The longevity and severity with which I've suffered sinusitis depresses
me. Nothing has provided lasting relief. Polyps keep returning. I wonder
if they will ultimately result in complications leading to my end. This
may be unduly pessimistic, since I've never heard of a fatality
attributed to sinus polyps. But sinus treatment, for me, has almost
become a way of life. My most recent surgical episode was yesterday.

Over the last 16 years I've had major sinus surgery eight times and have
been treated by more than a half dozen ENT surgeons. I've been on
Prednisone, Aquatab, Cipro delivered by sinus nebulizer as well as oral
antibiotics, lavages with amphotericin-b, Alkalol, and saline, and a
variety of steroid sprays. After surgery yesterday the doctor said he had
allocated for me in the O.R. and ended up spending over three hours with
me under general anesthesia. He ended up putting a stop to the operation
without removing all of the polyps, stating that he was very surprised at
the quantity of diseased tissue that he found and with the instruments at
his disposal he was unable to reach all the affected areas. We will meet
this Monday to discuss his proposal for yet another operation in which he
will apparently seek more aggressively the removal of the remaining
polyps. I have not yet had a chance to talk with him about this at all; I
only know this is what he said to my wife when I came out of the O.R.

A history of the procedures I've had in struggling with this curse
is pasted below. I'm not sure what I'm hoping to get in response from
this group. I've read the postings here over time and have found many of
them supportive and informative. At this point, with my mood perhaps
depressed further by the effects of post-operative hydrocodone, I can't
see any light at the end of the tunnel.

A medical dictionary defines a "polyp" as, "A smooth dome-shaped benign
neoplasm of covering and lining epithelium," and "neoplasm" as "A mass
of tissue that is actively and progressively growing because of
permanent defects its cells' growth-controlling mechanisms."
(http://www.usc.edu/hsc/dental/opath/Chapters/DictionaryP.html).

Is there any record of purportedly benign sinus polyps turning malignant?
It's been my understand that the worst case scenario, if left untreated,
is that my sinus airways could become entirely blocked by polyps. It was
nearly that bad for me in 1987 prior to my first surgery. I have also had
asthma all my life, which I do not doubt is related in some way to
condition of my sinuses. (No allergy to asperin or other medications that
I'm aware of though.)

Is there anyone in this group who's had polyps that have been so non-
responsive to any form of treatment? What hope is there to resolve this
condition, short of a lifetime series of surgeries? I'm now 45 years
old. At this rate, should I anticipate another eight to twelve sinus
surgeries in my lifetime? God help.

Is there a genetic therapy available - even experimentally - resulting
from research on the human genome perhaps, with respect to the
development of chronic polyps or benign tumors of this sort? Are there
any clinical trials underway for new treatments for sinus polyps? I'm
grasping at straws.

Whoever it was here that wrote the FAQ for this group, it's thorough and
to the point. Sinusitis sucks.

Any advice or words of informed counsel would be appreciated. I'm not
feeling very hopeful.

*  *  *


-= SURGICAL HISTORY =-

07-15-2004 - Endoscopic polypectomy, frontal sinus exploration, anterior
ethmoidectomy, maxillary antrostomy with tissue removal, and septoplasty
at St. Luke's Hospital, Newburgh, N.Y. by R. DeMaio, M.D. This procedure
(which took place yesterday) follows three years of lavage treatments
variously using amphotericin-b, Alkalol, and saline, under close medical
supervision, with medication on Aquatab for congestion, as well as Cipro
delivered by sinus nebulizer and periodic courses of Prednisone.

01-13-2001 - Image-guided bilateral endoscopic nasal polypectomy with
bilateral maxillary enterostomies, total ethmoidectomies and
sphenoidotomies at St. Luke's Hospital, Newburgh, N.Y. by R. DeMaio,
M.D. Pre-operative note gave this summary: "The patient is a 42-year-old
male with a long history of nasal sinusitis and polyps. The patient has
undergone Sinus surgery in 1988, '89 and '94. The patient has had
recurrent polyposis since this time. He has been treated by me for
reduction of the polyps for several months. He has had some success with
amphotericin b. lavaging of the sinuses. However the massive polyposis
should be debrided for improvement in his nasal airway. The patient is
now being admitted for endoscopic sinus surgery with image-guided
computerized system for bilateral maxillary antrostomies, total
ethmoidectomies and sphenotomies."

