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Have nasal problem. CT scan showed bilateral sino nasal polyposis. Will it be cured after surgery?

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My mother has some nasal problem. Nose keeps blocked. A CT scan has been done and report is as follows:

=======Procedure: Contrast enhanced axial & coronal section o PNS are obtained as per slice plan and evaluated.
Study Reveals:
-Rt. Maxillary sinus is completely filled with heterogeneously enhancing soft tissue density mass tesion which is extended medially to the osteomeatal complex through the widened ostium resulting bony erosion o its medial wall, inferiorly extended to the nasal cavity, antero superiorly extended to the fronto ethmoidal sinus with thickened trabaculae and posteriorly extended to the sphenoid sinus.
-Lt maxillary sinus is incompletely filled with heterogeneous soft tissue density mass lesion with is extended medially to the osteomeatal unit through the widended ostium/infundibulum, anetero superiorly extended to the ethmoidal and fronto-ethomidal recess, posteriorly extended to sphenoid sinus.
-Lt inferior turbinate seems to be normal
-Increased sclerosis with thickened lateral wall of maxillary sinus is open.
-Septum is central in position.
-Orbits are normal.

We have consulted some ENT consultants and they suggested surgery. Is there any possibilities to treat is without surgery?

Posted Fri, 16 Nov 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 7 hours later

Thank you for your query.

1. The CT findings are suggestive of nasal polyposis. Has she had a nasal endoscopy done?

2. If your mother has Asthma and Asprin and NSAID hypersensitivity in addition to nasal polyposis, she has Samter's Triad. Such patients have are prone to recurrence after surgery..

2. There is an underlying chronic inflammatory process in the nasal and sinus mucosa which causes the recurrence of nasal polyposis. This is mediated by many chemicals; to name a few: histamine, prostaglandins, proteoglycans, proteases, leukotirenes, interleukins (cytokines) and so on. Once released, only a few of these chemical mediators can be counteracted. Has she received any anti-leukotriene such as montelukast?

3. An ideal treatment combination includes an anti-histamine like levocetrizine or rupatidine, an anti-leukotriene, a steroid nasal spray, saline nasal washes and steam inhalation. SHe is already on oral steroids and a nasal spray.

4. Nasal polyposis is invariably accompanied by fungal infections and thick mucoid pus. AFRS (Allergic Fungal Rhino Sinusitis) is one end of the spectrum where the fungus is present only in the sinuses but still provokes an allergic reaction in the body.

5. You may share the CT PNS (Para Nasal SInuses) for an accurate assessment.

6. Since this is a chronic process, you may take a trial of medication for a few weeks and repeat a nasal endoscopy. Bilateral polyps are known to shrink and disappear for months on medical therapy alone. Surgrey may be planned if there is no response or if the fungal mucopus is still present.

Hope I have answered your query. Awaiting your reply.

Above answer was peer-reviewed by
Follow-up: Have nasal problem. CT scan showed bilateral sino nasal polyposis. Will it be cured after surgery? 3 hours later
Thanks for reply
1. Endoscopy not done yet.
2. My mother does not have Asthma and also does not have any other major decease (BP, Sugar, Heart problem etc). There is not other treatment is going except explained decese.

I have taken my mothe three big hospitals (Max, St XXXXXXX and Moolchand-Most reputed hospitals in Delhi) and two other ENT secialist serving in big hospitals. All suggested surgery "FESS".

Can we wait for 2-3 months for surgery if there is posiblities to treat it by using medicine.

Answered by Dr. Sumit Bhatti 9 hours later

Thank you for your writing back.

1. This is a chronic process and there is no urgency to operate.

2. She should definitely be given a trial of medication for a few months before surgery is considered.

Wishing her good health,

Above answer was peer-reviewed by
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