Surgery to open sinuses

Signs You May Need Sinus Surgery

There are several options for treating sinusitis. Treatments include medications, such as decongestants, antihistamines and nasal sprays, as well as flushing the sinuses. Unfortunately, these treatments are not effective for some patients. For individuals with sinusitis that is chronic or unresponsive to traditional treatments, sinus surgery can help. The doctors at the Head and Neck Associates of Orange County perform sinus surgery in Laguna Hills, San Clemente, Irvine and Mission Viejo, CA.

What is Sinusitis?

Sinusitis, also known as a sinus infection, is a condition in which the pathways that help the sinuses drain become blocked or inflamed. When these pathways are inflamed or blocked, then the sinuses cannot drain properly. Individuals who develop sinusitis can experience congestion, sinus headaches and difficulty breathing, among other symptoms. There are a variety of medications available to alleviate the symptoms of sinusitis, including nasal sprays, decongestants, antihistamines and antibiotics. Flushing the sinuses can help, as well.

Unfortunately, medications and flushing techniques do not always provide adequate or long-term relief from sinusitis. When that’s the case, sinus surgery can help. Sinus surgery helps by enlarging the pathways that drain the sinuses. Signs you may need sinus surgery include:

  • The sinusitis is chronic
  • The sinusitis has not improved with nonsurgical treatments
  • Anatomic abnormalities are present in the nasal or sinus passages

Sinus Surgery

Once a doctor has determined that you are a candidate for sinus surgery in Laguna Hills, San Clemente, Irvine or Mission Viejo, there are several options. Two common types of sinus surgery are Functional Endoscopic Sinus Surgery and Balloon Sinus Surgery. The type of sinus surgery performed will depend on your specific diagnosis. Benefits of either type of surgery include immediate and long-lasting relief from sinusitis and a short recovery period. Patients can typically return to normal activity 24 hours after surgery.

Functional endoscopic sinus surgery is performed using a nasal endoscope. The endoscope enables the doctor to see the inside of the sinus pathways. During the procedure, the doctor will clear away any blockages, such as polyps, excess tissue or small bits of bone. Once the procedure is complete, patients can enjoy open, clear sinus passages.

Balloon sinus surgery is performed by inserting a balloon catheter into the sinus pathways. Once the catheter is inside the sinus pathways, the balloon is inflated causing the sinus pathways to expand. A saline solution is sprayed into the expanded sinus pathways to flush out mucus and other debris clogging the sinuses. Once the sinuses are clear, the balloon is deflated and the catheter removed. Afterward, the sinuses remain clear and open with no further problems with sinusitis.

If you suffer from chronic sinusitis that does not improve with other treatments, you might benefit from sinus surgery. The Head and Neck Associates of Orange County offer sinus surgery in Mission Viejo, CA, with additional office locations in Laguna Hills, San Clemente and Irvine. To schedule an appointment or consultation at any of the office locations, call (949) 364-4361.

When Do You Need Sinus Surgery?

More often than not, sinusitis is treated with medicines and a variety of home treatment methods. Some of the medicines used to minimize sinusitis symptoms include:

  • Antibiotics
  • Decongestants
  • Mucolytics, which thin the mucus

How Do I Know If I Need Sinus Surgery?

If you’ve tried different medications and treatment options for a few months and sinusitis symptoms don’t improve, it’s considered chronic sinusitis. Very few people need surgery for sinusitis. However, it may be the best option in the following instances:

  • A CT Scan shows nasal or sinus polyps
  • The patient has sinus cancer
  • The patient’s sinuses have an abnormal structure
  • The sinus infection has spread to the bone

Options for Sinus Surgery

Dr. Kleiman provides in-office Balloon Sinuplasty to patients throughout Severna Park and Annapolis, MD.

The Balloon Sinuplasty procedure provides the following benefits to patients suffering from chronic sinusitis:

  • Patients are anesthetized with local anesthetics as opposed to general anesthesia
  • Shorter recovery time
  • Proven successful outcomes
  • More cost-effective due to avoiding facility fees and anesthesia

Call (410) 544-9988 to find out if you’re a candidate for Balloon Sinuplasty.

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Sinus, sinus surgery, Otolarnygology, Allergies

Newswise — ANN ARBOR, Mich. — It’s not uncommon for doctors to tell patients seeking a second opinion about sinus surgery that they don’t need the procedure, say doctors at the University of Michigan Health System’s Michigan Sinus Center.

Many patients have simply not had a full assessment of their symptoms, and the underlying causes of their sinus troubles have not been identified or treated.

