Surgery

If your ostia are permanently swollen shut and you've unsuccessfully tried other methods, sinus surgery may be your best option. Surgery can help return your sinuses to healthy functioning by returning the ostia to their normal size. Without proper drainage, mucus will build and your sinuses will continue to get infected. Sinus surgery can also repair other structural problems with your sinuses, including a deviated septum, polyps, cysts, and swollen nasal turbinates.

Surgery, however, is not a panacea. Even though 80 to 90 percent of patients report improvement after surgery, you still need to deal with the underlying factors that caused your ostia to swell shut in the first place or they may do so again. With some people, prolonged chronic sinusitis causes damage to the sinuses' mucous membranes that's irreversible. Still, surgery and other treatment can greatly ease symptoms and improve the quality of life.

The most common technique today is endoscopic sinus surgery, also called FESS (functional endoscopic sinus surgery). It's considered minor outpatient surgery (you aren't hospitalized overnight) with a low rate of complications -- about 3 percent (primarily bleeding). Unlike earlier techniques, the surgery is done through the nose instead of cutting into the gums or face, so the recovery period usually lasts only several days with patients usually returning to work from four to seven days after surgery. Full recovery takes about four weeks.

The operation itself generally takes one to three hours and may be done under either local or general anesthesia. Local anesthesia is often the better choice, since general anesthesia is riskier, more likely to cause gastrointestinal upset afterward, and typically takes longer to recover from.

Some surgeons routinely pack the sinuses with gauze or other materials after surgery to control bleeding, while others do so only if it's clear that post-surgical bleeding will be a problem. Packing, either while it's in place or as it's being removed, can be uncomfortable or hurt -- it's often the most painful part of sinus surgery.

Endoscopic sinus surgery has largely replaced turbinate surgery, which reduces the size of swollen areas inside the sinuses. Too many patients experienced a worsening of sinus symptoms after turbinate-reduction surgery. Although some ENTs still perform this type of surgery, most ENTs today feel that the turbinates should be preserved as much as possible.

Choosing a Surgeon

If at all possible, choose an experienced surgeon, as the success of endoscopic sinus surgery is often directly related to the surgeon's experience and skill. Complication rates are higher with surgeons who have completed less than a hundred procedure (Some experts recommend that it's best to go with a surgeon who's performed three hundred or more procedures). More severe complications, though rare, include meningitis, orbital cellulitis, and blindness.

The latest advance in sinus surgery is Image-Guided FESS, which is performed with a computer-imaging surgical device. Image-guided devices are thought to help prevent complications, particularly among patients who previously had sinus surgery or have extreme polypoid disease, advanced tumors, or a distorted anatomy. Among the image-guided surgical devices available are the VTI Insta-Trak, the ISG Viewing Wand, the ISG Infrared Optotrak, and the IGT Flash Point 5000.

Another new technique is Laser FESS, which is promoted as being less traumatic than conventional FESS. Some ENTs feel this is more an advertising gimmick than a genuine improvement and that conventional FESS is more effective.