Sinusitis: Why Surgery Isn’t Always the Answer

Benjamin B. Cable M.D.'s picture
By Benjamin B. Cab... on April 1, 2020

Sinusitis—the inflammation or swelling of the tissue lining the sinuses—is one of the most common chronic medical conditions in the United States.

It may not sound like a serious condition; however, those who have sinusitis tend to miss more work or school, experience facial pain and pressure, feel tired and even suffer from pain in their teeth.

There are four sets of sinuses:

  • In our forehead
  • Under our eyes
  • Two sets between our eyes

When the sinuses get inflamed, they become blocked and filled with fluid. This allows germs to grow, get trapped and cause an infection.

So how do you treat this?

By definition, “chronic” means more than three months at a time. If you’re experiencing issues that won’t go away with over-the-counter medication, it’s time to seek medical care. Start with your primary care physician, who is familiar with your medical history and can determine initial steps and medications to try.

It may take a few tries to fine-tune your treatment, but most patients with sinusitis can be treated effectively without having surgery.

About 80 percent of patients with chronic sinusitis have allergies, which is the most common cause of swelling in the nose.

Is Sinus Surgery Right For You?

If avoiding allergens or trying tailored medications and topical nose sprays don’t help, your physician may refer you to an ENT (ear, nose and throat) specialist for sinus surgery.

If sinus surgery is recommended, asking your doctor these questions can help you understand your options:

Which sinuses are blocked?
It’s important to identify and understand where you may have obstruction or where your sinuses aren’t draining properly, as not all surgical interventions treat all four sets of sinuses. Your physician may order a CAT scan to get a clearer picture; ask them to go over the findings with you. Make sure you’re not sick when you get your scan. In general, patients who do not have sinus blockages shown on their CT scans should not undergo surgery.

Where will you perform my surgery?
Having your surgery done in a few minutes at an outpatient clinic may sound enticing; however, it’s important to consider your surgeon’s background and experience. Complications from sinus surgery are rare but can be serious. Most sinus surgeries are still being performed in an operating room, with patients under some level of anesthesia.

If you are considering undergoing a surgical procedure in an outpatient clinic, your surgeon should help you understand how complications would be treated and who would treat them. If this is not part of your initial discussion, asking about these issues can help you make good decisions regarding your care and will help you ensure you have a comprehensive care team

Are you being paid to use specific techniques?
This might be the most uncomfortable question of all, but some physicians receive direct payment from the industry to use certain techniques. As a nonprofit health care system, Carilion Clinic does not operate in this manner.

Being a well-informed patient can help keep you from being over- or undertreated. Have an open dialogue with your physician and your surgeon—it’s likely that you may come to an effective plan with you care team sooner if you ask the right questions.
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Dr. Cable is the section chief of Carilion Clinic’s Otolaryngology Clinic and is a professor of surgery at the Virginia Tech Carilion School of Medicine. He leads a team of ENT specialists at facilities in Roanoke, Christiansburg, Wytheville and Smith Mountain Lake.

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