Is surgery the best option?
Sooner or later, the day will come. Our ENT physician explains that drugs are no longer effective and surgery is now the best option. ENT physicians will recommend surgery when there are too many outbreaks requiring steroids that can have serious side effects. Additionally, they may recommend surgery if we complain too much about breathing difficulties and fatigue.
After a year of antihistaminic treatments, my nasal polyps had reached stages three and four. My research led me to find one of the very best ENT surgeons in Europe, and he was amazing. But I knew so little about nasal polyps and surgery procedures, and I would do it differently now.
We should clearly understand the risks and other options before deciding to undergo nasal polyps surgery. The challenge is that we aren't in the best mental state when making this decision, so we should form our own opinions beforehand. Through my own experience, I will share everything I learned.
Non-invasive and invasive surgeries
When it comes to nasal polyps surgery, there are two different approaches.
The most common type of surgery is an invasive procedure performed under general anesthesia:
A polypectomy involves removing the polyps.
A turbinectomy enlarges the nasal cavity by removing the turbinate bones.
An ethmoidectomy involves opening up the ethmoid sinuses in one cavity in order to increase the size of the nasal cavity as a whole.
A septoplasty improves nasal airflow by adjusting the deviated septum.
After surgery, polyps are analyzed to determine their exact nature. We spend around ten days in the post-op period, and the worst part is taking off the nasal dressings.
Alternatively, you can go for a local anesthetic-induced polypectomy in your ENT office. The procedure is non-invasive since it does not cut into the nasal bones or mucosa, nor does it alter the nasal and sinus cavities.
ENT physicians generally favor invasive surgery. ENT physicians who are advocates of non-invasive surgery have a different perspective on the treatment of nasal polyps; they recommend a similar approach to the one described in this book.
It's crucial for us to make a conscious decision when it comes to invasive or non-invasive surgery because there are tremendous consequences down the road.
Risks and benefits
Back then, I did not have the knowledge I have today when I chose to undergo invasive surgery. In my mind, surgery was the only way to improve my condition. Additionally, I believed it would be a definitive solution to my problem, and if I dared to take the risk, I would reap the rewards. The situation improved for a few years, but then it deteriorated again.
I view surgery in a whole new light now that I have learned so much about nasal polyps. Every patient should understand the implications of an invasive procedure.
There is no doubt about the benefits:
- It provides immediate respiratory relief. As a result, we will be able to sleep, breathe, and be energetic again.
- Because our sinuses now have the ability to clean themselves, other symptoms are reduced. As a result, we should have fewer colds and sinus infections.
- It allows topical steroid sprays to penetrate deeper into our nasal cavity, reducing inflammation and polyp growth.
- It may help us regain our sense of taste and smell.
From this perspective, invasive surgery sounds great, but the benefits only address symptoms and their consequences, not underlying inflammation.
As with any surgical procedure, there are risks involved, and our ENT physician will be legally required to disclose them. We will need to consider:
- General anesthesia like for any other surgery.
- The surgery area is very close to the optic nerves.
- Empty nose syndrome. A surgery that is too invasive changes the airflow in our nasal cavities dramatically. It is extremely rare, but the consequences are severe, and there is no way out.
- We may not be able to recover our sense of smell and taste.
Our ENT is not legally required to disclose other risks, but they are more prevalent and should be considered very seriously as well.
Relapse risk. An ENT physician will likely discuss the relapse rate one or two years after surgery, which is around 30%. Although they present this statistic as a good result, I view it as a huge risk. Moreover, it is much harder to get data on the relapse rate three or five years after surgery. These statistics are difficult to find probably because they are not advantageous. It would not surprise me if there was a 50% chance of relapse after five years. Five years may seem like a long time, but it goes by much faster than we expect. Having not addressed the underlying inflammation could result in a 50% chance of being in a worst situation in five years. A second, even riskier operation might be required.
Each operation is a little more dangerous than the last. Once, my ENT physician, one of the best in Europe, quietly said, "I don't like to come back in there". With the nasal cavity now abnormal, the surgeon will have a harder time finding specific fixed points.
- Each surgery traumatizes the nasal cavity and sinuses. The more surgeries we have, the greater the risk of inflammation, which is a fuel for nasal polyps. Therefore, if the first surgery relieves us for seven years, the second may relieve us for only five years, and the third may relieve us for only two years.
