From the Guidelines
A patient with mild sinus disease and a deviated nasal septum should initially be managed with medical therapy, including intranasal corticosteroids and saline nasal irrigation, before considering surgical intervention, such as septoplasty, to correct the deviated septum and improve nasal airflow. The management plan should prioritize reducing inflammation and improving nasal airflow, as the patient's symptoms are likely related to the deviated septum and mild sinus disease. According to 1, the nasal septum is off-center in approximately 80% of the general population, and a clinically significant deviated nasal septum is present in 26% of patients with nasal obstruction.
The first-line treatment includes intranasal corticosteroids, such as fluticasone propionate (50 mcg, 1-2 sprays per nostril daily) or mometasone furoate (50 mcg, 2 sprays per nostril daily), for at least 4-6 weeks, as they reduce inflammation and improve nasal airflow. Additionally, saline nasal irrigation using a neti pot or squeeze bottle with isotonic saline solution (1/4 teaspoon salt in 8 oz of distilled water) twice daily can help clear mucus and irritants.
For acute symptoms, a short course of oral decongestants like pseudoephedrine (60 mg every 4-6 hours for no more than 3-5 days) may provide temporary relief, though these should be avoided in patients with hypertension or cardiovascular disease. If symptoms persist despite 6-12 weeks of appropriate medical therapy, or if the patient has significant nasal obstruction due to the septal deviation, surgical intervention may be considered. This typically involves septoplasty to correct the deviated septum, sometimes combined with functional endoscopic sinus surgery if the sinus disease warrants it, as noted in 1.
Some key points to consider in the management plan include:
- The degree of septal deviation and its impact on nasal airflow
- The presence of turbinate hypertrophy and its contribution to nasal obstruction
- The patient's response to medical therapy and the need for surgical intervention
- The potential benefits and risks of surgical procedures, such as septoplasty and turbinate reduction surgery, as discussed in 1.
By prioritizing medical therapy and considering surgical intervention only when necessary, the patient's symptoms can be effectively managed, and their quality of life can be improved.
From the Research
Diagnosis
- The patient has been diagnosed with mild sinus disease, characterized by minimal mucosal thickening of the ethmoid air cells 2.
- The patient also has a deviated nasal septum, which is mildly deviated to the left side.
- The osteomeatal complexes are patent, and the nasal septum deviation is not causing any significant obstruction.
Management Plan
- For the mild sinus disease, treatment options may include guided endoscopic procedures to alleviate stenosis and open inflamed ethmoid cells, as well as medical therapy to reduce inflammation and promote drainage 2.
- For the deviated nasal septum, treatment options may include septoplasty to correct the deviation, although this may not be necessary unless the deviation is causing significant symptoms or obstruction 3, 4.
- It is also important to address any underlying conditions that may be contributing to the sinus disease, such as allergies or asthma 5.
- The patient should be monitored for any changes in symptoms or disease progression, and adjustments to the treatment plan can be made as needed.
Associated Conditions
- The patient has punctate calcific density in the right parotid gland, which may be a benign condition but should be monitored for any changes or symptoms 2.
- The patient also has shotty bilateral neck lymph nodes, which may be a sign of an underlying infection or inflammatory condition 6.
- Vascular calcification in the cavernous segment of the bilateral internal carotid artery (ICA) and bilateral vascular calcification in the visualized part of the neck may be a sign of atherosclerosis or other vascular conditions, and should be monitored and addressed as needed 6.