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Sinusitis: Should I Have Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Sinusitis: Should I Have Surgery?
Get the facts
- Have surgery to treat long-term (chronic) sinusitis.
- Don't have surgery. Take medicines and use home treatment.
Key points to remember
- Very few people need surgery for sinusitis. Most people can treat the problem with home care and medicines.
- Surgery may be a good choice for people who have long-term (chronic) sinusitis. They may get one infection after another because something blocks the flow of mucus from the sinuses or because of another health problem. Surgery can remove blockages and make the sinus openings bigger. This helps the sinuses drain, preventing more infections.
- To be sure that surgery is a good choice, you need to have a CT scan of your sinuses. This test will be done after you have followed what's called "maximum medical treatment" for 4 to 6 weeks. This means that you take medicines and follow home treatment to reduce infection and swelling. That helps your doctor see what's causing your infections.
- You may need more than one surgery to fix your sinuses.
- After surgery, you still may need to take medicines, such as antibiotics, and follow home treatment for a long time.
- If you get chronic sinusitis because of allergies or another problem, you need to get that problem under control before you have surgery. You will have better results from surgery if you use medicine and home treatment after surgery to help to keep that problem under control.
When a mucous membrane gets inflamed, it swells. This can block the normal flow of fluid from the sinuses into the nose and throat. Bacteria and fungi (plural of fungus) are more likely to grow and cause an infection in sinuses that can't drain.
The main cause of sinusitis is a viral infection, usually a cold. Allergies or other problems 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 have had more than three sinus infections in 1 year that needed antibiotics to clear up, OR
- You have had a sinus infection for more than 12 weeks that antibiotics have not cleared up.
Surgery may be a good choice for some people who have chronic sinusitis.
Surgery helps the sinuses drain, preventing 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 for certain serious problems—such as pus in a sinus, infection of the facial bones, or a brain abscess. The doctor makes an opening into the sinus from inside the mouth or through the skin of the face.
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 prescribe:
- Antibiotics to help fight infection.
- Steroid nasal spray to reduce inflammation and help you heal.
- Pain medicine.
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, such as nasal polyps, 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 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, which can prevent sinus infections.
- Improve your sense of smell. (But in some cases, scarring from surgery could decrease your sense of smell.)
Endoscopic surgery improves symptoms for about 90 out of 100 people. About 10 out of 100 people find that it doesn't help them.1
Surgery has the best chance of working if you use a steroid nasal spray and do home treatment after surgery to prevent future infections. You may need to use these treatments for a long time.
Sinus surgery can lead to minor or serious problems.
- A small number of people have
minor problems, such as:
- Scar tissue.
- A hole in the tissue between the nostrils (nasal septum).
- 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.
- The surgery might not work, so you could need a second surgery.
Most of the time, you can treat your sinus problem with home care and medicines.
- Drink plenty of fluids to help keep the mucus thin.
- Hold a warm, damp towel or a warm gel pack to your face for 5 to 10 minutes several times a day.
- Breathe warm, moist air from 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.
- Use saltwater nasal drops or washes to help keep your nasal passages open and to wash out mucus and bacteria. You can buy saline nose drops or saline nasal washes (such as a Neti Pot) at a drugstore or grocery store, or you can make your own at home. If you make your own saline at home, use distilled water or water that has been boiled and then cooled. You may also find it helpful to gargle with warm salt water.
- If you need to blow your nose, do it gently. Blowing your nose too hard may force thick mucus back into your sinuses. Keep both nostrils open when you blow your nose.
- Take pain relievers, such as acetaminophen or ibuprofen, that you can buy without a prescription.
- Use decongestants to reduce the swelling of the mucous membranes. Before you use these medicines, check the label. They may not be safe for young children or for people who have certain health problems. Be careful when using some spray decongestants. They usually shouldn't be used for more than about 3 days, because they can cause more swelling of the mucous membranes after the medicine wears off.
- Take antibiotics as directed, if your doctor prescribes them. Antibiotics can treat most short-term (acute) sinusitis when it is caused by bacteria.
- Use steroid nasal sprays to reduce inflammation in the nasal passages.
- Use mucolytics (such as guaifenesin) to thin the mucus in your sinuses.
Your doctor might advise you to have surgery if:
- You have many sinus infections that need treatment with antibiotics.
- Home treatment doesn't stop your pain and other symptoms.
- You've taken medicines and done home treatment for 4 to 6 weeks, and tests show that you have a sinus problem that surgery can fix.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You may be asleep. Or the doctor may numb the area (like at the dentist) and give you medicine to make you sleepy.
- You may have some packing in your nose after surgery. Some types dissolve on their own. Gauze packing will need to be removed a few days after surgery.
- You still need to take antibiotics and use steroid sprays after surgery to prevent infection.
- You may have to sleep with your head raised for a few days.
- You can't bend forward for a few days after surgery.
- It may clear up your sinus pain and pressure.
- Endoscopic surgery improves symptoms in about 90 out of 100 people.1
- You may get rid of bad breath caused by sinus infections.
