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How to manage nasal polyps?

Q: I am 33 years old and have been suffering from allergic cold, sneezing and nasal congestion for the past several years. The mucus which comes out of nose is green in colour and does not come out easily, sometimes even blood is mixed in the mucus. It usually takes weeks to recover. After consultation and medication from various doctors it was found to be Allergic rhinitis. The doctor advised broncho-vaxom (oral immunobiotherapy for recurrent RTI) for three months (10 capsules per month), but no significant improvement resulted. Recently I noticed that in morning when nasal congestion is maximum, I clear up my nose and a huge quantity of dark green mucus is discharged, and thereafter I feel relieved temporarily but still I realised that I am not able to breathe freely from the right nostril compared to the left nostril. Thereafter I had a CT scan of the PNS (sinuses). The finding were: 1) Mucosal hypertrophy of inferior and middle turbinate and of nasal septum of right nostril; 2) Polyp maxillary sinus What treatment is available for the above finding? I would like to have surgery only if there is no other alternative.

A:When rhinitis starts at your age it is often not due to allergies. If you have skin prick tests or IgE RAST blood tests which are negative for common inhaled allergens such as house dust mite, then allergy is unlikely. Polyps can be due to chronic infection in sinuses, or can occur with neither allergy nor infection underlying them. Sometimes they shrink on nasal steroid spray or drops,(eg fluticasone, beclomethasone, betamethasone, mometasone, budesonide etc), or, if this fails, a short course of steroid tablets. Surgery may be required if the polyps do not respond to medical treatment, in which case post-operative nasal steroids may be required to prevent or delay regrowth.

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