Surgery always sounds like a big deal, but in many cases, it is the most effective and crucial option to help patients regain a better quality of life.
When should you consider sinus surgery?
Generally, I recommend considering sinus surgery when chronic sinusitis or recurring sinus infections do not respond to medication, including antibiotics, nasal steroid sprays, or saline rinses. In some cases, there may be other indications that make surgery the most suitable option, such as:
Nasal polyps: These are soft, non-cancerous growths that can block your nasal passages and sinus cavities, causing breathing difficulties and frequent infections.
Abnormal nasal anatomy: For example, a deviated septum or enlarged turbinates can obstruct airflow and prevent proper drainage from the sinuses.
Fungal sinusitis: Sometimes, a fungal infection can develop in the sinuses. This type of infection often doesn't respond to standard antibiotics and requires surgery to remove the fungus.
Sinus tumors or cysts: Although rare, if a mass or cyst develops in the sinuses, surgery may be necessary.
Simply put, the goal of sinus surgery is to improve ventilation and mucus drainage in your sinuses, reduce inflammation, and make future treatments more effective.
Today, the most modern and popular type of sinus surgery is Functional Endoscopic Sinus Surgery (FESS). This is a minimally invasive procedure with no external incisions. The surgeon uses an endoscope (a thin tube with a light and camera) inserted through your nostrils to get a clear view of the sinus cavities. They then use special small instruments to remove blockages, inflamed tissue, or polyps and widen the sinus drainage pathways.
In addition to FESS, other procedures may be performed in combination or separately, depending on the patient's specific problem. These include:
Septoplasty: If a patient has a deviated septum, this procedure corrects the nasal wall.
Turbinate Reduction: If the turbinates are too large, this surgery reduces their size to widen the nasal passages.
The surgeon will determine the most suitable surgical approach for you based on a detailed CT scan and an assessment of your individual sinus anatomy. There are also more specific techniques, such as Full House FESS and Limited FESS, or a targeted surgery on a single sinus.
Having a detailed conversation with your doctor is crucial. You should consider and discuss the following points with your doctor:
Diagnosis and Treatment History: You must be confident that you have a thorough diagnosis, which typically includes a CT scan and nasal endoscopy. You should also tell your doctor about all the treatments you have tried and why they haven't worked as expected.
Goals and Expectations: It's important to understand the goals of the surgery. While surgery can significantly improve your symptoms, it may not be a "complete cure" in all cases. Some patients, especially those with chronic sinusitis, may still need to continue with medication after the surgery.
Potential Risks and Complications: While modern sinus surgery is generally safe, like all surgeries, there are risks, though they are very rare. These include:
Bleeding: Usually not severe, but in some cases, it can be serious and require intervention in the operating room.
Infection:
Changes in sense of smell or taste: This is usually temporary.
Numbness in the upper teeth:
Eye complications: (e.g., bruising, temporary double vision; or in extremely rare cases, loss of vision, as the sinuses are very close to the eyes).
Cerebrospinal fluid (CSF) leak: This is very rare.
Recurrence: It may be necessary to have revision surgery in the future.
Anesthesia: Sinus surgery is typically performed under general anesthesia. You will be asked to see a cardiologist for a pre-operative evaluation, especially if you are older, have underlying medical conditions, take blood thinners, or have had complications with major surgery before.
Recovery Process: It is important to understand what to expect immediately after and during your recovery:
Post-operative discomfort: Mild pain, a feeling of stuffiness, and nasal congestion are normal.
Nasal packing: The doctor may place a dissolvable or removable material in your nose to absorb blood or support the nasal structures.
Nasal rinses: Saline nasal rinsing is crucial after surgery to keep the nasal passages clean, prevent crusting, and promote healing.
Activity limitations: You must avoid strenuous activities, heavy lifting, straining, coughing, sneezing, or blowing your nose forcefully for a period of time or about 2 weeks in most cases.
Follow-up appointments: Regular follow-up visits with your doctor are essential to check on the healing process and clean the nasal passages. Complete recovery can take several weeks to months.
Cost: Discuss all potential costs, including the number of follow-up visits. The cost varies by hospital. Some hospitals offer surgical packages that include one night's stay and the entire procedure. Often, if special instruments are used, the hospital will inform you in advance so you can get an estimate from your insurance company. You will typically know how much of the cost is covered and how much you need to pay before the surgery. Sinus surgery is usually considered a necessary procedure, so insurance companies rarely deny coverage unless a specific exclusion has been signed or old medical history was concealed. When you are discharged, you may find a small increase in the final bill, for example, for certain medications you requested outside the package or specific medications needed to address individual post-operative issues, or if you choose to stay an extra day.
The decision to have sinus surgery is an important one. I wish you a smooth surgery and the best possible outcome.
Asst. Prof. Dr. Wirach Chitsuthipakorn