Question: A 42 year old woman presents with complaints of bilateral nasal obstruction, facial pressure, and nasal drainage (post-nasal and rhinorrhea) which have been bothersome to her for at least the past 2 years. She has intermittent exacerbations, for which she is treated with antibiotics and over the counter decongestants by her primary care physician every few months. She is otherwise healthy, endorses no specific allergic symptoms, does not have asthma, takes aspirin without difficulty, and has never undergone surgery. She is interested in whether or not surgery would alleviate her symptoms. On nasal endoscopy, you note inflamed appearing mucosa, without polyps, masses, ulcerations, crusts, or mucopurulence. The remainder of her exam is benign. What is first line management that should be trialled in this patient?

[Answer will be posted with next week's new question]

Answer to last week's question: What Is In A Name (Mar 9, 2015):

Granulomatosis with polyangiitis (Wegener Granulomatosis): necrotizing granulomatous inflammation and pauci-immune vasculitis in small- and medium-sized blood vessels.