20. When is surgery necessary for patients with sinus problems?
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Peter Hwang, M.D.
Associate Professor and Director
Stanford Sinus Center Stanford, CA
Most patients with sinusitis can be successfully managed using a variety of medications (see #3). However, patients who do not respond to extended courses of broad medical therapy may possibly benefit from surgery. The decision to proceed with surgery is based on several factors, including severity of symptoms, CT scan findings, general health of the patient, and the clinical judgment of the doctor.
sinus-faq20-drmcgraw Becky L McGraw-Wall, M.D. Houston, TX
The first step in managing sinusitis and nasal polyps is medical treatment with adequate antibiotic coverage, decongestants, mucolytics, and nasal or systemic steroids patients who have persistent, chronic or recurrent sinus infections or nasal polyps, despite attempts at appropriate medical management, may be candidates for sinus surgery.
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Todd Kingdom, M.D. Denver, CO
This is a question that cannot be effectively answered in this short communication. Many indications and patient conditions may be treated by sinus surgery. Generally speaking, chronic infection of the sinus cavities that will not resolve with aggressive medical therapy is the most frequent indication for sinus surgery. This description may include patients with symptoms for 3-6 months or for years. It may also apply to a patient who experiences frequent sinus infections each year (recurrent rhinosinusitis). Other common indications for nasal and sinus surgery include obstructed nasal breathing with or without sinus infections. Nasal polyp formation and anatomic deformities (deviated septum or turbinate enlargement) are some of the more common conditions in this group. Overall, medical therapy is the primary and front-line method for treating most sinus problems. Surgery is reserved for those conditions when medical therapy fails. However, sinus surgery may not be curative and additional medical therapy after surgery is often required.
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Berrylin J. Ferguson, M.D. Pittsburgh, PA
Surgery is necessary if the patient's symptoms cannot be alleviated with medical therapy. Usually this means the patient will have tried a nasal steroid spray and have had an allergy evaluation. If the patient is being treated for infectious sinusitis a culture should be obtained so that the patient can be placed on antibiotics directed by the culture findings. Rarely is surgery necessary for a diagnosis.
Becky L McGraw-Wall, M.D.
