Question:  A 44 year old female is referred for chronic rhinosinusitis with nasal polyposis.  On further questioning she endorses worsened nasal obstruction with beer and wine.  Urinary LTE4 levels are elevated.  She has severe nasal polyposis on endoscopy and completely opacified paranasal sinuses.  You recommend surgery along with aspirin desensitization therapy.  Which should be performed first?  [Answer will be posted with next week's new question]

Answer to last week's question, "Problems In The Pyramid" (April 3, 2017)

Cholesterol granuloma.