Here are five things everyone should consider before undergoing sinus surgery:

1. “The most common causes of sinus problems are nasal allergies, a deviated or crooked septum and chronic sinusitis, which can be caused by a combination of infection and allergic reaction,” says the Sinus Center’s Mark A Zacharek, M.D., associate professor of otolaryngology at U-M.

This means your doctor needs to do a full evaluation of your symptoms, understand your medical history and attempt to treat any underlying allergies that may be wreaking havoc in your sinuses, before recommending surgery.

(Watch a video of the Michigan Sinus Center doctors discussing sinus surgery at: http://bit.ly/nENe5I.)

2. While your doctor may order a CT scan to get a better picture of what’s going on inside your sinuses, abnormalities are quite common and most don’t require surgery, says the Sinus Center’s Melissa Pynnonen, M.D., associate professor of otolaryngology at U-M.

“Your doctor can’t just look at your CT scan and know that you need sinus surgery,” Pynnonen says. “Your doctor needs to talk with you, evaluate your symptoms and consider a course of medical therapy before considering sinus surgery.”

3. If you have severe headaches, sinus surgery is not likely to help, Pynnonen says. Most often, severe headaches are caused by migraines or other headache conditions.

4. After diagnosing chronic sinusitis, your doctor should offer what is known as “maximal medical treatment,” Zacharek says.

This may include a combination of extended antibiotic treatment, oral steroids, sinus rinses and nasal steroid sprays, he notes.

5. If you have chronic sinusitis that has failed to respond to these medical treatments, then surgery would be a logical next step, says Jeffrey Terrell, M.D., director of the Michigan Sinus Center.

The Michigan Sinus Center is located in Livonia. For more information visit our nose and sinus disorders website at http://www.uofmhealth.org/medical-services/noseandsinus or to make an appointment call 734-936-8051.

More information about sinus care can be found at:http://www.uofmhealth.org/News/sinus-tips-0504

Part 1 of 2 articles

Explore This Issue

August 2009

PHILADELPHIA-Surgeons are faced with many options for approaching diseases of the sinus, and the right approach is not always clear-cut. Five experts reviewed several approaches at Rhinology World held recently here, with some favoring a more aggressive approach, some preferring to be less aggressive, and others highlighting new technology.

FESS: Often a Good Option

Bradley F. Marple, MD, Professor of Otolaryngology at the University of Texas Southwestern Medical School, cited studies to make the case that functional endoscopic sinus surgery (FESS) is a very good option for patients.

Overall, he said, patient satisfaction levels are high. But he noted that mucociliary clearance is only part of the answer and that inflammatory disease can remain. Further management of inflammation is then needed.

Studies show that those with more severe disease enjoy greater relief, which raises the questions of where the bar should be set, when FESS is actually needed, and whether patients get sufficient treatment before surgery is performed.

But there have been few studies comparing the effects of the surgery to other options, he said.

What do we have in terms of comparative data? It’s limited, Dr. Marple said. Endoscopic sinus surgery undeniably provides a broad ability; it’s a very powerful platform to target disease.

In chronic rhinosinusitis, the overwhelming data suggest that patients feel better after sinus surgery. Persistence of some inflammation is present-and that raises the question: Are we really accomplishing what we set out to accomplish at the very beginning by simply opening and ventilating sinuses?

-Bradley F. Marple, MD

Pros and Cons of FESS

Dr. Marple set out to address the advantages of the surgery as well as its drawbacks.

Sinus surgery can relieve obstruction, provide ventilation, and remove or relocate tissue and structures. Surgery fails to primarily address allergies, viral upper respiratory infections, and many kinds of headaches, Dr. Marple said.

The indicators that sinus surgery might be needed are that medical management of chronic rhinosinusitis and recurrent acute rhinosinusitis has failed, when there are complications associated with acute bacterial rhinosinusitis, the presence of mucocele, chronic anterior headache, problems with smelling, neoplasm, and/or cerebrospinal fluid leaks.

Other indicators are association with a dacryocystorhinostomy, orbital decompression, and choanal atresia.

Some of these indicators are up for debate, though, including whether surgery is always needed when treatment fails, whether it is appropriate for chronic anterior headaches that are caused by problems with the anatomy, and whether it is suitable for handling problems with the sense of smell.

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“They put a camera in my sinuses, so that I could see exactly what was going on and exactly what the problem was,” Rebecca says.

