sinusitis: should i have surgery?

sinusitis is an inflammation of the mucous membrane inside the nose and sinuses. sinuses are the hollow spaces in your skull around the eyes and nose.

when the mucous membranes get inflamed, they swell and make more mucus. this can block the normal flow of fluid from the sinuses into the nose and throat. bacteria and viruses are more likely to grow and cause an infection in sinuses that can't drain.

allergies and nasal polyps also can block the nasal passages and lead to sinusitis.

there are two types of sinusitis: acute (short-term) and chronic (long-term). you may have chronic sinusitis if:

• you've had at least two of the following four symptoms for at least 12 weeks: a stuffy or blocked nose, pain or pressure in the head and face, thickened and discoloured nasal drainage, or a reduced sense of smell.

and

• you have signs of inflammation in your sinuses when the doctor looks at them or when a ct scan shows that they are inflamed.

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

surgery helps the sinuses drain, preventing symptoms and infections. the doctor usually makes the sinus openings bigger by removing:

• infected, swollen, or damaged tissue.
• bone, to make a wider opening to let mucus drain from the sinuses.
• growths (polyps) inside the nose or sinuses.

there are two types of sinus surgery:

• endoscopic surgery is the type that is done most often. the doctor puts a thin, lighted tool called an endoscope in the nose to remove small amounts of bone or tissue that block the sinus openings. the doctor also can remove polyps.
• traditional surgery may be done in rare cases. the doctor makes an opening into the sinus from inside the mouth or through the skin of the face. this surgery may be done if you've had several endoscopic surgeries and are still having symptoms, if you have a sinus tumour, or if your doctor thinks it's necessary because of your sinus structure and symptoms.

sometimes another problem inside the nose (such as a deviated septum) also needs to be fixed. this may be done during the same surgery.

after surgery, the doctor may recommend:

• a steroid nasal spray to reduce inflammation and help you heal.
• pain medicine.
• antibiotics to help fight infection.

here are some reasons your doctor might suggest sinus surgery as the next step:

• your doctor says that you have chronic sinusitis. and you've taken medicines and followed home treatment, but your symptoms have not gone away.
• the ct scan shows that something, such as nasal polyps, is keeping your sinuses from draining as they should.
• you have a sinus infection caused by a fungus. infections caused by fungi cannot be cleared up with antibiotics.
• you have a serious problem such as an infection that spreads beyond your sinuses. this is rare.

sinus surgery can:

• help your sinuses drain. this can relieve symptoms such as a stuffy or blocked nose, pain, and pressure.
• improve your sense of smell. (but in some cases, scarring from surgery could decrease your sense of smell.)

endoscopic surgery may improve symptoms in people who have not been helped by medical therapy alone.^{footnote 1}

surgery has the best chance of working if you do home treatment and go to all of your follow-up appointments. you will likely need to use home treatments for a long time to help keep your sinuses healthy.

sinus surgery can lead to problems.

• a small number of people have problems such as:
  • scar tissue.
  • bleeding.
  • infection.
  • a reduced sense of smell for a while.
  • bruising and swelling around the eyes.

• serious but rare problems can include:
  • heavy bleeding.
  • injury to the eye area.
  • inflammation of the tissue that covers the brain (meningitis).
  • leakage of the fluid around the brain.
  • brain injury.
• scarring from surgery could decrease your sense of smell forever.
• the surgery might not work, so you could need another surgery.

most of the time, you can treat your sinus problem with home care and medicines.

home treatment

• use saline (saltwater) nasal washes. this helps keep your nasal passages open. it also can wash out mucus and allergens. you can buy saline nasal washes (such as a neti pot) at a drugstore or grocery store, or you can make your own at home.
• drink plenty of fluids to help keep the mucus thin.
• do not smoke. smoking can make your symptoms worse. if you need help quitting, talk to your doctor about stop-smoking programs and medicine. these can increase your chances of quitting for good.
• breathe warm, moist air. you can use a steamy shower, a hot bath, or a sink filled with hot water. avoid very cool, dry air. a humidifier can add moisture to the air in your home. follow the directions for cleaning the machine.

medicines

• use a steroid nasal spray to reduce the swelling of the mucous membranes.
• take allergy medicines. they may be used to treat nasal allergies (allergic rhinitis) or nasal polyps.
• take pain relievers if needed, such as acetaminophen or ibuprofen, that you can buy without a prescription.
• take antibiotics as directed, if your doctor prescribes them. antibiotics can treat most short-term (acute) sinusitis when it is caused by bacteria.

be safe with medicines. read and follow all instructions on the label. some medicines may not be safe for young children or for people who have certain health problems.