (Flixonase), which probably helped. I am currently using Mometasone nasal spray, but my nose remains incredibly clogged at night, forcing me to breathe through my mouth. Vicks nasal spray is quite helpful, however, I am afraid to use it because of the rebound effect. How many consecutive nights can I take Vicks nasal spray safely? I also utilized an ear wax camera to look up my nostril. I know I should not have done it, but I noticed a red spot on a stalk and was wondering if it was a polyp. Or is it merely a byproduct of the turbinate? I have uploaded a picture.
Please help.
Hello,
Welcome to icliniq.com.
A solid endoscopy to rule out polyps is the greatest thing that can be done. The ear wax camera is not decisive, even if at first glance it appears to be a turbinate since polyps are normally white and pale, and the nasal steroids are continued. If used for more than 14 days, Vicks nasal spray can produce rhinitis medica-mentors and create reflex congestion, therefore please discontinue use. If you have CRS (cytokine release syndrome) with nasal polyps, it is usually recommended that you see your ENT (ear nose, and throat specialist) once a year and have a thorough endoscopy done since a brief course of oral steroids may be required if the polyps have grown in size and if you have AFRS (allergic fungal rhinosinusitis). I suggest you take a capsule of Itraconazole (oral) (triazoles) should also help, and you should try to get your Mometasone nasal spray (Mometasone furoate) switched to Budesonide nasal spray (micronized budesonide), which has a better effect.
I hope this helps.
Thank you and take care.
Regards.
Patient's Query
Hello doctor,
Thank you for your response. I will surely consider your recommendations. I would like to ask you a few questions concerning my disease, which is chronic rhinitis with polyposis. I have had it for the past 13 years since I was 23. I have had allergy testing several times and they have all come back negative, so I can only presume it is not allergic. My blood eosinophils have always been on the high side at 0.5 to 7 %, thus it might be related to my immune system. My father had a history of nasal polyps and acquired asthma when he was 40, which makes me concerned about my chances of having asthma. I also underwent a spirometry test, which came out normal. Do you think I will acquire asthma in the future? Can my rhinitis develop into asthma? Does the fact that up to 60 % of persons with polyps acquire asthma indicate that I have a 60 % risk of developing asthma in the future? I also wanted to inquire about moisturizing because my sinuses seem quite dry and restricted at the back towards the nasopharynx, which I believe is due to the daily steroid sprays. I am already utilizing saline irrigation, but is there anything more I can do to increase moisture?
Hello,
Welcome back to icliniq.com.
Your father appears to have Samter's triad, which includes Aspirin sensitivity, nasal polyposis, and asthma. Although you may not have all of these symptoms, the newest name for this is unified airway disease. Please do not worry because the incidence may not be 60 % but maybe closer to 30 %. Immunomodulatory drugs such as Daclizumab (monoclonal antibody) or Omalizumab (anti-asthmatic) are the best long-term treatments available. It is common for your nasal cavities to feel dry owing to the regular use of steroid sprays, therefore in addition to both saline sprays, you can apply glycerine to moisturize your sinuses.
I hope this helps.
Thank you and take care.
Regards.
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Otolaryngology (E.N.T)
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