More than that, though, they told Rebecca exactly how they would fix it. “They both recommended endoscopic sinus surgery,” Rebecca says. “They went over everything, outlined the pros and cons, and after examining me and looking at my test results, said I’d be a good candidate for it.”

Living and breathing easily again

“When I first saw Rebecca, she was, honestly, pretty miserable,” Dr. Choby says. “She was suffering from severe nasal polyps. Like many other patients with nasal polyps, she also had significant inflammation in her lower airway and her lungs. In combination, these were contributing to her chronic cough, asthma, and decreased senses of smell and taste.”

A CT scan revealed that Rebecca’s sinuses also were blocked completely on both sides. “In light of this, we recommended endoscopic sinus surgery, so that we could not only remove the polyps but also maximally widen her sinus openings,” Dr. Choby says. “This allows for optimal sinus drainage and improved delivery of the topical medications she’d need after surgery, which are one of the most important parts of the surgery from our standpoint.”

“My entire patient experience from start to finish was wonderful, and I now know firsthand why Mayo Clinic was recently named the best hospital in the world.”

Rebecca Bough

Given all she and her loved ones had been through to that point, Rebecca readily agreed to the recommendation and scheduled the surgery with Dr. Choby for the following morning. Once the surgery was complete, Rebecca says it didn’t take long for her to realize she’d made the right decision.

“I felt better immediately after the procedure. Even better, I can now taste food again, my headaches are gone, and my sense of smell is also starting to come back,” Rebecca says. “My entire patient experience from start to finish was wonderful, and I now know firsthand why Mayo Clinic was recently named the best hospital in the world. My only regret is that I didn’t make an appointment sooner.”

  • Learn more about nasal polyps and chronic sinusitis.
  • Check out the Department of Otorhinolaryngology (ENT)/Head and Neck Surgery.
  • Connect with others talking about chronic sinusitis on Mayo Clinic Connect.
  • Explore Mayo Clinic.
  • Request an appointment.

Tags: Chronic sinusitis, Dr. Garret Choby, Dr. Linda Yin, Dr. Vivek Iyer, ENT/Audiology, Nasal Polyps

My Experience With Sinus And Nasal Surgery

Surgery. The word makes most people cringe. I don’t know a single person who jumps with joy when their doctor tells them they need surgery. No matter the type of surgery you may have to undergo, it’s a scary process nonetheless. The “what ifs” cloud your brain, and everything you learned from “Grey’s Anatomy” is finally put to the test. (Either you suddenly feel like you can conquer anything like Dr. Gray, or you start over-reacting and assuming the worst like Dr. Stevens.) While there are potential risks to any surgery, it’s important to note that surgery is, for the most part, better for you in the long run if your doctor does tell you you’re out of options. So, get into your scrubs, and snap on your gloves—it’s time to go under the knife. (If your surgeon happens to resemble Dr. Shepherd, what’s there to complain about?)

I recently (and by recently, I mean last Wednesday) had sinus and nasal surgery. OK, what does that entail? For me, a lot. I have suffered monthly sinus infections and exposed myself to possibly everything under the sun that could be harmful to my poor sinuses. (Literally… I’m allergic to everything. It’s hard to avoid everything when you don’t live in a bubble.) I tried every over-the-counter cold and flu remedy and almost began the dreadful allergy shot once a week before my ENT doctor told me, “Allergy shots will be a waste of your time. You may not see improvements for another three years. Let’s consider surgery.”

*DING DING DING* Surgery. There’s that nuisance of a word.

We discussed it, weighed the pros and cons and scheduled the surgery right away. Since my life seems to be a series of unfortunate events… I had more than one thing done:

1. Functional Endoscopic Sinus Surgery (All eight sinus cavities, four on each side of my face)
2. Septoplasty
3. Turbinate Reduction

I had no clue what those procedures entailed, so instead of copying and pasting medical terminology for you to read and potentially not comprehend, I’ll put it into my own words:

Functional Endoscopic Sinus Surgery was performed to widen all eight of the sinus cavities in my face (Sphenoid sinuses, Frontal sinuses, Ethmoid sinuses and Maxillary sinuses). Basically, all your sinus cavities are little holes. My surgeon went in endoscopically and widened all those little holes to make it harder for them to get clogged when I have a sinus infection in the future.

A Septoplasty was performed to straighten my septum. I don’t know how crooked it was originally, but apparently, it was crooked enough to be surgically corrected, so… Thanks, Doc.

Lastly, a Turbinate Reduction was performed to remove teeny-tiny inferior turbinates in my nose that obstructed my nasal passage. Once again, another procedure done to help me breathe better.

