Sinusitis is a condition that affects millions of people in the US every year. An acute bacterial sinusitis lasts four weeks or less and can be treated by the use of basic medication such as saline nasal spray, nasal corticosteroids, decongestants, and antibiotics. Recurrent acute sinus infections (more than 3 per year) or a chronic sinus infections (lasting 3 months or longer despite antibiotic and steroid treatment) may even require surgery. Here is a list of signs that will tell you when it is time for you to consider surgery.
Signs you need sinusitis surgery
Chronic Persistent Sinus Problems
When one or more of your sinuses develop a bacterial infection that won't easily respond to medication and remains inflamed for a period greater than 60-90 days, you have a condition referred to as Chronic Sinusitis. Patients usually visit specialists when the infection has reached a stage where treating it by the usual remedies for treating sinusitis is no longer useful. A specialist will use a more aggressive medical therapy and evaluation process that includes - bacterial cultures to look for resistant bacteria, prolonged broad spectrum antibiotics, radiologic studies that may include CT scans of the sinuses, and endoscopic examination of the nasal passages and sinus openings, and more, before considering surgery as the next logical step.
Acute Recurrent Sinus Infections
While there is no official frequency of infections that can tell you when surgery is needed, here is a rule of thumb that is frequently applied.
- 3-4 or more occurrences of sinusitis infection in the last 12 months
- Presence of anatomic abnormality obstructing normal sinus drainage seen on CT scan
Frequent Headaches of Sinus Origin
Although frequent headaches are one of the most common reasons why people visit sinus specialists, they are not always related to sinusitis. In some cases headaches are due to sinusitis while in other cases the headaches are a result of migraines. In rare cases, underlying migraines can also be exacerbated by underlying sinusitis. While a very obvious and clear source of sinusitis is detectable in some patients, others either do not show any clear signs of headaches of sinus origin.
If the problem is clear, additional medical therapy is considered to take care of the problem and if there are no signs of improvement, surgical options are discussed. The process gets complicated when the cause of the headaches is either not clear or completely undetectable. In such situations medical therapy and other options such as neurologic consultation are tried. If this does not help, it is appropriate to proceed with a surgical intervention.
Airway Obstruction
Specific anatomic abnormalities such as nasal polyps, nasal septal deviations, prominent turbinate hypertrophy, and adenoid hypertrophy that cause nasal airway obstruction are not responsive to medical treatment such as nasal steroids or oral steroids and such abnormalities usually need surgical intervention.
Dangerous Sinus Problems that need Surgery
Patients facing dangerous sinus problems such as the ones mentioned below definitely need surgery.
- Sinus tumors
- A cyst or mucocele eroding bone and separating the brain from the sinuses
- Sinus infections that start spreading beyond the sinuses, into the skull or facial bones
- Spinal fluid leaks that can be related to some type of head injury or previous sinus surgery
Word of advice
Sinusitis complications can get severe if not treated correctly and on time. It is therefore, recommended that if you or any of your loved ones is facing a sinus problem, you must see a sinus specialist immediately. A general ENT while trained in these areas, lacks the expertise for such complicated and dangerous problems that a fellowship certified sinus specialist offers to safely perform these more complex sinus procedures. A fellowship certified sinus specialist offers the full-spectrum of sinus, nasal, and skull base treatments and does all that it takes to get you well again.
