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Medical Forum / Diseases and Disorders / Sinusitis / May 2007Sinusitis & nasal polyps - surgery the only option?
Hello everyone, Last week on thursday (April 26th) I had my very first consultation with an ENT. My complaints were occasional nasal blockage during allergy season. Two weeks before that, I had been put on Cetirizine (Zyrtek) by an allergologist (who also recommended the subsequent visit with the ENT). The same day of the ENT visit I was sent for a CT scan which showed blockage of the frontal, ethmoid and (I think - not quite sure right now and the CT scans are at the ENT's) maxilliary sinuses on the right side and part of the left side. I also have some nasal polyps. but I don't have symptoms from the sinusitis. After the CT scan and still the same day, the ENT scheduled surgery for monday (May 7th). However he neither mentioned alternative treatment possibilities nor the amount of time needed for recovery after surgery (let alone, risks, etc). I only learned about this through my own research online and some information material I've been given while scheduling an appointment with another ENT (for this Wednesday, May 2nd). Thus I'm currently reluctant about going for surgery right away and also feel that I could not have made an informed decision about it at my visit. Since April 27th I have already been taking the glucocorticoid Methylprednisolone as preparation for surgery. Since then, I haven't been having problems breathing through the nose. So I'm wondering, is surgery really my only option even though no other medical treatment has been tried yet? (As I mentioned, I've not been to an ENT before). I'm not feeling bad due to the sinusitis itself (currently I'm doing quite well actually due to the polyps shrinking from the oral glucocorticoid). As mentioned above, I have also scheduled a second appointment with another ENT for this Wednesday (May 2nd) and will wait for his opinion. But maybe someone here can shed more light on the sinusitis / polyps situation? Fast responses are appreciated :-) (So I have more information gathered for the appointment with the 2nd ENT). Unfortunately there is not much time left until the surgery, to which I wouldn't have agreed at such an early date in the first place - had I known what I know now. Depending on the 2nd ENT, I might still cancel it. Is it even common that surgery is scheduled at the first visit? Thank you all in advance :-), Andi > Hello everyone, > [quoted text clipped - 43 lines] > > Andi Yes they will schedule surgery first assuming that you are there bacause "medical management" has failed, which it may or may not be the case. Investigateing further and getting a 2ed opinion sounds like the right thing to do. If your ENT is not accessible and talking to you now, that does not bode too well for your communication during your aftercare. What kind of surgery is the ENT proposing? Hi :), first of all thanks for your response. > Yes they will schedule surgery first assuming that you are there > bacause "medical management" has failed, which it may or may > not be the case. Well I would've actually expected the ENT to ask me about that or point out other things to try first before going for surgery. At least here in Germany, we often consult the specialists right away (well at least I don't bother with the familiy physician, when I'm pretty sure what the problem is). My first visit was with an allergologist, she also suggested the appointment with the ENT (which I was expecting / planning on anyway). > Investigateing further and getting a 2ed opinion sounds like the right > thing to do. > If your ENT is not accessible and talking to you now, that does not > bode too well for your communication during your aftercare. Unfortunately, yes, that's what I'm thinking, too. By the way, it is not himself who will perform the surgery, but he will send me to a hospital in a bigger city nearby. That also brings up questions of aftercare, if he himself does not perform the surgery - is he able to do proper aftercare or does this mean going back to the hospital every few days? > What kind of surgery is the ENT proposing? I'm sorry that I forgot to explicitly mention it in my last post, what is planned is a FESS. I've already been to the family physician for necessary pre-OP checkups. Andi > Hello everyone, > [quoted text clipped - 32 lines] > But maybe someone here can shed more light on the sinusitis / polyps > situation? Fast responses are appreciated :-) I would STRONGLY recommend you not have surgery until AFTER you've gotten a second opinion from another ENT (and maybe even a third opinion from yet another one). Even if you do decide to go for surgery, you may find that you have more confidence in the 2nd or the 3rd ENT to do the surgery than the 1st one you consulted. You may find that the 2nd or the 3rd seems to have more experience with your type of problem than the 1st one. That was my experience. If you think you have allergies, you ought to check into that first with a competent allergist. Because even surgery won't produce lasting results if the underlying allergies aren't treated. I'm surprised that no family physician ever tried you on topical steroid nasal sprays. Right now, oral steroids are your best bet to shrink the immediate swelling in your sinuses, and aggressive allergy treatment combined with topical nasal steroid sprays to produce long-term improvement. If those treatments fail to open up your sinuses, then surgery is the way to go. In my case, I had no allergies; my sinusitis symptoms were all year round and was due to an underlying infection that steroids could temporarily relieve but not cure. But it sounds like you might well benefit from allergy therapy. Good luck.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. Hi there :), thanks for the response! > I would STRONGLY recommend you not have surgery until AFTER you've > gotten a second opinion from another ENT (and maybe even a third opinion > from yet another one). Fortunately, my appointment with the second ENT is tomorrow, so there is still enough time to cancel the surgery (apart from that I have not signed any paperwork yet). > Even if you do decide to go for surgery, you may find that you have more > confidence in the 2nd or the 3rd ENT to do the surgery than the 1st one > you consulted. You may find that the 2nd or the 3rd seems to have more > experience with your type of problem than the 1st one. That was my > experience. The ENT himself does not perform the surgery, but some surgeon in a hospital nearby will. Tomorrow I will also ask the 2nd ENT if he knows something about success rates there and where he sends his patients once they are candidates for surgery. > If you think you have allergies, you ought to check into that first with > a competent allergist. Because even surgery won't produce lasting > results if the underlying allergies aren't treated. Right now, all I have from the allergologist is Zyrtek / Cetirizine to avoid allergy symptoms. I've been told that I can only start hyposensitization (for pollen allergy) later this year when pollen season is over. > I'm surprised that no family physician ever tried you on topical steroid > nasal sprays. Right now, oral steroids are your best bet to shrink the > immediate swelling in your sinuses, and aggressive allergy treatment > combined with topical nasal steroid sprays to produce long-term > improvement. If those treatments fail to open up your sinuses, then > surgery is the way to go. That's what I'm thinking all the time - that I should at least have tried less invasive alternatives before going for surgery (which is not a problem in itself, but I just don't think it's a good idea to go for it right away). Let's see what the other ENT will say tomorrow. > Good luck. Thank you! :-) Andi ---> The ENT himself does not perform the surgery, but some surgeon in a hospital nearby will. Tomorrow I will also ask the 2nd ENT if he knows something about success rates there and where he sends his patients once they are candidates for surgery. Is that common that a doctor will schedule you for surgery that is to be conducted by another surgeon? Don't rush into surgery. I wish I hadn't. > Hi there :), > [quoted text clipped - 22 lines] > something about success rates there and where he sends his patients once > they are candidates for surgery. I'm not happy to hear that, though maybe that's how it's done in your country. I always want to talk with the surgeon who is doing the surgery directly, before deciding whether to have the surgery and whether he's the best one to do it. There are ENTs in the United States who aren't trained to do functional endoscopic surgery. I had an appointment with one once. Needless to say, I never went back to see her again. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. Hi again :), just came back from the 2nd ENT. In accordance with him I have now cancelled the surgery. I will finish my course of oral steroids, and then I have my next appointment and we will decide on what to do next. Maybe a Polypectomy might be necessary, but let's see. I've also been asking around and got several recommendations for another ENT not far away (just in case ;)). Thanks everyone for replying, I will keep you updated when there are any news. Other than that, maybe you still have some additional tips on how to keep healthy? As I mentioned, I haven't really tried anything yet (irrigation, steam inhalation, etc). See you, Andi |
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