Structural problems with the nose and sinuses may ultimately require surgical correction to cure them. This should be done only after more conservative measures have been tried and failed. Septal deviation, septal spurs, septal perforation, enlargement of the turbinates, and nasal/sinus polyps can lead to pooling of or overproduction of secretions, blockage of the normal pathways leading to chronic sinusitis, and chronic irritation. The surgery is performed by an ear-nose-throat doctor (otolaryngologist). Surgery can also enhance the delivery of nasal medications and rinses into the nasal cavities.
My preference is to prescribe a short course of oral steroid which is tapered (reduced gradually) every two days for a total of ten days. A nasal steroid spray is prescribed for long-term use. The nasal steroid sprays are not addictive and may help to maintain good airflow through the nasal passages as the oral steroid is eliminated. The patient is instructed to stop the TND within two days, allowing time for the oral steroid to take effect. If there is no history of blood pressure elevation, heart, thyroid or eye problems, an oral decongestant (. Sudafed) may also be recommended. I also recommend nasal saline rinses.