Chronic inflammation of the sinus linings, known as chronic rhinosinusitis, is the main condition leading patients to consider surgery. This persistent inflammation lasts twelve weeks or more despite treatment, causing symptoms like nasal congestion, facial pressure, and reduced sense of smell. Surgery is generally regarded as a last option, only recommended when standard medical therapies have been maximized without sufficiently improving the patient’s quality of life.
Exhausting Non-Surgical Treatment Options
Before surgery is discussed, patients must undergo intensive medical treatment known as maximal medical therapy. This approach uses non-surgical methods over four to twelve weeks to reduce inflammation and clear infection. A cornerstone of this treatment is regular nasal saline irrigation, which washes away mucus and debris from the nasal passages. Intranasal corticosteroid sprays are also prescribed to reduce swelling in the sinus lining, helping to open natural drainage pathways.
If a bacterial infection is suspected, an oral antibiotic may be prescribed for three to six weeks. For severe inflammation or nasal polyps, a short course of oral corticosteroids may be added to rapidly decrease swelling. Managing underlying conditions like allergies with antihistamines or immunotherapy is also an important component. The failure of this comprehensive medical approach to resolve symptoms is the primary trigger for considering surgery.
Diagnostic Factors Indicating Surgical Need
The decision to proceed with surgery requires objective evidence that medical therapy cannot overcome. A formal diagnosis of chronic rhinosinusitis requires symptoms to be present for at least twelve consecutive weeks, including two or more cardinal symptoms such as nasal blockage or discharge.
The most definitive evidence is a computed tomography (CT) scan of the sinuses, typically obtained only after maximal medical therapy has failed. This imaging allows the physician to visualize the internal anatomy and the extent of the disease, looking for blocked drainage pathways and mucosal thickening. The CT scan must show objective signs of disease, such as irreversible mucosal thickening or complete opacification, confirming persistent inflammation.
Structural issues that physically block drainage, such as extensive nasal polyps, a severely deviated septum, or specific anatomical variants, are strong indicators for surgery. The recommendation for surgery is made when persistent, objective findings on imaging and physical examination are coupled with the patient’s continued poor quality of life despite adherence to the full medical regimen.
Overview of Common Sinus Procedures
The most established surgical method for chronic sinus disease is Functional Endoscopic Sinus Surgery (FESS). This procedure uses small instruments and an endoscope to access the sinus cavities through the nostrils without external incisions. The main goal of FESS is to widen the natural drainage openings (ostia) and remove physical obstructions like diseased tissue, bone, or polyps. Enlarging these pathways restores proper ventilation and allows medicated rinses to reach the inflamed sinus lining more effectively.
A newer, less invasive option is balloon sinuplasty, suitable for patients with less severe or localized disease. This technique involves inserting a small balloon catheter into the sinus opening and inflating it to gently expand the passage. Unlike FESS, balloon sinuplasty does not involve cutting or removing bone and tissue, resulting in a faster recovery. The choice depends on the specific diagnosis, the severity of the obstruction, and whether structural issues like large polyps need removal.
Recovery and Long-Term Post-Surgical Management
Following sinus surgery, patients typically experience discomfort, congestion, and bloody drainage, similar to a severe cold. Patients may require several days to a week off work. It is advised to avoid strenuous activities, heavy lifting, and forcefully blowing the nose for at least one week to prevent bleeding. The full internal healing process takes four to six weeks, or longer for those with extensive disease or polyps.
Immediate and consistent use of saline nasal irrigations, often starting the day after the procedure, is essential post-operatively. These rinses clear out crusting, mucus, and dried blood, promoting faster healing and preventing scar tissue formation. Patients will have follow-up visits for endoscopic checks and debridement, which involves removing debris or scar tissue to ensure pathways remain clear. While surgery improves sinus mechanics, it does not cure the underlying inflammatory tendency, meaning long-term maintenance with nasal sprays is often necessary to sustain results.