11-28-1994 - Septoplasty, bilateral Lynch frontal sinusotomy, bilateral
total intranasal ethmoidectomy, bilateral sphenoid sinusotomy with
polypectomy, bilateral maxillary sinusotomy with removal of polyps, left
nasal sinus endoscopy with osteomeatal complex resection and antrostomy,
with excision of nasal polyps bilaterally at Horton Memorial Hospital,
Middletown, N.Y. by Edward Fisher, M.D. Operative note: "The sinus was
filled with polyps. They were removed sequentially using the bean
forceps and sucker. An intrasinus septum between the medial and lateral
right frontal sinus was drilled to create one larger space. The area of
the frontal sinus down toward the frontal recess was cleared of polyps.
An incision was then made on the left for the left Lynch procedure. * *
* The septum was replaced back to the midline, by creating an incision
on the right side at the beginning of the bony septum. Previous surgery
had resected it posteriorly and inferiorly. The right mucosal flap was
elevated from the bony septum. The bony septum was then removed and was
then fractured back to the midline. When this was completed, the septum
was midline, which facilitated the anterior ethmoidectomies and frontal
recess approach. When the surgery was completed, the nasal cavities were
packed with Vaseline gauze and the patient was returned to the Recovery
Room in satisfactory condition."

11-13-1992 - Referred for a consult with a well-known ENT doctor a major
teaching hospital in New York City. Dr. Liu's referral letter reported:
"This is a gentleman who is status three post sinus surgeries, the last
of which was performed by me. Despite performance of the frontal recess
area and in the ethmoid dome, the patient has again recurrence of polyps
and has severe headache in this region. Steroids, antibiotic, and
mucolytic agents have been done with unsatisfactory control of this
problem." For financial reasons this referral was not pursued beyond one
office visit. Outpatient treatment with Dr. Liu continued for another
year, with little long-term change.

09-01-1992 - Endoscopic sinus surgery with removal of polyps at Wayne
Memorial Hospital, Honesdale, Penna. by P. Liu, M.D. Upon discharge: "He
is about four months post endoscopic sinus surgery. The patient did well
initially. He had exposure to an environmental allergen with significant
flaring up and polypoid reaction. Since then the patient has had
recalcitrant polypoid sinusitis despite steroid injections, antibiotics,
and decongestants. He has opacification of the sinuses on the CT scan.
Because of failure of treatment, the procedure of polyp removal and re-
establishment of aeration of the sinuses through endoscopic sinus
surgery * * * Polyps within the ethmoid frontal recess was opened up.
Dissection was carried up to the frontal recess region. The natural
osteum of the maxillary sinus was opened up. Posterior dissection was
carried close to the posterior ethmoid air cell and down to the area of
the sphenoid area, and packing was placed in the area. There was about
500 cc. loss of blood. The patient was thoroughly suctioned out. He
tolerated the procedure well and was in stable condition throughout the
procedure."

03-13-1992 - Endoscopic sinus surgery in the office of P. Liu, M.D. with
local sedation. Post-op note: "Since the last surgery he has failed to
significantly improve and has complaints of severe headache, pressure,
and nasal obstruction. CT scan shows sphenoid opacification on the right
side, collection of opacification on selected ethmoid areas. He was
treated conservatively for a while, and despite this has continued to
have problems. The patient had a WBC of 17,000 off antibiotics. He was
placed on antibiotics and his WBC came down to 14,000. In view of
persistent infection and failure of medical therapy, the procedure of
revision endoscopic sinus surgery with septoplasty were discussed***  

05-01-1991 - Endoscopic sinus surgery with removal of polyps Wayne
Memorial Hospital, Honesdale, Penna. by P. Liu, M.D.

12-15-1989 - Bilateral intranasal spheno-ethmoidectomies, bilateral
Caldwell-Luc, and bilateral excision of middle turbinates at Westchester
Medical Center, Valhalla, N.Y. by A. Moscatello, M.D. Upon discharge:
"At the time of surgery the patient was found to have polyps occupying
the entire maxillary sinuses bilaterally and the ethmoid sinuses
bilaterally. The ethmoid and maxillary sinuses were extenterated
completely."

03-08-1988 - Bilateral nasal polypectomy, bilateral sphenoidectomy, and
bilateral Caldwell-Luc at Mercy Community Hospital, Port Jervis, N.Y. by
J. Navare, M.D. Post-op note: "This is a 30 year old who was admitted
with bilateral nasal polyps and total obstruction of the nasal airway.
Was found to have involvement of the bilateral ethmoid and maxillary
sinuses... Was found to have polyps in all ethmoid and maxillary
sinuses."

02-22-1988 - Initial physician office visit for sinus complaints with K.
Karsai, M.D. of Monticello who diagnosed "multiple nasal polyposis" and
referred treatment to Y. Newland-Pagan, M.D. of Liberty; who in turn
referred surgery to Dr. Navare and subsequently to Dr. Moscatello
(above).

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