Friday, September 3, 2010

Nasal Polyps-Medical or Surgical treatment, Personal Experience

Nasal Polyps is one disease where Rhinologists would love to operate but hate to follow up the patients. Good job of clearing the disease through latest instruments goes in vain when the polyps start coming again after few days or months. Local inhaled steroids help preventing the recurrence but not always. Systemic steroids are given as a desperate measure to save surgical reputation of surgeon. Only very few lucky patients does not require steroids. Many require revision surgery eventually but few undergo by the same surgeon and the same cycles starts again.
May be my other colleagues have a better experience. Initially I thought my technique is wrong and I felt frustrated treating nasal polyposis. For last couple of years I have started giving systemic steroids for recurrent cases. The results were wonderful. All allergic polyps melted like anything. But, the moment steroids are withdrawn, polyps started coming again. So many of my operated cases have become steroid dependent now and I am giving them in low dosage for maintenance. (Is Steroid an ENT Friend?).
Taking this cue from my experience, I treated a 14 year child with systemic steroids whose parents were not willing for surgery. After One month, there was almost 50 percent reduction in nasal polyp mass. Quite impressed with results on CT scan, I started tapering the steroid dose over a one month time. A repeat CT after two months showed the same pre-treatment bulk of nasal mass on CT Scan.
SO, Either Surgery or Steroids are no permanent solution. So where should we look for permanent treatment of nasal polyps. Few points are mention worth here
1. Is Nasal Polyps primarily a Medical or surgical disease?
All Rhinologists are too much focused on Surgical aspects and more funds should be diverted for research in medical treatment of nasal polyps and I see a permanent treatment there.
2. Why only one side affected?
In many case, I have observed that sinuses opposite to the deviated nasal septum develops the Nasal Polyposis. So, why there is so much fuss especially in private . practice to cash DNS into currency. Is some kind of excess flow of air provokes polyp formation?
3. Many cases, mostly females, who doesn’t have polyps in CT scan , but are troubled by thick nasal discharge, which responds to medical treatment temporarily. Is there any role of surgery in Non Polyposis chronic sinusitis?

4. I have seen conventional open surgery for nasal polyps like cold well luc and External ethmoidectomy during my residency. For recurrent Nasal Polyps, are these radical surgeries justified instead of giving life long steroids?

5. Few of my patients who have recurrent polyps and not inclined for revision surgery, there polyp bulk is same for so many years on inhaled steroids. Except for thick discharge occasionally, there is no other complaint. Like a small glomus in an elderly, should we leave such subset of patient on inhaled steroids alone

1 comment:

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