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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.

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Treatment of Nasal Polyps with Dr. Patricia Loftus on the BackTable ENT Podcast)
Ep 13 Treatment of Nasal Polyps with Dr. Patricia Loftus
00:00 / 01:04

BackTable, LLC (Producer). (2021, January 1). Ep. 13 – Treatment of Nasal Polyps [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Patricia Loftus discusses Treatment of Nasal Polyps on the BackTable 13 Podcast

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 discusses Treatment of Nasal Polyps on the BackTable 13 Podcast

Dr. Ashley Agan

Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.

Dr. Gopi Shah discusses Treatment of Nasal Polyps on the BackTable 13 Podcast

Dr. Gopi Shah

Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.

Show Notes

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.

Resources

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

Transcript Preview

[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.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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