Sinus surgery is usually an elective procedure that is scheduled in advance. The goal of most sinus surgery is to improve a patient’s quality of life. In some rare cases, sinus problems can be life threatening and a surgical emergency. Examples include sinus infections that have spread to surrounding structures, such as the eye or brain.
In most cases, however, you have plenty of time to decide whether you should undergo surgery. If a physician recommends sinus surgery immediately without a history of trying other options, this should raise a red flag. The vast majority of my patients have tried and failed multiple medical therapies prior to considering surgery.
I often first prescribe topical intranasal steroids and saline irrigations. Oral steroids and antibiotics can also be used occasionally. I frequently order allergy testing such as skin prick and/or RAST testing. If testing is positive, we try allergen reduction and avoidance, antihistamines or other allergy medications. For patients with severe or recalcitrant allergies, subcutaneous or sublingual immunotherapy may be a great option.
If there are persistent symptoms despite trying medical therapy, my next step is usually ordering a CT scan. If a CT scan shows sinus blockages or other anatomic findings, I offer sinus surgery as an option. In some rare cases (in cases of an entity called recurrent acute sinusitis), I consider sinus surgery with a negative CT scan.
It is important to note that even if a CT scan shows sinus blockages, that does not mean you should have surgery. I often tell people that despite what the imaging shows, if your sinus and nasal symptoms are relatively mild and not disruptive to your overall quality of life, it is probably not worth undergoing sinus surgery. Another alternative to traditional sinus surgery is in-office sinus procedures. My extensive experience with advanced in-office sinus procedures (including polypectomy, maxillary antrostomy, and partial ethmoidectomy) makes my practice unique. The advantage of this option is the avoidance of general anesthesia. However, this approach is usually less aggressive than traditional sinus surgery. I usually reserve this as an alternative for patients with milder sinus issues, or for patients that cannot undergo general anesthesia.
As you can see, there are multiple options to consider prior to undergoing sinus surgery. The majority of my patients are treated with medications and allergy therapy. Only the minority undergo traditional surgery. While sinus surgery has a very high success rate, it does not address underlying allergies, nor is it a replacement for medical therapy in the future. Furthermore, though the risks are very low, there are rare complications to sinus surgery. Consequently, I am conservative and methodical prior to offering sinus surgery as an option to my patients. There is almost never a rush to get sinus surgery, so explore all your options and take your time before you decide!