BackTable / ENT / Podcast / Episode #13
Treatment of Nasal Polyps
with Dr. Patricia Loftus
We speak with Dr. Patricia Loftus from UCSF Otolaryngology - Head & Neck Surgery discussing her clinical and surgical approach to treating Nasal Polyps.
BackTable, LLC (Producer). (2021, January 1). Ep. 13 – Treatment of Nasal Polyps [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Patricia Loftus
Dr. Patricia Loftus is Assistant Professor in the Rhinology & Skull Base Surgery division in the Department of Otolaryngology – Head and Neck Surgery (OHNS) at the University of California, San Francisco.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
In this episode, Dr. Patricia Loftus joins Dr. Gopi Shah and Dr. Ashley Agan to outline the diagnosis and management of patients with nasal polyps. They identify common presenting symptoms and physical exam findings as well as discuss the roles of imaging, culture, and biopsy.
Medical management including the risks and benefits of antibiotics and oral steroids are reviewed. Endoscopic surgical approaches and their utility in different clinical presentations are described. Pre-, peri- and post-operative considerations are also discussed.
The discussion then evolves to focus on conditions that clinicians should be aware of including allergic fungal sinusitis (AFS), cystic fibrosis (CF), primary ciliary dyskinesia (PCD), and central compartment atopic disease (CCAD). Finally, they highlight recent developments in management including the role of biologic therapies such as Dupixent.
Dr. Loftus’ Email Address: Patricia.Loftus@UCSF.edu
Women in Rhinology Twitter Handle: @Women_Rhinology
Women in Rhinology Instagram: @women_in_rhinology
Biologics for Nasal Polyps: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013513.pub2/full
[Dr. Patricia Loftus]
Yeah. Like you said, we always try medical management first, and for CRS with nasal polyps, this is a disease where prednisone is actually recommended. We have guidelines that give us different options. However, patients with polyps, which are eosinophilia-driven, tend to do well with prednisone because they respond well to steroids. So, this is something that's recommended if the patient doesn't have any contraindications to it. In a patient who is treatment-naive and can take prednisone, I will do a steroid taper.
There's no specific taper that you should do. What I like to do is 40 milligrams for four days, 30 for four days, 20 for four days, 10 for four days. So, it's 40 pills over a 16 day taper. I would say that most rhinologists tend to not go higher than 40. From what I read, someone looked into it like about the dosage that you hit that kind of had side effects and might've created lawsuits, or something along that line. They kind of found that 40 was okay to go up to. That's what most of us do. Also, I will definitely tell them, do saltwater rinses. We know there's a recommendation for that and we know there's a recommendation for intranasal corticosteroids. Intranasal corticosteroids that are FDA approved are Flonase or the sprays. But as you guys know, we do tend to add our steroids to rinses. I use budesonide for that. It is off-label technically. There's not robust data and I think mostly because it is off-label, but we know that it does work. What's nice about adding the budesonide is that with the rinse, it's higher volume, can kind of get into the nose and sinus cavities a little bit better.
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