Before You Turn to Surgery Patients who respond to medical therapy do not need surgery, adds Mark A. Zacharek, MD, residency program director for the department of otolaryngology and head and neck surgery at Henry Ford Hospital in Detroit. But those whose CT (computed tomography) scans show “persistent disease” are possible candidates for surgery, says Dr. Zacharek. “Before resorting to sinus surgery, you should try maximum medical therapy,” says Martin Citardi, MD, chairman of the department of otolaryngology and head and neck surgery at the University of Texas Medical School in Houston. That may include a long course of antibiotics, sinus irrigations, and steroid medications. The next step, if there is no relief, is to get a CT scan. Says Dr. Citardi, “If there is still evidence of chronic sinus disease or there is an obstruction of the sinuses that can only be relieved by surgery, then surgery is recommended.” When Sinus Surgery Is Recommended Reasons for sinus surgery include:
Evidence of chronic sinusitis even after aggressive medical treatmentSinus disease caused by a fungal infectionNasal or sinus polypsStructural abnormalities of the nose or sinusesSinus infection that has spread to boneCancer of the sinusChronic sinusitis with HIV
Types of Sinus Surgery The most common surgical procedure for patients with chronic sinusitis is endoscopic sinus surgery, Zacharek says. Certain types of aggressive fungal infections as well as rare tumors of the sinus may call for “traditional or external surgical approaches involving incisions in the gum line or over the eyebrows in the forehead,” he explains. Surgeries used on the sinuses are:
Functional endoscopic surgery. This surgical procedure uses a lighted tube called an endoscope to look directly into the nose and sinuses. During an endoscopy, the surgeon can remove tissue, clean out the sinuses, and enlarge sinus openings for drainage.Balloon sinuplasty. “In this surgical procedure, a catheter with an inflatable balloon is inserted into the sinus and the balloon is then inflated to widen sinus openings,” explains Citardi.Open sinus surgery. In some more complicated cases of chronic sinusitis, an incision may be made directly over the sinus so it can be opened, diseased tissue can be removed, and the sinus reconstructed.
Pros and Cons of Sinus Surgery The biggest pro for sinus surgery is that it usually works. It may take several months for healing to be complete, and during this time post-operative care is very important. “Studies show that sinus surgery is 85 to 90 percent effective,” says Citardi, adding that a particular pro for the endoscopy procedure is that it has few complications and that the patient feels little pain, if any, during recovery. Another plus is that it’s usually outpatient surgery, Zacharek says. As for the cons, patients need to know that post-sinus surgery care is as important as the surgical procedure itself. Patients need to come back for endoscopic examinations and clean-out. Says Zacharek, “The patient must understand that sinus surgery is not necessarily a cure for chronic sinusitis. Post-operative care may require regular sterile sinus irrigations and the use of nasal sprays.” Some complications associated with sinus surgery include bleeding, infection, and loss of vision. Serious complications are very rare, occurring in much less than 1 percent of cases. Sinus surgery for chronic sinusitis and related problems is used only when all else fails. The best results for sinus surgery happen when you and your ENT surgeon have realistic expectations and work closely together before and after your surgery. Find more information in the Everyday Health Ear, Nose, and Throat Center.