- You may have some pain and bleeding for 2 weeks after surgery.
- You could have less sense of smell after surgery.
- Serious but rare risks can include heavy bleeding, meningitis, and brain injury. But these happen in less than 1 out of 100 sinus surgeries. That means they don't happen more than 99 times out of 100.2
- Surgery might not work. About 10 out of 100 people find that it doesn't help.1
- You could need to have another surgery.
- You take antibiotics for a bacterial infection.
- You use steroid nasal sprays, decongestants, and over-the-counter pain medicines.
- You do other self-care, such as washing your nasal passages with saline, putting a warm cloth on your face, and blowing your nose gently.
- Home care may get rid of your sinus infections.
- Antibiotics are effective for bacterial infections.
- You don't have the risks of surgery.
- You don't have the pain of surgery or need to deal with follow-up care.
- You can decide later to have surgery if home care doesn't help you enough.
- Home care might not get rid of your sinus problem.
- Antibiotics don't work for viral infections and don't work for all types of bacterial infections.
- It won't fix certain serious problems, such as an infection in the bones of your face or a brain abscess.
- Antibiotics can cause side effects, which may include allergic reaction, nausea, and diarrhea.
- Steroid nasal sprays can cause side effects, which may include a burning feeling in the nose and nosebleeds.
- Spray decongestants can make congestion worse if you use them for more than 3 days.
Personal stories about choosing surgery for sinusitis
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have had one sinus infection after another for the better part of a year. I've been taking antibiotics and using steroids and decongestant nasal sprays for a month now with no results. My doctor just did a CT scan and found out that one of my sinuses is blocked. He says he can fix it with surgery.
Pete, age 43
I've had a couple of bouts of sinusitis this year, so I asked my doctor about sinus surgery. She said there are some stronger antibiotics and other treatments I should try. I agree that it's better to try the medicines.
Misti, age 32
My doctor fired all the medicines at this infection that she could, and I took them just the way she told me to, but nothing seemed to work. After she looked at my CT scan, my doctor thinks what I've got may be a fungal infection. That would explain why the antibiotics I've tried haven't helped. I hate the idea of having the surgery, but I have tried everything else.
Marona, age 54
I have pretty bad sinusitis, and I've had it a few times over the years. The last time I got it, my doctor prescribed antibiotics and showed me how to wash out my sinuses with salt water, and that worked. I'm going to try that again, and my doctor says there are some other things we can try, too, like nasal sprays and allergy medicines.
Jonathan, age 29
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have sinus surgery
Reasons to use home treatment
I want to do everything I can to stop my sinus infections.
I want to avoid surgery if at all possible.
I'm not afraid of the risks of surgery.
I don't want to take any chance on problems from surgery.
The pain and pressure in my sinuses is making me miserable.
I can control the pain and pressure with medicines.
I'm tired of not breathing well.
I can still breathe well.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
What else do you need to make your decision?
Check the facts
Do most people need surgery to treat sinusitis?
- YesSorry, that's not right. Very few people need surgery. Medicines and home care usually are enough.
- NoThat's right. Very few people need surgery. Medicines and home care usually are enough.
- I'm not sureIt may help to go back and read "Get the Facts." Very few people need surgery. Medicines and home care usually are enough.
Do you need to try several weeks of medicines and other treatment before you and you doctor decide about surgery?
- YesThat's right. You need to follow your doctor's plan of medicine and other treatment for 4 to 6 weeks. This treatment can reduce swelling so your doctor can see what is causing your sinus infections.
- NoThat's not right. You need to follow your doctor's plan of medicine and other treatment for 4 to 6 weeks. This treatment can reduce swelling so your doctor can see what is causing your sinus infections.
- I'm not sureIt may help to go back and read "Get the Facts." You need medicine and home treatment for 4 to 6 weeks. This will reduce swelling so your doctor can see what is causing your sinus infections.
Will you probably still have to take medicines and use nasal sprays after surgery?
- YesYou're right. You may still have to take antibiotics and use steroid nasal sprays after surgery. They can help you heal and fight infection.
- NoSorry, that's not right. You may still have to take antibiotics and use steroid nasal sprays after surgery. They can help you heal and fight infection.
- I'm not sureIt may help to go back and read "Get the Facts." You may still have to take antibiotics and use steroid nasal sprays after surgery. They can help you heal and fight infection.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Patrice Burgess, MD - Family Medicine|
|Specialist Medical Reviewer||Donald R. Mintz, MD - Otolaryngology|
- Suh JD, Chiu AG (2012). Acute and chronic sinusitis. In AK Lalwani, ed., Current Diagnosis and Treatment Otolaryngology Head and Neck Surgery, 3rd ed., pp. 291–301. New York: McGraw-Hill.
- Joint Council of Allergy, Asthma, and Immunology (2005). The diagnosis and management of sinusitis: A practice parameter update. Journal of Allergy and Clinical Immunology, 116(6 Suppl): S13–S47.