Sinus Surgery

Most people are able to treat sinusitis with medicines such as antibiotics and home treatments. But some people get repeat infections because something blocks the flow of mucus from the sinuses or there is another medical problem. Surgery may remove blockages and enlarge the sinus openings to help the sinuses drain. This can help prevent future infections. Consider the following when making your decision:

  • Very few people need surgery for sinusitis. To be sure that surgery is a good choice, you need to be diagnosed with chronic sinusitis and have a CT scan of the sinuses done after you have used maximum medical treatment for four to six weeks. By reducing infection and swelling, this treatment helps the doctor see what is causing the repeat infections.
  • Surgery may be the only way to get a badly blocked, infected sinus to drain. But surgery does not always work. As many as one out of five people who have the surgery need a second operation.
  • If you are getting chronic sinusitis because of another medical problem, such as allergies:
  • You need to get that problem under control before you have surgery.
  • You will have a better result from surgery if you use medicine and home treatment after surgery to help keep that problem under control.

What is sinusitis?

Sinusitis is infection or inflammation of the mucous membranes that line the sinus cavities. When a mucous membrane becomes inflamed, it swells. This can block the normal drainage of fluid from the sinuses into the nose and throat. Bacteria and fungi are more likely to grow and cause infection in sinuses that cannot drain properly.

Sinusitis most often is the result of viral infection, typically a cold. Nasal allergies or other conditions that block the nasal passages can also lead to sinusitis.

There are two types of sinusitis: acute (sudden) and chronic (long-term.). You may have chronic sinusitis if:

  • You have had more than three sinus infections in one year that needed antibiotics to clear up
  • You have had a sinus infection for more than eight weeks that antibiotics have not cleared up.

Sinus surgery may be a good treatment for some people who have chronic sinusitis.

What is sinus surgery?

The goal of sinus surgery is to help the sinuses drain. To do this, a surgeon usually enlarges the openings of the sinuses by removing:

  • Infected, swollen or damaged tissue.
  • Bone, to create a wider opening for drainage of mucus from the sinuses.
  • Growths (polyps) inside the nose or sinuses.

There are two types of sinus surgery: endoscopic and traditional. Endoscopic surgery is done most often.

  • Endoscopic surgery may be done to remove small amounts of bone or other material blocking the sinus openings or to remove nasal growths (polyps). Normally, a thin, lighted tool called an endoscope is inserted through the nose so the doctor can see and remove whatever is blocking the sinuses.
  • Traditional surgery may be done when complications from sinusitis, such as the development of pus in a sinus, infection of the facial bones or brain abscess have occurred. In this type of surgery, the doctor makes an opening into the sinus from inside the mouth or through the skin of the face.

If there is a problem with a structure inside the nose (such as a deviated septum), this may be fixed during the same surgery. Surgery to repair the septum is called septoplasty. After surgery, the doctor may prescribe:

  • Antibiotics to help fight infection.
  • Steroid medicines to reduce inflammation and improve healing.
  • Pain medicine.

Regular doctor visits are needed for two to six weeks after surgery to make sure the sinuses are healing well. Sinus surgery is always done by an ear, nose and throat (ENT) specialist (also called an otolaryngologist).

Who needs surgery for sinusitis?

Very few people need surgery to treat sinusitis. You may need surgery if you have been through the following steps:

  1. You have been diagnosed with chronic sinusitis by an ENT doctor.
  2. After being diagnosed, you have used the maximum medical treatment for sinusitis. Maximum medical treatment includes at least four to six weeks of antibiotics, a steroid medicine and other prescription medicines to clear up the infection and reduce the swelling in your sinuses.
  3. You have had a CT scan of your sinuses after using the maximum medical treatment as prescribed by your doctor. It is very important to have the CT scan done after this treatment. By reducing swelling and infection as much as possible, this treatment lets your doctor see what could be causing the repeat infections.

You might need surgery if:

  • The CT scan shows that something is keeping the sinuses from draining properly.
  • Your doctor suspects that you have a sinus infection caused by a fungus. This may be the case if antibiotics have not cleared up the infection. Antibiotics work for bacterial infections but not for fungal infections.
  • You have a serious problem from sinusitis, such as the spread of the infection beyond the sinuses. This rarely happens; if it did, more extensive surgery would be required.

What are the benefits of sinus surgery?

  • By helping the sinuses drain, sinus surgery helps prevent sinus infections.
  • Your sense of smell may improve.

Click to download printable instructions for post-operative care