Patient's Query
Hello doctor,
I am a 37-year-old female and have had 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 on the left side of the face, as well as, at times, difficult airflow on the left side. I have to take nasal steroids daily. My symptoms are rhinitis, sneezing, running, and an uncomfortable sensation in the nostrils.
I was initially told by my ENT doctor that my sinus CT scan did not look too bad and to treat it conservatively. I asked about balloon sinuplasty, and he agreed, but only under general anesthesia.
I saw another ENT as I heard he does surgery under local anesthesia; however, he said that balloon sinuplasty 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 anesthesia. I am currently using nasal Fluticasone drops, Mometasone spray, and Cetirizine, and I also have no allergies.
I do not want a general anesthetic and wondered if I could get another opinion.
If my septum is severely deviated, a septoplasty and turbinate reduction are required to help my symptoms.
Would balloon sinuplasty help?
I have included my CT scan images from last year.
Kindly help.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
From the limited scan images you have uploaded (attachments removed to protect the patient's identity), all I can say is
1. The DNS (deviated nasal septum) is very minimal to cause all of your symptoms.
2. The turbinates are hypertrophied, no doubt.
You seem to be suffering from allergic rhinitis with CRS (chronic rhinosinusitis), but your sinuses are not in that bad shape, which requires some surgery.
Rhinitis sneezing is a typical pattern of allergic rhinitis.
All you might need is an allergic skin prick test to know what allergies you have and then undergo immunotherapy for those allergies, which is sort of a permanent solution for allergic rhinitis. Surgery may not benefit you much.
Was a nasal endoscopy done by your ENT?
Revert with the answer to assist further.
Thank you and take care.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I was wondering to what extent the septum deviation and the turbinates hypertrophied. Are these mild or severe?
Just a bit of background on my condition: I have had the CRSwNP condition for 14 years, and it is responsive to steroid drops. It is most likely non-allergic, as I have had many skin and blood allergy tests over the years, but they always come back negative. I have also been unable to identify a trigger. Symptoms are very persistent unless suppressed by nasal steroids. The only change in my blood results is that my eosinophil count is always slightly high at 0.5 x 10/9. I think it is either CRSwNP (as diagnosed) or eosinophilic rhinitis, as it is so persistent that I cannot miss two days without nasal steroids, or the symptoms are very uncomfortable.
Yes, at all my ENT appointments, nasoendoscopy has been done; sometimes grade 1 polyps are present and other times they are not (usually when I take steroid drops, they shrink).
Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Regarding the septum, based on the two images you have sent to determine whether it is a severe obstruction or something, although I feel it has very limited DNS (deviated nasal septum), you will need more pictures or cuts for a proper assessment. If it is an eosinophilic disease, I would suggest you try immunomodulators like Omalizumab (monoclonal antibody).
I suggest you consult your specialist doctor, discuss with him or her, and take the medicines with their consent.
I hope this helps.
Do get back in case of any further queries.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply, and I can understand.
It is difficult to decide whether to go ahead with the surgery on the letter, as my obstruction is only part of it, and I worry about developing complications and something called empty nose syndrome if I have turbinate reduction.
Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
No, I still really do not feel that surgery is going to take away all your symptoms, especially headaches, pressure, and all those.
We in tropical countries routinely do turbinate reduction, and we have hardly come across any empty-nose syndrome cases.
It is more of a psychological entity experienced by people with pre-existing psychiatric conditions who undergo the surgery.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
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Answered byDr. Akshay. B. K.
Medically reviewed byiCliniq medical review team
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