Most people are able to treat sinusitis with medicines such as antibiotics and home treatments. But some people get repeat infections because something blocks the flow of mucus from the sinuses or because of another medical problem. Surgery may remove blockages and enlarge the sinus openings to help the sinuses drain. This can help prevent future infections.

Consider the following when making your decision:

• Very few people need surgery for sinusitis. To be sure that surgery is a good choice, you need to be diagnosed with chronic sinusitis and have a CT scan of the sinuses done after you have used maximum medical treatment for 4 to 6 weeks. By reducing infection and swelling, this treatment helps the doctor see what is causing the repeat infections.
• Surgery may be the only way to get a badly blocked, infected sinus to drain. But surgery does not always work. As many as 1 out of 5 people who have the surgery need a second operation. ¹
• If you are getting chronic sinusitis because of another medical problem, such as allergies:
  • You need to get that problem under control before you have surgery.
  • You will have a better result from surgery if you use medicine and home treatment after surgery to help to keep that problem under control.

What is sinusitis?

Sinusitis is infection or inflammation of the mucous membranes that line the sinus cavities. When a mucous membrane becomes inflamed, it swells. This can block the normal drainage of fluid from the sinuses into the nose and throat. Bacteria and fungi (plural of fungus) are more likely to grow and cause infection in sinuses that can't drain properly.

Sinusitis most often is the result of viral infection, typically a cold. Nasal allergies or other conditions that block the nasal passages can also lead to sinusitis.

There are two types of sinusitis: acute (sudden) 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 8 weeks that antibiotics have not cleared up.

Sinus surgery may be a good treatment for some people who have chronic sinusitis.

What is sinus surgery?

The goal of sinus surgery is to help the sinuses drain. To do this, a surgeon usually enlarges the openings of the sinuses by removing:

• Infected, swollen, or damaged tissue.
• Bone, to create a wider opening for drainage of mucus from the sinuses.
• Growths (polyps) inside the nose or sinuses.

There are two types of sinus surgery: endoscopic and traditional. Endoscopic surgery is done most often.

• Endoscopic surgery may be done to remove small amounts of bone or other material blocking the sinus openings or to remove nasal growths (polyps). Normally, a thin, lighted tool called an endoscope is inserted through the nose so the doctor can see and remove whatever is blocking the sinuses.
• Traditional surgery may be done when complications of sinusitis-such as the development of pus in a sinus, infection of the facial bones, or brain abscess-have occurred. In this type of surgery, the doctor makes an opening into the sinus from inside the mouth or through the skin of the face.

If there is a problem with a structure inside the nose (such as a deviated septum), this may be fixed during the same surgery. Surgery to repair the septum is called septoplasty. For more information, see the topic Repair of a Deviated Septum (Septoplasty).

After surgery, the doctor may prescribe:

• Antibiotics to help fight infection.
• Steroid medicines to reduce inflammation and improve healing.
• Pain medicine.

Regular doctor visits are needed for 2 to 6 weeks after surgery to make sure the sinuses are healing well.

Sinus surgery is always done by an ear, nose, and throat (ENT) specialist (also called an otolaryngologist).

Who needs surgery for sinusitis?

Very few people need surgery to treat sinusitis. You may need surgery if you have been through the following steps:

1. You have been diagnosed with chronic sinusitis by an ENT doctor.
2. After being diagnosed, you have used the maximum medical treatment for sinusitis. Maximum medical treatment includes at least 4 to 6 weeks of antibiotics , a steroid medicine, and other prescription medicines to clear up the infection and reduce the swelling in your sinuses.
3. You have had a CT scan of your sinuses after using the maximum medical treatment as prescribed by your doctor. It is very important to have the CT scan done after this treatment. By reducing swelling and infection as much as possible, this treatment lets your doctor see what could be causing the repeat infections.

You might need surgery if:

• The CT scan shows that something is keeping the sinuses from draining properly.
• Your doctor suspects that you have a sinus infection caused by a fungus. This may be the case if antibiotics have not cleared up the infection. Antibiotics work for bacterial infections but not for fungal infections.
• You have a serious problem from sinusitis, such as the spread of the infection beyond the sinuses. This rarely happens, and it would require more extensive surgery.

What are the benefits of sinus surgery?

• By helping the sinuses drain, sinus surgery helps prevent sinus infections.
• Your sense of smell may improve.

What are the risks of sinus surgery?

• Minor problems occur in a small number of people who have sinus surgery. These include scar tissue attaching to nearby tissue, bleeding or infection, a hole in the nasal septum, or bruising and swelling around the eyes.
• Serious complications are rare but may include heavy bleeding, injury to the eye area, inflammation of the membrane that covers the brain (meningitis), leakage of the fluid that surrounds the brain, or brain injury.
• Surgery may decrease your sense of smell.
• The surgery may not work, so you might need a second surgery.

If you need more information, see the topic Sinusitis.

Your choices are:

• Have surgery to treat chronic sinusitis.
• Continue to treat sinusitis with medicines and home treatment.

The decision whether to have surgery for sinusitis takes into account your personal feelings and the medical facts.

Deciding about having sinus surgery

Reasons to have sinus surgery

Reasons not to have sinus surgery

You still have sinusitis after trying multiple courses of antibiotics and at least 4 to 6 weeks of maximum medical treatment. A CT scan done after using maximum medical treatment shows that you have a chronic sinus infection, a blocked sinus, or an abnormal growth in your sinuses. Your doctor thinks your sinusitis is caused by a fungus, so antibiotics won't work. The infection has spread beyond your sinuses. Are there other reasons you might want to have sinus surgery?

You have not tried multiple courses of antibiotics and at least 4 to 6 weeks of maximum medical treatment. You have not been diagnosed with chronic sinusitis. You had a CT scan before using at least 3 weeks of maximum medical treatment. To know if surgery is right, you need to have a CT scan after using the maximum medical treatment. A CT scan done after maximum medical treatment did not show blockages or other problems that surgery could fix. Are there other reasons you might not want to have sinus surgery?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about sinus surgery. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I am tired of having one sinus infection after another.	Yes	No	NA*
I have tried only one antibiotic.	Yes	No	NA
I am willing to use antibiotics, steroid medicine, and home treatment after surgery to help prevent further infections.	Yes	No	Unsure
I know that complications of surgery are rare, but it still seems too risky to me.	Yes	No	Unsure
My doctor thinks I will keep getting sinus infections if I don't have the surgery.	Yes	No	NA
The CT scan didn't show anything that would cause me to need surgery.	Yes	No	NA
I have taken antibiotics, steroids, and decongestants as prescribed, and I'm still sick after at least 4 weeks of treatment.	Yes	No	NA
I want to try every other treatment available before I consider surgery.	Yes	No	Unsure

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have sinus surgery.

Check the box below that represents your overall impression about your decision.

Leaning toward having sinus surgery

Leaning toward NOT having sinus surgery

Citations

1. Farwell DG, Pinczower EF (2001). Rhinosinusitis. In KH Calhoun, ed., Expert Guide to Otolaryngology, pp. 179–201. Philadelphia: American College of Physicians.

Other Works Consulted

• Farwell DG, Pinczower EF (2001). Rhinosinusitis. In KH Calhoun, ed., Expert Guide to Otolaryngology, pp. 179–201. Philadelphia: American College of Physicians.

• 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.

Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Denele Ivins
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Donald R. Mintz, MD - Otolaryngology
Last Updated	August 15, 2008