All three of these procedures took place just six minutes shy of three hours. Of course, I looked forward to the amazing sleep I knew I would get thanks to anesthesia. (Honestly, the good sleep and pain meds were what curbed my anxiety and got me through my surgery.) My surgeon told me that the first week would be dedicated to acute recovery, the second week would be hell because I’ll feel like I have an amplified case of sinusitis and then another eight weeks will pass before I’m completely healed. 10 weeks dedicated to recovery… all for some silly, endoscopic procedures.

What scared me the most about this surgery were the people who told me it would be the worst pain of my life. They told me horrible stories of people they knew who had undergone the same procedures. Let me tell you just how WRONG those people were (except for my boyfriend… he told me it would be easy peasy, and I should’ve listened to him). The first two days after surgery were a breeze. I felt pretty damn fantastic because I felt a difference in the way I breathed—I mean, I could actually breathe. Once those first two days passed… eh, I started to feel the pain. The pain wasn’t excruciating, though. The pain was simply uncomfortable. My nose hurt like a b****, and my face was all puffy and tender, but if I had to rate my pain on a scale from 1-10, I’d say my pain remained at a steady four.

What people told me versus what I experienced were two completely different things. *Cue the sarcasm* Thanks for making me freak out over nothing, everyone. You’re all awesome.

My experience with these procedures was a pleasant one: manageable pain, very little facial bruising and excellent care from a compassionate surgical team at Charleston ENT & Allergy.

Surgery doesn’t have to be scary, and you should never undergo a surgical procedure until you’ve discussed all possible options with your doctor. But after struggling with crappy sinuses and allergies all my life, I’m glad to have found some relief. Only four days have passed since my surgery, and I can already tell a significant difference in the way I breathe.

When You Need Sinus Surgery

Before You Turn to Surgery

Patients who respond to medical therapy do not need surgery, adds Mark A. Zacharek, MD, residency program director for the department of otolaryngology and head and neck surgery at Henry Ford Hospital in Detroit. But those whose CT (computed tomography) scans show “persistent disease” are possible candidates for surgery, says Dr. Zacharek.

“Before resorting to sinus surgery, you should try maximum medical therapy,” says Martin Citardi, MD, chairman of the department of otolaryngology and head and neck surgery at the University of Texas Medical School in Houston. That may include a long course of antibiotics, sinus irrigations, and steroid medications. The next step, if there is no relief, is to get a CT scan. Says Dr. Citardi, “If there is still evidence of chronic sinus disease or there is an obstruction of the sinuses that can only be relieved by surgery, then surgery is recommended.”

When Sinus Surgery Is Recommended

Reasons for sinus surgery include:

  • Evidence of chronic sinusitis even after aggressive medical treatment
  • Sinus disease caused by a fungal infection
  • Nasal or sinus polyps
  • Structural abnormalities of the nose or sinuses
  • Sinus infection that has spread to bone
  • Cancer of the sinus
  • Chronic sinusitis with HIV

Types of Sinus Surgery

The most common surgical procedure for patients with chronic sinusitis is endoscopic sinus surgery, Zacharek says. Certain types of aggressive fungal infections as well as rare tumors of the sinus may call for “traditional or external surgical approaches involving incisions in the gum line or over the eyebrows in the forehead,” he explains.

Surgeries used on the sinuses are:

  • Functional endoscopic surgery. This surgical procedure uses a lighted tube called an endoscope to look directly into the nose and sinuses. During an endoscopy, the surgeon can remove tissue, clean out the sinuses, and enlarge sinus openings for drainage.
  • Balloon sinuplasty. “In this surgical procedure, a catheter with an inflatable balloon is inserted into the sinus and the balloon is then inflated to widen sinus openings,” explains Citardi.
  • Open sinus surgery. In some more complicated cases of chronic sinusitis, an incision may be made directly over the sinus so it can be opened, diseased tissue can be removed, and the sinus reconstructed.

Pros and Cons of Sinus Surgery

The biggest pro for sinus surgery is that it usually works. It may take several months for healing to be complete, and during this time post-operative care is very important. “Studies show that sinus surgery is 85 to 90 percent effective,” says Citardi, adding that a particular pro for the endoscopy procedure is that it has few complications and that the patient feels little pain, if any, during recovery. Another plus is that it’s usually outpatient surgery, Zacharek says.

