Chronic Sinusitis Surgery
Sinusitis can also be referred to as rhinosinusitis. It occurs when the paranasal sinuses become inflamed. There are many causes of this inflammation, but the most common are infection, allergies and autoimmune deficiencies. Most cases are due to a viral infection and resolve over the course of 10 days. When these infections reoccur several times throughout the year, you have recurrent acute sinusitis. When the infections don’t go away, you many be suffering from chronic sinusitis and additional treatment may be required.
Chronic sinusitis surgery is often recommended when other medical treatment has not cured or improved chronic sinus infections.
The aim of treating chronic sinusitis is to:
- Reduce sinus inflammation
- Keep nasal passages draining
- Eliminate the underlying cause
- Reduce sinusitis exacerbations
Chronic sinusitis treatment before considering surgery
Appropriate medical management to reduce the symptoms and causes of chronic sinusitis should be attempted before considering surgery. This includes:
- Saline nasal irrigation: You spray or irrigate your sinuses with a saline solution to flush your nasal passages.
- Nasal corticosteroids: These are nasal steroid sprays that help prevent and treat inflammation. Medications such as fluticasone (Flonase), budesonide (Rhinocort Aqua), triamcinolone (Nasacort AQ), and mometasone (Nasonex) are commonly used nasal sprays.
- Oral corticosteroids: These medications are used to relieve inflammation from severe sinusitis, particularly nasal polyps. Prednisone and methylprednisolone are two tablet steroids. Long-term use of oral corticosteroids can cause serious side effects, so they are recommended only to treat severe symptoms.
- Decongestants: Available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. OTC oral decongestants include Sudafed and Actifed. Oxymetazoline (Afrin) is an OTC nasal decongestant spray which should be taken for a few days at most — because oxymetazoline can cause more severe congestion.
When to choose chronic sinusitis surgery
Surgery is recommended if you have chronic sinusitis symptoms. The following factors indicate that surgery should be considered:
- If your doctor gives you a diagnosis of chronic sinusitis.
- You’ve had “appropriate medical treatment”, which consists of taking medication and following home treatment for at least 4 to 6 weeks. This treatment may include antibiotics, a steroid nasal spray, air purifiers, and other prescription medicines.
- You have had an endoscopic nasal exam with a fiber-optic lens to allow your doctor to evaluate the anatomy and infection sites in your nose.
- You’ve had a CT scan, a high-quality series of X-rays of your sinuses after the 4 to 6 weeks of treatment. The CT scan needs to show inflammation and indicate that something is preventing your sinuses from draining.
Surgery may also be needed if:
- You have a sinus infection caused by a fungus. Antibiotics can’t clear up infections caused by a fungus.
- You have a serious problem, such as an infection that spreads beyond your sinuses (this is rare).
If chronic sinusitis persists after receiving four to six weeks of antibiotics, nasal steroids, and nasal saline irrigations, chronic sinusitis surgery is usually recommended.
Chronic sinusitis surgery options
If you and your doctor agree that surgery is right for you, endoscopic surgery is almost always the preferred method for chronic sinusitis.
Endoscopic surgery has been very effective in treating chronic sinusitis, with positive feedback given by patients who have had this procedure. These patients “report significantly improved quality of life following minimally invasive endoscopic sinus surgery”, according to a study led by Oregon Health & Science University (OHSU). Quality of life was significantly improved over patients who received medical management alone. Patients typically experience better breathing, less nasal discharge, and a better overall feeling of health.
Endoscopic sinus surgery
Endoscopic surgery has been found to improve symptoms in about 90 out of 100 people. A nasal endoscope, which is a thin, flexible or rigid tube with an attached light, is inserted into the nose. This provides the doctor with an inside view of the your sinus passages.
Surgical instruments are inserted alongside the endoscope. These instruments allow the doctor to remove small amounts of bone or other material, such as growths (polyps) of the mucous membrane that block the sinus openings. Enlarging a narrow sinus opening also may aid drainage. Depending on the source of the obstruction, various other instruments may be used. Local or general anesthesia are both options.
The surgery, which takes 30 to 90 minutes, is performed by our practice in an ambulatory surgery center with anesthesia provided by a board certified anesthesiologist. Chronic sinus surgery may also be done in a hospital, a doctor’s office or a clinic.
Balloon sinus surgery
Balloon Sinuplasty is a surgical technique using a guide wire that is inserted into the sinus and a balloon that is then inflated to open the blocked sinus.This technique can provide immediate relief of sinus pressure. Tissue is not removed during balloon sinus surgery and a swollen sinus opening may reclose in patients not chosen appropriately. Having nasal polyps without polyp removal is a contraindication for balloon sinus surgery.