Young man with pain in his sinus touching the bridge of his nose.

Surgery can significantly improve quality of life for patients suffering from nonstop sinus issues.

Sinus problems — including nasal congestion, facial pressure, fatigue and headaches — impact everyone from time to time. But for many patients, these symptoms may persist for months without end. 

According to the Centers for Disease Control and Prevention, and research published in the journal Otolaryngology – Head and Neck Surgery, tens of millions of American adults are living with chronic rhinosinusitis or sinusitis.

Surgery can be a positive option for patients if medical treatments haven’t brought relief, says Bozena Wrobel, MD, an otolaryngologist with the USC Caruso Department of Otolaryngology – Head and Neck Surgery, part of Keck Medicine of USC, who specializes in advanced procedures to treat chronic sinonasal problems. 

“Patients should understand that although surgery is not curative for chronic rhinosinusitis, it allows us to treat this inflammatory problem more effectively, and it can significantly improve quality of life,“ Dr. Wrobel says. 

What is chronic rhinosinusitis? 

Chronic sinusitis refers specifically to inflammation of the sinuses, and chronic rhinosinusitis includes inflammation of the nasal cavity. “This is not just a disease in the sinuses, but it’s also in the nose,” Dr. Wrobel explains. “It’s multifactorial, with a lot of different presentations.”

Symptoms of chronic rhinosinusitis include:

Nasal obstruction or congestion
Anterior or posterior drainage 
Decreased sense of smell
Facial pressure or pain
Fatigue

Patients may be diagnosed with chronic sinusitis or rhinosinusitis if they have experienced symptoms for at least 12 weeks straight without relief.

Who is eligible for sinus surgery?

Dr. Wrobel emphasizes that for patients with mild or moderate symptoms, medical treatments may include saline rinses, antibiotics, anti-inflammatory medications, topical and systemic steroids and antihistamines if the patient also has allergies.

“If a patient has tried these things and quality of life is still decreased, then surgery becomes an option,” Dr. Wrobel says. “And patients with severe symptoms are definitely good candidates for sinus surgery.”

To determine whether to proceed with a surgery, patients first undergo a nasal endoscopy to evaluate structural issues like a deviated septum or enlarged turbinates (small structures in the naval cavity) to assess any degree of inflammation, swelling of the sinonasal membranes or to look for polyps. “Polyps look like teardrops in the nose,” Dr. Wrobel says, “and can be the reason why patients are feeling obstruction, facial pressure or a decreased sense of smell.” 

The second test is a CT scan, which allows specialists to see whether the sinus cavities have thickened tissue, polyps present or are filled with mucus, or whether they are draining properly or are blocked by a disease process. “The CT scan plays a very important role in the diagnosis of chronic rhinosinusitis and making decisions about whether a patient is a candidate for surgery,” Dr. Wrobel says.

What are the sinus surgery options at Keck Medicine?

The degree of surgery recommended is always tailored to the patient’s unique disease, Dr. Wrobel says. As part of Keck Medicine, the USC Caruso Department of Otolaryngology – Head and Neck Surgery offers a range of sinus surgery types to treat both moderate and advanced diseases, all of which are minimally invasive and involve endoscopes inserted into the nostrils:

Balloon sinuplasty

This is the least complex surgical option. The provider inserts and then inflates a balloon into the sinus cavity, which permanently enlarges the sinus openings and makes it easier for mucus to drain. A balloon sinuplasty is best for mild cases and patients without nasal polyps.

Functional endoscopic sinus surgery

This surgery involves widening and clearing the patient’s natural drainage pathways. The provider removes polyps, tissue and bone that are blocking the sinus openings. 

Lothrop procedure

The modified endoscopic Lothrop procedure is an advanced, highly specialized surgery to treat patients with severe rhinosinusitis symptoms for whom more traditional sinus surgery has failed, specifically to address frontal sinus disease. “It’s a drill-out procedure where we connect the two frontal sinuses to create one bigger drainage pathway,” Dr. Wrobel explains. 

Endoscopic medial maxillectomy

An endoscopic medial maxillectomy is reserved for the most severe cases affecting the maxillary sinuses (the area behind the cheeks) in patients with conditions such as odontogenic sinusitis, allergic fungal sinusitis or cystic fibrosis, Dr. Wrobel says. It’s also used to remove tumors from the maxillary sinuses. 

“At the USC Caruso Department of Otolaryngology – Head and Neck Surgery, we are fellowship-trained surgeons specialized in advanced frontal sinus surgeries,” Dr. Wrobel says. “Sinus surgery is very safe, with less than 1% of patients experiencing complications. And in the hands of an experienced surgeon, the risk is even lower.”

How is recovery after sinus surgery?

Patients who undergo more complex procedures may stay one night in the hospital for observation, but the majority of endoscopic sinus surgery patients go home the same day. Some patients may experience a decrease in smell, although in most patients this is only temporary as the sinuses heal.

Dr. Wrobel says sinus surgery is not painful but that patients can expect to feel fatigued with difficulty concentrating for a few days. She instructs patients to do a saline nasal rinse four to six times per day for the first three weeks after surgery in order to clear mucus or dried blood from the nasal passages.

Patients should avoid aggressively blowing their nose for the first three weeks to prevent bleeding. Patients are also encouraged to sleep with their head elevated to relieve drainage. 

Dr. Wrobel adds that while patients with preexisting migraine issues may experience headaches for a short time following surgery, sinus procedures don’t cause new headache issues.

Patients can expect to fully recover within six weeks.

Is sinus surgery worth it?

The National Institutes of Health calls endoscopic sinus surgery the “gold standard” for treating chronic rhinosinusitis when medical therapy hasn’t worked. Dr. Wrobel describes living with chronic rhinosinusitis like having the flu all the time and says that sinus surgery is proven to help.

“Sinus surgery has an incredible success rate,” she says. “Research has shown it can alter the trajectory of asthma or even prevent asthma in some patients. Surgery also allows us to treat sinus disease with less-harmful medications. While the patient still has the underlying disease, surgery can make living with it much more manageable.”

Home

When Is Surgery a Good Option for Chronic Sinus Problems?