Do I Need Sinus Surgery?

Michael T. Cecil, MD, FACS, Lexington Clinic Otolaryngologist

Chronic sinusitis is a very common illness in the United States. Approximately 1 in 5 antibiotics that are prescribed in adults are for sinusitis. Chronic sinusitis is defined as persistent inflammation in the sinuses of at least 12 weeks duration. Symptoms typically include thick discolored drainage, nasal obstruction, facial pain/pressure and decreased sense of smell. Other symptoms may include fever, bad breath, dental pain and headache. Some of these symptoms can also be seen with allergic rhinitis; however, this is usually associated with clear nasal drainage as well as sneezing and itching.

Typically, a diagnosis of chronic sinusitis is made by reviewing a patient's history, as well as a physical examination including a nasal endoscopy. This requires placing a thin scope in each nasal cavity after spraying the nasal linings with a topical anesthetic agent. It is a relatively painless procedure that is done in the office. A CT scan of the sinuses is often required as well to evaluate for inflammation in the sinus cavities.

Treatment of chronic sinusitis typically includes using a several week course of an antibiotic along with a nasal steroid spray and nasal saline irrigations. Sometimes, oral steroids are used as well. In certain instances, this medical therapy is not effective. Cases that do not respond to maximal medical therapy are then considered for Endoscopic Sinus Surgery (ESS).

ESS is performed under general anesthesia in the operating room as an outpatient procedure. It is performed by placing rigid telescopes in the nasal cavities to project an image on a monitor which magnifies the surgical field. Instruments are then placed in the nasal cavities alongside the telescopes to open the sinus cavities and allow the infection to drain more properly. It is very important to continue medical therapy for several weeks after ESS since antibiotics are still required to clear the chronic infection. Most patients respond very well to this intervention and are typically back to work within a week.