Patient's Query
Hello doctor,
I am a 39-year-old female.
PMH (past medical history)- Non-allergic rhinitis with grade 1 polyposis.
Medicines - Alternate between Mometasone spray and Fluticasone nasal drops. Saline rinse for a dry nose.
I feel lost with my sinus symptoms and am not sure what to do. I have had rhinitis and polyps for the past 15 years - symptoms are a runny nose, congestion, and sneezing. These symptoms are well-managed, alternating between Mometasone and Fluticasone drops (I use the drops when symptoms worsen).
However, for the past three years, I developed a new, very specific symptom at the back of my left sinus - it feels very dry, heavy, and narrow, like I am straining to breathe. If I try to exercise or go running, it feels even more like I am straining to get air through, even though objectively, air must be going through, as I can blow it out.
I saw an ENT who noticed mild rhinosinusitis but did not think that I needed surgery; he said my turbinates looked ok.
Later, I saw another ENT, a sinus specialist who said that I need a septoplasty, turbinate reduction, a fess ethmoidectomy, and antrumostomies.
However, the right side feels ok even though the septum deviates to the right. I do not know what to do as I am getting very opposing opinions from different ENTs. I have time to decide. I am worried about unnecessary surgery.
I have tried to identify the cause of this symptom myself, in case it was something as simple as a dry patch. I noticed that when I reduce the nasal steroid medication, this dry, heavy, narrow feeling is reduced; however, I then get a feeling of mucus at the back of the left sinus. It might sound strange, but the symptom makes me feel unmotivated, and it is hard to distract myself from it.
I just do not know what the answer is, and was looking for further opinion. I have attached two CT scans - one is when I take the drops once a day, and the other is on a dose of twice a day. As you can see, the inflammation improves.
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
As you said, there is non-allergic grade 1 polyposis, which means your maxillary sinus opening is getting blocked, causing you symptoms of blockage, and the nasal bone is deviated to the right side.
When you use a steroid spray, you feel more dryness; otherwise, mucous keeps coming. It all means your disease is not getting cleared only by medicines. For quite a long time, you have used sprays and tablets, but you can not cure the issues.
I saw your CT (computed tomography) file attached (attachment removed to protect the patient's identity). It shows you have a mild form of sinus blockage. So, I will recommend that you go for nasal irrigation therapy for three months with anti-cold medicines and see the improvement. And if this does not resolve your problem, then you will have to undergo surgery to relieve the sinus blockages.
So, please understand sinus disease treatment works better when managed both surgically and medically. So I would like you to follow medical therapy first and then go for surgery if required. I hope this will resolve your issue.
The probable causes: Chronic sino-polyposis.
Differential diagnosis: DNS (deviated nasal septum).
Probable diagnosis: Rhinosinusitis.
Treatment plan: Medical management followed by surgery.
Regarding follow-up: SOS (if necessary) follow-up.
Preventive measures: Take steam inhalation two times a day. Avoid cold, sour food.
I hope this information will help you.
Kindly follow up if you have more concerns.
Thank you.
Patient's Query
Hello doctor,
Thanks for your reply.
I have a few questions - despite having this condition for many years, I do not feel it has been given an exact diagnosis.
I am confused, as my symptoms, especially initially, presented more like rhinitis- like it was constantly reacting to something, and without adequate medication, became more and more blocked. There are times when I have what feels like attacks of rhinitis or blockage.
Antihistamines help somewhat; however, I have been investigated for allergies many times, and tests are always negative. Neither can I identify any particular triggers. Plus, I do not have eye symptoms, so I do not think it is an allergy. But I do not understand why antihistamines help (partly) if it is not an allergy. To my knowledge, antihistamines do not generally help with CRS.
Based on my CT scans and symptoms, would you say my condition is CRS or rhinitis? Or do I have both?
In terms of surgery, are there any harms to having turbinate reduction if turbinates are not the primary issue?
Please help.
Thank you.
Hello,
Welcome back to icliniq.com.
I can understand your concern.
I would like to help clarify your concerns. Based on your symptoms, the most likely diagnosis is chronic rhinosinusitis. To confirm this, I recommend a nasal endoscopy. This involves inserting a small camera into the nose to directly visualize what is happening inside. It will help us determine whether there are nasal polyps (and whether they are single or multiple), if they are still present, and whether there is mucosal swelling (edema) in the nasal lining. The endoscopy gives us a real-time, detailed view of your nasal passages.
Regarding your second concern: Initially, you experienced more rhinitis-like symptoms. Now, you are feeling more nasal blockage. This is because, over time, the body responds to persistent inflammation with structural changes, leading to turbinate hypertrophy, an enlargement of the turbinates that causes a feeling of congestion.
This type of blockage can come and go. Additionally, you have a right-sided deviated nasal septum, which contributes to the increased sense of blockage on that side.
For your third query: Even though your condition may not be purely allergic, antihistamines can still help. These medications are effective not only for allergies but also for controlling cold-like symptoms and inflammation in general. According to your CT (computerised tomography) scan, there is an obstruction at the sinus openings, which is causing your recurrent symptoms. I suggest continuing with antihistamines and nasal irrigation. However, if symptoms persist despite these treatments, surgical intervention may be needed to relieve the obstruction.
I hope this helps.
Kindly follow up if you have more concerns.
Thank you.
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