Surgery will be suggested by your doctor when "maximal medical treatment " has failed. By maximal medical treatment we refer to adequate and different types of therapy with medicines that proved their efficacy on chronic (rhino)sinusitis on large clinical trials. Surgery is also the preferred treatment for chronic fungal sinusitis, complicated sinusitis and mucoceles (encapsulated collection of secretions).
The standard procedure is functional endoscopic sinus surgery or FESS. The goal for every patient who gets operated for chronic (rhino)sinusitis is to remove the disease in key areas, to restore adequate aeration and drainage of the sinuses, to remove nasal polyps if it is present, and overall to protect normal nasal functioning.
Yes, chronic (rhino)sinusitis does not exclude the presence of other anatomic mainly deformities in the nose. Septal deviation, nostril problems can add burden to a patient with chronic (rhino)sinusitis by interfering with nasal airflow. Addressing these problems with functional nose surgery may significantly alleviate patient's nasal obstruction. Another benefit from functional nose surgery is that correction of anatomic variants can lead to sinus drainage improvement.
Pain in the post-surgical period is very uncommon and it is considered a sign of persistent inflammation. However, every patient is different and depending on the extent of your surgery, the usage and type of nasal sponge, that is used to prevent or control bleedings inside the nose, you may experience some discomfort, congestion and headache during the early recovery period. In such case, your doctor will prescribe painkillers for the first few days.
Sinus surgery is a challenging procedure and despite the availability of new instrumentation, complications during surgery may still occur. The major complications include bleeding, intracranial injury (inside the skull), and visual disturbances. Examples of minor complications include effusion of blood around the eye ('blue eye') or redness of the skin around the eye, watery eyes, scar formation inside the nose and persistence of the disease.
In general, we tend to be much more conservative when treating children than adults with chronic (rhino)sinusitis. Sinus surgery during childhood is preserved for really serious conditions such as persistent disease in patients with cystic fibrosis as well as orbital (eye) and intracranial (inside the skull) complications.
We do not always recommend sinus surgery to our patients. Chronic (rhino)sinusitis is a chronic inflammatory disease that is treated with drugs that reduce inflammation. Sinus surgery is generally suggested for chronic (rhino)sinusitis patients with persistent symptoms in whom medical therapy has failed. Surgery is also the preferred treatment for chronic fungal sinusitis, complicated sinusitis and mucoceles (encapsulated collection of secretions).
Treating symptoms of chronic (rhino)sinusitis by surgery can improve symptoms of asthma, as the inflammation of your sinuses (upper airways) and the inflammation of your lungs (lower airways) are related.
The best post-operative care after a sinus surgery is intensive and frequent rinsing of the nose and sinuses with large amounts (at least 250 mL per time) of saline water and (re-)starting your nasal medication. You will also see your ear-nose-throat (ENT)-doctor more frequently during the first weeks to months after sinus surgery. These extra visits are used for cleaning your nose and sinuses for example of blood crusts and giving extra care if necessary.
It is very important that you (re-)start your usual medication after surgery. Surgery will not cure the chronic disease of your mucosa and without restarting medication your symptoms will soon return after surgery.
Most nasal symptoms improve after sinus surgery. Recovery from sinus surgery is individual and depends on your health and type of procedure, but most people need to be away from work or school for several days. Once your nose and sinuses are healed, you should be able to resume your normal activity level. You will have some swelling and soreness inside your nose after the surgery, but this is normal. Likely your doctor may recommend nasal rinsing with saline to manage your symptoms after surgery.
Sinus surgery offers a significant improvement of patient's quality of life. In particular, sinus surgery will relieve most of your symptoms that are attributable to chronic (rhino)sinusitis such as nose obstruction, runny nose, postnasal drip (nasal secretions in the throat) and facial pain. The effects of surgery on reduced smell vary strongly between patients and depends on the extent of the disease. Surgery is also expected to improve patient's sleep quality, work performance and daytime fatigue.
Since chronic (rhino)sinusitis is a chronic inflammatory disease surgery cannot free you from the disease forever. Even after sinus surgery continuous medical treatment is necessary for lifetime since asymptomatic disease persists. Additionally, in approximately 20% of patients undergoing surgery, symptoms will recur and revision surgery might be indicated.
Approximately 20% of operated patients respond insufficiently to sinus surgery and revision surgey might be required. Negative predictors related to an increased risk of revision surgery are asthma, aspirin intolerance, cystic fibrosis, extensive nasal polyps, smoking and occupational exposures to respiratory irritants. Data on the role of allergy on outcome of sinus surgery are contradictory.
It has been reported in scientific papers that in approximately 20% of patients undergoing surgery, symptoms will recur. Patients with asthma, sinusitis where the upper (frontal) sinuses are affected, aspirin-exacerbated respiratory disease (AERD) and exposure to occupational agents have been connected with poorer surgical outcomes. Doctor's surgical skills and extent of surgery can also significantly affect the outcome. Post-operative care is just as critical as pre-operative assessment and techniques used during surgery. Patients must be prepared to meticoulesly rinse the nasal cavity with saline solutions and use nasal corticosteroid sprays.
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