Surgery is used only when treatment with medications has failed to control sinusitis. When certain rare complications develop, such as when the infection spreads to the bone or inside the brain, surgery may be needed in addition to antibiotics.

The goal of surgery is to make drainage of the sinuses better, usually by removing the blockage and draining the mucus. This may mean 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.
• A foreign object that is blocking a nasal or sinus passage. This usually occurs in children.

Surgery may be the only means of getting a badly blocked, infected sinus to drain properly. However, surgery does not always completely eliminate sinusitis. Up to 20% of people may need a second operation.⁵

Surgery is most successful when used along with medication and home treatment to prevent future sinusitis. A second surgery and future sinusitis may be avoided if antibiotics are taken to prevent reinfection.

For more information on when surgery is a good choice, see:

Should I have surgery for sinusitis?

Surgery Choices

Endoscopic surgery is preferred over traditional surgery for most cases of chronic sinusitis that require surgery. It is less invasive, less expensive, and has a lower rate of complications.

Endoscopic surgery may be done to remove small amounts of bone or other material blocking the sinus openings or to remove growths (polyps) of the mucous membrane. Normally, a small tube called an endoscope is inserted through the nose so the health professional can see and remove the material blocking the sinuses. In some cases, a laser is also used to burn away tissue blocking the sinus opening.

Traditional surgery may be done when complications of sinusitis-such as the development of pus in a sinus cavity or infection of the facial bones-have occurred. In traditional surgery, an opening is made directly into the sinus cavity from inside the mouth or through the skin of the face.

What To Think About

There are few clear-cut reasons for sinus surgery, and very few people require it. The decision to operate depends on the success of prior treatment. Situations that may support the need for surgery include:

• Failure of treatment to improve symptoms after 2 or more antibiotics have been tried for 4 to 6 weeks (or 2 to 3 months in children).
• Persistence of symptoms due to thickened mucous membranes, growths inside the nose (nasal polyps), or other problems that cause a blockage.
• A CT scan that shows evidence of long-term (chronic) sinus infection or a blocked drainage opening for a sinus.
• A sinus infection that is caused by a fungus.
• The development of a serious complication of sinusitis. Such complications are rare, but usually involve the spread of the infection beyond the sinuses. The facial bones can become infected (osteomyelitis), or the lining of the brain can become infected (meningitis). Also, the infection can spread outside the sinus and create a pocket of pus (abscess) in an eye socket, the brain, facial bones, or the soft tissues of the face.

The extent of the blockage and other problems determine how extensive your surgery will need to be. Surgery may be limited to removal of infected tissue or small growths (polyps) inside the nose. More extensive surgery involves removing pieces of bone to create a wider opening to allow a sinus to drain.

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