Invasive surgery does not cure nasal polyps for the long run. Unlike our belief, a surgical procedure like this is not a reward for those who are courageous enough to undergo it. To prevent polyps from growing again, we will need topical steroids. We will still have to use steroids and antibiotics if they do. The reality is that the invasive surgery we are considering may worsen our situation, and there is no turning back.
An alternative approach involves a non-invasive surgery, which has similar benefits:
- It provides immediate respiratory relief. As a result, we will be able to sleep, breathe, and be energetic again.
- The sinuses can now clean themselves, alleviating other symptoms. It should be easier for us to avoid colds and sinus infections.
- The procedure only requires local anesthesia and has a shorter recovery period.
- Since it does not cause trauma to the nasal cavity or sinuses, it does not trigger inflammation.
There is a major drawback to noninvasive surgery, which is that nasal polyps are likely to grow back within a few months.
What is the real benefit of this procedure? It's a way of getting better quickly and buying us some time to start treating our condition holistically.
Taking a decision when backed into a corner
We now understand the importance of deciding whether to undergo surgery, and the differences between invasive and non-invasive procedures. The challenge is that we have to make that decision under tremendous pressure.
Having spent months exhausted and depressed, we are now desperately searching for a way out. Surgery, however, has short-term risks that could be concerning or even frightening. In order to make us feel as comfortable as possible, our ENT physician will tell us that he does this procedure every day, that it will make us feel so much better, and that this is our only option.
As a result of the pressure, we are unable to step back and thoroughly understand the procedure and its consequences. In addition, we may refuse to make a conscious and personal decision, instead surrendering to our ENT physician's advice.
Remember that ENT physicians are primarily surgeons. A surgeon's life revolves around surgery; it's what they do for a living. After prescribing antihistamines, antibiotics, and steroids, and none of them worked, they strongly believe surgery is their only option. Further, most ENT physicians will assume that the only option is invasive surgery. They are aware of the risk of relapse and come to believe that multiple surgeries are the only solution. It's a vicious cycle with no end in sight.
There is a minority of ENT physicians who oppose invasive surgery and favor a comprehensive approach to nasal polyps, which includes non-invasive surgery as well.
It is important to understand our ENT's position, as he may lean towards a particular procedure without discussing both approaches with us at the same time. He almost seems to have decided for us without consulting us. It’s critical to ask ourselves how our ENT physician views nasal polyps surgery, and if it does match our own goals.
My take on surgery
As I reflect on the months that followed, I am glad that I said "no" to a second surgery. Other readers are just as happy.
Sandine: “During times of discouragement, it seems so easy to schedule a surgery: thank you for stressing that surgery is not a solution in and of itself. My ENT physician told me a year ago that if it becomes very problematic for you, I can operate, but there are substantial risks that it can return even more. Therefore, she advised me against this option and suggested that I try to handle the situation better by myself, without, however, giving me any keys.."
Celine: "Since then, the polyps have receded. Almost two months after the diet, I saw my ENT physician again, and a miracle happened: no more surgery insight. A shift took place. Polyps have been significantly reduced."
Corinne: “I was in stage four on the verge of surgery! It was wonderful to re-discover my sense of smell and breath at night! I also reduced my milk consumption. Gluten seemed to have no effect on me."
Laurent: "After suffering from nasal polyps for over twenty years and undergoing two surgeries, I began looking for alternative treatments when I discovered Bertrand's book. This book confirmed what I had recently anticipated: there are other options besides surgery and traditional medicine."
In Summary / Take Action
Invasive surgery should only be used as a last resort. Don't be fooled into thinking surgery is the best solution or that those who take risks always succeed. This is not a definitive solution, but it is a definitive decision.
- Having this book in hand, we should give ourselves at least six months to explore all other viable options before deciding on surgery. Even after surgery, we will have to make some changes to prevent a relapse. Making those changes before surgery might improve our condition and enable us to avoid surgery altogether.
In cases where we feel awful, it is best to consult with an ENT doctor who can perform non-invasive surgery. It is the only surgery that has no consequences. It will give us some relief and time to explore other options. Our next chapter discusses noninvasive surgical options.
- We should explore all options and avenues discussed in this book. If we think it is impossible to change our diet, we should reconsider that belief. It's much easier to stop eating dairy than to undergo invasive surgery.
- If we just had an invasive surgery, we should focus on reducing our risk of relapse to prevent further surgery in a few years.