As for the cons, patients need to know that post-sinus surgery care is as important as the surgical procedure itself. Patients need to come back for endoscopic examinations and clean-out. Says Zacharek, “The patient must understand that sinus surgery is not necessarily a cure for chronic sinusitis. Post-operative care may require regular sterile sinus irrigations and the use of nasal sprays.”

Some complications associated with sinus surgery include bleeding, infection, and loss of vision. Serious complications are very rare, occurring in much less than 1 percent of cases.

Sinus surgery for chronic sinusitis and related problems is used only when all else fails. The best results for sinus surgery happen when you and your ENT surgeon have realistic expectations and work closely together before and after your surgery.

Find more information in the Everyday Health Ear, Nose, and Throat Center.

Why is sinus surgery performed?

Sinus infections are usually treated with medication rather than surgery. Sinus surgery may be necessary when those infections are recurrent or persistent. Sinus surgery is most commonly used to treat chronic sinusitis (inflammation of the nose and sinuses), but may be needed for other sinus problems.

Surgery involves enlarging the openings between the sinuses and the inside of the nose so air can get in and drainage can get out. It may involve removing infected sinus tissue, bone or polyps. Modern sinus surgery has less post-surgical bleeding, is less invasive and involves a shorter recovery time than sinus surgery in the past.

What are the types sinus surgery?

  • Functional endoscopic sinus surgery (FESS): This is now the most common type of sinus surgery. It can be done on an outpatient basis. It is done by looking through the nostril with a nasal endoscope (a small telescope) to see the inside of the nose and the entrances to the sinuses. Other instruments are used through the same nostril to perform the procedure
  • Image-guided surgery: FESS is often done with an image-guided system that uses computed tomography (CT) scans to aid the surgeon in identifying the anatomy and removing as little tissue as necessary. This system helps the surgeon to know when they are getting close to the margin of the sinus and thus improves safety as well.

Other procedures may be used for more serious sinus problems, including the Caldwell Luc operation and endoscopic skull base surgery.

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Health Care

Before Surgery: In preparation for your surgery, your physician may prescribe preoperative medications to optimize the condition of your sinuses for surgery. The medications may include antibiotics and/or oral steroids. Please be sure to start any preoperative medications on the appropriate day and adhere closely to the prescription. In addition, you should avoid taking the following medications for at least fourteen days prior to surgery: aspirin, ibuprofen (Motrin/Advil), naproxen (Aleve), other non-steroidal anti-inflammatories (NSAIDS), vitamin E (multivitamin is OK), gingko biloba, garlic (tablets), and ginseng. These medications can thin the blood and create excessive bleeding. Tylenol is safe and may be taken anytime up to the day of surgery. St. John’s wort should also be avoided for 2 weeks prior to surgery because of possible interactions with anesthesia medications. If you take the blood thinner Coumadin, please discuss discontinuation of this medication with your surgeon.
If you smoke, it is critical that you stop smoking for at least three weeks prior to surgery, and at least four weeks after surgery. Smoking can contribute to scarring, poor healing, and failure of the operation. Your primary care physician can direct you to resources for smoking cessation. Finally, it is important to inform your primary care physician that you are planning to have sinus surgery. Your primary care physician can help to clear you medically for surgery. Most of the necessary pre-operative testing will be performed at Stanford on the day of your preoperative visit, but occasionally we will request old records from your primary care physician. We will make every effort to keep your primary care physician informed regarding your medical status both before and after your surgery.
During Surgery: In most cases, you will receive general anesthesia for your surgery, which means you will be asleep for the entire procedure. However, if you have a preference for local anesthesia, please let your doctor know as this may also be an option in some cases. After your surgery has been completed, you will spend about one hour in the recovery room, followed by an additional recovery period of 1-2 hours in the second stage recovery unit. Most patients feel well enough to go home the day of surgery. You will most likely go home without nasal packing.
After Surgery: You can expect mild bleeding for 1-2 days after surgery and a general sense of fatigue for 1-2 weeks after surgery. In general, pain can be successfully controlled with narcotic or non-narcotic medications. For more details about postoperative care, please see the separate guide, “Postoperative Care Instructions.” You will have a series of postoperative visits that are critical for a successful outcome. At each visit your doctor will perform a procedure called nasal endoscopy to check how the sinuses are healing. An additional procedure called debridement may be necessary in order to clean blood from the sinuses and prevent early scar tissue formation. (Please note that these procedures are not included in the surgical charge and thus are billed separately.) Your visit schedule will usually consist of 3 visits over the first 6 weeks. Thereafter, your visits will be spaced a few months apart, depending on how well your sinuses are healing.

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