From the Guidelines
The initial management for a patient with a deviated septum and nasal polyp involves a stepwise approach starting with intranasal corticosteroids, such as fluticasone propionate (2 sprays per nostril daily) or mometasone furoate (2 sprays per nostril daily) for at least 4-6 weeks, as recommended by the most recent guidelines 1. This approach is based on the understanding that nasal polyps are an inflammatory condition of the nasal and sinus mucosa, and intranasal corticosteroids have been shown to be effective in improving sense of smell and reducing nasal congestion 1. The treatment should be combined with saline nasal irrigation twice daily using a solution of 240ml distilled water with 1/4 teaspoon of salt and 1/4 teaspoon of baking soda. For patients with significant symptoms, a short course of oral corticosteroids may be added, such as prednisone 20-40mg daily for 5-7 days to reduce polyp size and inflammation, as suggested by the guidelines 1. Antibiotics are only indicated if there is evidence of bacterial infection. These medical therapies aim to reduce inflammation, improve nasal airflow, and potentially shrink the polyp, by suppressing inflammatory mediators and reducing mucosal edema. If medical management fails after 6-12 weeks, referral to an otolaryngologist for consideration of surgical intervention is appropriate, which may include functional endoscopic sinus surgery (FESS) for polyp removal and septoplasty to correct the deviated septum, as recommended by the guidelines 1. Patients should be counseled that complete symptom resolution may require both medical therapy and eventual surgical correction. It is essential to note that the presence of a deviated septum can contribute to nasal obstruction, and correction of the septum may be necessary to improve nasal airflow, as discussed in the guidelines 1. The goal of treatment is to improve the patient's quality of life, reduce symptoms, and prevent complications, such as chronic sinusitis or nasal polyp recurrence, as emphasized by the guidelines 1.
From the Research
Initial Management for Deviated Septum and Nasal Polyp
The initial management for a patient presenting with a deviated septum and nasal polyp on physical exam involves a comprehensive assessment and consideration of various treatment options.
- Clinical Assessment: The diagnosis of a deviated septum can be made through clinical assessment, while imaging techniques such as computed tomography (CT) scans are used to classify and assess the severity of the deviation 2.
- Treatment Options: Surgical correction, specifically septoplasty, is a common treatment option for nasal septal deviation, with high satisfaction levels and low complication rates 2, 3.
- Medical Management: For patients with nasal polyps, medical management with intranasal corticosteroids, such as fluticasone, can improve symptoms and quality of life 4. However, the effectiveness of intranasal steroids in reducing nasal obstruction due to a deviated septum is limited 5.
- Surgical Intervention: Septoplasty, with or without turbinate surgery, has been shown to improve nasal obstruction symptoms and quality of life in patients with deviated nasal septum, with a relatively low rate of complications 6.
Considerations for Nasal Polyps
- Fluticasone Exhalation Delivery System: The use of a fluticasone exhalation delivery system has been shown to improve care by increasing superior/posterior intranasal corticosteroid deposition and reducing nasal polyp grade 4.
- Surgical Management: Surgical management of nasal polyps, often in conjunction with septoplasty, may be necessary for patients who do not respond to medical management or have significant nasal obstruction.
Key Findings
- Septoplasty is an effective treatment option for deviated nasal septum, with significant improvements in nasal obstruction symptoms and quality of life 2, 6.
- Medical management with intranasal corticosteroids can improve symptoms and quality of life in patients with nasal polyps, but may not be effective in reducing nasal obstruction due to a deviated septum 4, 5.