Patient's Query
Hello doctor,
I am a 37-year-old female who was diagnosed with chronic rhinosinitis with polyps. I took allergy tests, which came back negative (even though antihistamines help). I take medications like Flixonase drops and Ceritizine. I have had CRSwNP for 12 years and had a CT scan a few months ago due to worsening symptoms. After the scan, the symptoms improved a little with increasing medication and the consultant said that continuing with conservative management might be best but that surgery was up to me. I have attached the CT scan of the sinuses.
1) How bad would you say this is compared to the general population?
2) Would medication or a course of Prednisone reduce the mucosal thickening in the maxillary sinus or is it permanent?
3) What dosage of Prednisolone should I take and for how long?
Hello,
Welcome to icliniq.com.
I will clear all your doubts. At the outset, after looking at your scans (attachment removed to protect the patient's identity) I doubt the diagnosis of chronic rhinosinusitis with nasal polyps (CRSwNP). We treat CRS patients every day in and out. As I can see in your CT scan there is a lot of mucosal thickening in the maxillary sinuses other than that there is no evidence of polyps in your nose. I would say surgery would be of no use to you. Let us diagnose your condition properly. What are the symptoms that bother you? Is there any nasal discharge, headache, nasal obstruction, or frequent sneezing? Any person at a random point in time if they undergo a CT scan would show some amount of mucosal thickening that is nothing to be worried. Antihistamines giving you relief again point out the fact that you might be suffering from simple allergic rhinitis. Get back to my questions. Let us diagnose your condition properly before undergoing a futile surgery.
Thank you.
Patient's Query
Hello doctor,
Thanks for your reply, I understand what you are saying. My main symptoms are sneezing or a feeling that I need to sneeze, a runny nose, and a blocked nose even without mucus. This is present all year round and is on and off throughout the day. If I use no medication at all the symptoms are much worse. My nose becomes extremely blocked. Over the past year, I have started to feel more congestion at the back of my sinuses. I have been unable to identify a specific trigger and all allergy tests have been negative despite being repeated. I take Flixonase steroid drops and Ceritizine helps a lot. I do not find the nasal sprays help as much. I use saline rinse too. I do get polyps if my nose is untreated. On nasal endoscopy sometimes small grade 1 polyps can be seen. I have attached some reports if they are of any help. If I could try to find the root cause of this I would be very grateful.
Hello,
Welcome back to icliniq.com.
Based on your complaints and the amount of recovery you feel with steroid nasal sprays, most probably it is a case of severe allergic rhinitis. When it goes to the extreme they might have noticed some small polyps. Polyps are nothing but inflamed and edematous nasal mucosa nothing to worry about they are not tumors. Sometimes when the patient is on chronic antihistamines the allergy tests might come back negative, but your symptoms and relief pattern go in hand with severe allergic rhinitis. For mild polyposis a short course of steroids a total of 24 to 30 days in a year with maximal dosage is completely safe as you are not a diabetic. But also keep in mind there will be some amount of mucosal thickening whenever you get a CT scan done as you have allergic rhinitis. Since you do not have headaches, foul-smelling nasal discharge, anosmia, or hyposmia your complaints do not exactly fit into the profile of a CRS. We need to treat your allergy specifically. Taking nasal steroid sprays and antihistamines life-long would not cause any side effects so do not worry. I hope I was able to give some clarity regarding your issue. Get back to me if you have any further queries, and I will help you out.
Thank you.
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Answered byDr. Akshay. B. K.
Medically reviewed byiCliniq medical review team
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