At 41, can endoscopic sinus surgery cure my nasal polyps?

Question

Hello doctor,

I am a 41-year-old man with long-standing nasal congestion, reduced sense of smell, and recurrent sinus infections. Nasal endoscopy showed bilateral nasal polyps, and my CT (computed tomography) sinuses revealed opacification of the ethmoid sinuses. I have tried intranasal corticosteroids for three months with partial improvement. Please tell me.

Should I consider endoscopic sinus surgery?
Are biologic therapies like Dupilumab suitable for someone with frequent recurrence?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

You have chronic rhinosinusitis with nasal polyps that is partially responsive to medical therapy. Functional endoscopic sinus surgery is recommended when there is persistent obstruction or sinus disease after medical therapy. Surgery helps in

Removing polyps.
Open sinus ostia.
Improve drainage.
Enhance intranasal drug delivery.

It is particularly suitable for patients like you who still have symptoms and CT-documented sinus opacification after adequate medical therapy. Postoperatively, maintaining daily intranasal steroids and saline irrigation remains essential.

The recurrence rates after surgery can reach 20 to 60 percent within four years, depending on the inflammation type and comorbidities such as asthma or aspirin-exacerbated respiratory disease. Biologics are indicated for patients with severe or recurrent chronic rhinitis and nasal polyps.

Those who have persistent symptoms despite surgery and corticosteroids, or those who are unsuitable for surgery. Dupilumab (interleukin‑4/IL‑13 antagonist) has shown significant benefit in reducing polyp size, improving smell, and lowering the need for systemic steroids or revision surgery.

You should continue postoperative steroid sprays and saline irrigation to maintain patency and minimize recurrence. If polyps recur or symptoms persist despite optimal postoperative therapy, biologic therapy like Dupilumab can then be considered, particularly if you have comorbid asthma, aspirin sensitivity, or frequent need for systemic steroids.

I hope this information helps you.

Feel free to ask further queries.

Thank you.