ENT Outpatient F2F Clinic Letter

Re: ENT Clinic Appointment On 1 November 2024 I am writing to summarise what we discussed at your appointment today about your persistent blocked nose and difficulty breathing through your right nostril. Diagnosis 1. Chronic Rhinosinusitis with Nasal Polyps 2. Deviated Nasal Septum Management Plan 1. Functional Endoscopic Sinus Surgery (FESS) with Septoplasty and Turbinate Reduction General Anaesthetic Day Case Approximate Duration: 2 hours 2. Prescribed a course of Fluticasone Propionate nasal spray, two sprays in each nostril twice daily for 3 months post-surgery. 3. Referral to Allergy Clinic for further investigation of potential environmental triggers. 4. Follow-up appointment scheduled in 6 weeks post-surgery for review. During your visit, we discussed the following. You reported a history of persistent nasal congestion, particularly on the right side, for the past two years. You also experience a reduced sense of smell and occasional clear nasal discharge. You have tried over-the-counter nasal decongestants without significant long-term relief. Your Medical History You have a history of seasonal allergies, managed with antihistamines as needed. Your Medications Cetirizine 10mg once daily as needed for allergies. Allergies Penicillin (rash) Dust mites (sneezing, runny nose) Social History You are a non-smoker. You consume alcohol occasionally, approximately 2 units per week. You work as an accountant. You live with your spouse in a house with no known mould issues. On Examination Ears: Tympanic membranes intact and mobile bilaterally. No signs of infection or effusion. Oral Cavity And Throat: Oropharynx clear, no tonsillar hypertrophy. Posterior pharyngeal wall unremarkable. Neck: No palpable lymphadenopathy or masses. Thyroid non-tender and normal in size. Anterior Rhinoscopy: Significant deviation of the nasal septum to the right, obstructing the right nasal airway. Bilateral nasal polyps noted, larger on the right, partially obscuring the middle meatus. Flexible Nasendoscopy: Confirmed septal deviation and bilateral nasal polyps, with evidence of mucosal oedema and purulent discharge in the right middle meatus. Postnasal space clear. Larynx appears healthy with symmetrical vocal cord movement. Investigations And Results We discussed the results of your recent CT scan of the paranasal sinuses, which showed extensive mucosal thickening and opacification of the ethmoid and maxillary sinuses bilaterally, consistent with chronic rhinosinusitis, along with significant septal deviation and nasal polyps. Impression You have chronic rhinosinusitis with nasal polyps and a deviated nasal septum. This is causing your persistent nasal blockage, reduced sense of smell, and difficulty breathing through your nose. We discussed that the polyps are inflammatory growths within the sinuses and nose. Discussion About Surgery We discussed the option of Functional Endoscopic Sinus Surgery (FESS) with Septoplasty and Turbinate Reduction, which is a procedure to open up your sinus drainage pathways, remove the polyps, straighten your nasal septum, and reduce the size of your nasal turbinates. Anaesthetic: General Anaesthetic Admission: Day Case Approximate Duration: 2 hours Alternatives Discussed: Medical management with steroid nasal sprays and saline rinses, which you have already tried with limited success. The option of not proceeding with surgery was also discussed, which would likely result in continued symptoms. The risks and complications we discussed were: - Bleeding, usually minor but occasionally requiring further intervention. - Infection, which would be treated with antibiotics. - Changes in sense of smell, which can occasionally occur. - Recurrence of polyps, which can happen despite surgery. - Very rarely, damage to the eye or brain due to the proximity of the sinuses. We discussed that you would likely require a week to ten days off work for recovery, and that you should avoid strenuous activities during this time. You will receive detailed post-operative instructions. What You Can Do To Help It is important to continue using the Fluticasone Propionate nasal spray as prescribed after surgery to help prevent polyp recurrence. Regular nasal douching with saline solution will also be beneficial for nasal hygiene and to aid healing. When To Seek Urgent Help If you experience severe bleeding from your nose, a sudden change in vision, severe headache, or a high fever after surgery, please contact the ENT ward immediately or attend your nearest emergency department. Next Steps Your surgery date will be arranged, and you will receive a letter with the details. We will see you back in the clinic approximately 6 weeks after your surgery to assess your recovery and discuss the allergy clinic referral. Please do not hesitate to contact me if you have any questions or require further information. Please note this letter has been transcribed by Heidi Health, an AI transcribing tool, and has been checked for errors.