Surgery

The goal of surgery is to make drainage of the sinuses better, usually by removing the blockage and draining the mucus. This may mean removing:

• Infected, swollen, or damaged tissue.
• Bone, to create a wider opening for drainage of mucus from the sinuses.
• Growths (polyps) inside the nose or sinuses.
• A foreign object that is blocking a nasal or sinus passage. This usually occurs in children.

Surgery may be the only means of getting a badly blocked, infected sinus to drain properly. But surgery does not always completely eliminate sinusitis. Some people may need a second operation.

Surgery is most successful when used along with medicine and home treatment to prevent future sinusitis. A second surgery and future sinusitis may be avoided if antibiotics are taken to prevent reinfection.

For more information on when surgery is a good choice, see:

Sinusitis: Should I Have Surgery?

Surgery choices

Endoscopic surgery is preferred over traditional surgery for most cases of chronic sinusitis that require surgery. It is less invasive, less expensive, and has a lower rate of complications.

Endoscopic surgery may be done to remove small amounts of bone or other material blocking the sinus openings or to remove growths (polyps). Normally, a thin, lighted tool called an endoscope is inserted through the nose so the doctor can see and remove whatever is blocking the sinuses.

Traditional surgery may be done when complications of sinusitis—such as the development of pus in a sinus, infection of the facial bones, or brain abscess—have occurred. In this type of surgery, the doctor makes an opening into the sinus from inside the mouth or through the skin of the face.

What to think about

Very few people need surgery to treat sinusitis. But you may need surgery if ALL of these are true:

• Your doctor says that you have chronic sinusitis.
• You've followed what's called "maximum medical treatment" for 4 to 6 weeks. This means that you've taken medicines and followed home treatment for at least 4 to 6 weeks. This treatment includes antibiotics, a steroid nasal spray, and other prescription medicines.
• You've had a CT scan of your sinuses after the 4 to 6 weeks of treatment. It is very important to have the CT scan done after this treatment. Reducing the swelling and infection as much as possible lets your doctor see what could be causing your infections.
• The CT scan shows that something is keeping your sinuses from draining as they should.

You also may need surgery if:

• You have a sinus infection caused by a fungus. Infections caused by fungus cannot be cleared up with antibiotics.
• You have a serious problem such as an infection that spreads beyond your sinuses. This is rare.

The extent of the blockage and other problems determine how extensive your surgery will need to be. Surgery may be limited to removal of infected tissue or small growths (polyps) inside the nose. More extensive surgery involves removing pieces of bone to create a wider opening to allow a sinus to drain.

Sinus surgery is always performed by an ear, nose, and throat (ENT) specialist (also called an otolaryngologist).