When Do You Need Sinus Surgery?

For some people, medications aren’t enough to clear up sinus infections. Here are some steps you can take if you’ve had enough.

Sinus infections are no fun. They cause pressure, swelling and congestion that can be painful and even debilitating. And if one acute infection isn’t bad enough, some people get them over and over again. This is called chronic rhinosinusitis (CRS). There are surgical procedures that can treat these repeat infections — but when are they necessary?

If you have a serious sinus infection, the first step is to see what you can do to avoid surgery, which should be viewed as a last resort. Consider your home and workplace environment — avoid smoke and allergy triggers, and use humidifiers to moisten the air, as dry air can be irritating. Seek treatment for allergies, which may include regular shots. Practice cold prevention by washing your hands often, avoiding sick people and treating illness if it occurs. Also, it’s a good idea to get a flu vaccine, as cold and flu infections can create a breeding ground for rhinosinusitis.

If you continue to get sinus infections after taking these preventive measures, the next step is to receive medical therapy from an ear, nose and throat (ENT) specialist. This will likely require several weeks of antibiotics, steroid medications and nasal sprays and irrigations. If you still don’t respond to treatment, your doctor may perform a CT scan to see what’s causing the infection to persist.

You might need surgery if you have badly damaged sinus tissue, benign growths (called polyps), a fungal infection or structural problems that are preventing your sinuses from draining.

“The role of sinus surgery is to reestablish drainage pathways of the sinuses and provide access for delivery of topical medications, as well access for future in-office procedures,” says Bozena B. Wrobel, MD, an otolaryngologist at Keck Medicine of USC and associate professor of clinical otolaryngology – head and neck surgery and director of rhinology, allergy and endoscopic skull base surgery at the Keck School of Medicine of USC. “If large openings are achieved through surgery and the disease reoccurs, it can be managed through in-office procedures: polypectomies or placement of steroid-eluding stents,” Wrobel says.

Luckily, new techniques in nasal surgery allow it to be a relatively pain-free procedure that often can be done on an outpatient basis with a short recovery time. Endoscopic sinus surgery is done by inserting a small endoscope with a camera into the nose so that the doctor can perform the surgery without an external incision. The procedure is done under general or local anesthesia. Diseased tissue, polyps and possibly bone are removed to allow a larger passageway in your sinuses. Sometimes, a balloon is inserted to widen the sinuses (a procedure known as sinusplasty).

The surgery has a high success rate, with rare complications. Because the procedure is performed behind the eyes, loss of vision is one possible, but unlikely, complication. However, if chronic sinusitis is left untreated, it can also lead to vision problems. If you have concerns about the risks of the surgery, talk to your doctor.

A successful surgery will mean follow-up appointments so that your doctor can track your progress and provide postoperative care, which may include nasal irrigations and nasal sprays. You may also need to continue some medications to prevent a recurrence of the infection. Although you may not be completely cured, with the proper follow-up care, you should experience a great reduction in symptoms.

Sinus surgery is rarely needed, but it’s a good option for people with chronic rhinosinusitis.

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