How to manage chronic rhinosinusitis with nasal polyps?

Question

Hello doctor,

I am a 37-year-old female. I have had CRSwNP (chronic rhinosinusitis with nasal polyps) for 14 years and symptoms have worsened slightly over the past two years. I experience pressure and a sensation of fullness at the side of the face and at times I find difficult airflow at the left side. I have to take nasal steroids daily. My symptoms are rhinitis, sneezing, running, and an uncomfortable sensation in the nostrils. Also, pressure and fullness particularly left side.

I was initially told by my doctor that my sinus CT scan did not look too bad and it could be treated conservatively. I asked about balloon sinoplasty and he agreed but only under general anesthetic.

I consulted another doctor as I heard he does surgery under local anesthetic however he said that balloon sinoplasty would not help and that my issue was a severely deviated septum and turbinate hypertrophy. He wants to do a septoplasty and turbinate reduction under general.

I do not want a general anesthetic and wondered if I could get another opinion on whether my septum has severely deviated and if a septoplasty and turbinate reduction are required to help my symptoms. Would balloon sinuplasty help? I have included CT scan images from last year and a doctor's letter. Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

You have shared only two pictures (attachment hidden to protect the identity of the patient) of the CT (computed tomography) scan. To have a complete picture of the sinuses I need to have a look at the whole CT file. Whatever I can assess from the single axial and coronal picture, the status of the sinuses is not that bad to require any surgical intervention. Yes, the septum is quite deviated and needs correction to improve airflow.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

The deviation will not get worse over time, but yes correcting the septum will have a positive impact on the CRS (chronic rhinosinusitis) symptoms, as it will improve the ventilation and drainage of the sinuses. Further, it will make the sinuses more accessible to the steroid nasal douching. Nasal sprays are not that effective, you should do nasal douching with steroid solution using nasal wash devices.

I hope this helps.

Thank you.