Modern Sinus Surgery: Chronic Sinusitis and Nasal Polyp Relief With Less Pain, Shorter Recovery.

Frontline medical treatments typically work well.

MedStar Health sinus experts blend the benefits of medicine and surgical intervention. These frontline treatments, alone or in combination, provide adequate relief for most patients:

• Antibiotics for sinus diseases: If bacteria are to blame for your chronic sinus woes, courses of antibiotics might help relieve the bulk of your congestion and pain.
• Medicated sinus sprays: Medicated allergy sprays such as topical corticosteroids (i.e. Flonase, Nasonex) or antihistamines (i.e. Azelastine) are safe to use long-term. However, the medication only works on areas it can touch. If polyps or other obstructions are blocking your sinuses, you might not get the full benefit.
• Oral or injectable medications: Steroid medications taken by mouth or injections can help reduce inflammation if other methods don’t work. Prednisone, for example, can help dissolve polyps and temporarily reduce sinus irritation. Long-term steroid use is not recommended due to side effects such as weakened bones or developing cataracts.
• Nasal saline rinses: High volume saline irrigations (i.e. NeilMed Sinus Rinse, Navage, neti pot) can bathe” the sinuses, cleaning the sinuses and nasal passages out while keeping them moist, which helps to reduce inflammation. These systems also help clear particles such as pollen out of your nasal passages, reducing irritation.

During treatment, your doctor may conduct a CT scan to make sure we’re on the right path with your care plan. If you are feeling better but your CT scan still shows inflammation, surgery is likely not needed but reiterates the importance of continued use of the topical medication and rinses to prevent recurrence of your symptoms. However, if inflammation is too much for the medication alone to handle, surgery may ultimately be a good option.

Please note: Surgery is not a cure-all. Even with even the most severe sinus problems, surgery is a complement to long-term maintenance with medical therapy.

Who can benefit from sinus surgery?

Patients who might benefit from surgery include those whose:

• Symptoms continue to come back after adherence to nonsurgical treatments.
• Nasal polyps don’t go away with medication.
• Structural problems, such as a deviated septum, can’t be resolved with nonsurgical treatment.

All patients who are considering surgery get a pre-operative CT scan. The sinuses in the front and back of the head are situated close to delicate structures such as the brain, nerves, blood vessels, and your eyes.

CT imaging helps us create a precise, effective surgical plan that avoids those structures while adequately addressing your problem areas, creating more open sinus drainage passageways, and disturbing as little unaffected tissue as possible.

Sinus surgery is like keeping house.

If your home has multiple rooms with tight corners, walls, and doors, it can feel stuffy and difficult to move around. But if you have an open floor plan, it’s easier to move freely throughout the home. The same is true with your sinuses.

With surgery, we open the sinuses by removing debris such as inflamed tissue or bits of bone that crowd the space. Advanced surgical tools such as the endoscope – a lighted tube with a camera in the tip – let us see deeper into the sinuses to explore exactly what is wrong and where. Using this tool, we can perform functional endoscopic sinus surgery (FESS) to target just the affected areas without opening or disturbing the rest of the sinuses.

Freer sinuses allow better drainage and ventilation so medication can touch the places where relief is needed. And, just like your home, ongoing maintenance is required to keep your sinuses in top shape.

During surgery, we use CT navigation software as a double-check tool to confirm that we are addressing all the affected cells in your sinuses. The navigation software shows us in real-time where our small tools are in your sinuses and it shows us the surrounding tissue. Paired with surgical and anatomical expertise, this technology helps validate our surgical plans, resulting in more precise, efficient, and safe surgeries.

Post-surgery recovery and maintenance.

While recovery is generally not painful, many patients will experience some uncomfortable congestion or sinus pressure for a few weeks after surgery. The tissues inside the sinuses will scab and crust over, just like any other surgical wound, which causes temporary stuffiness.

Most patients can return to work and normal activities within a week. The major restriction is no heavy lifting, which can increase the risk of bleeding.

All patients should follow these post-surgery guidelines, along with special instructions from your doctor:

• Avoid smoking: Smoking stunts the body’s ability to clear particles and air from the sinuses. It also slows the healing process. You wouldn’t fill your home with smoke – your sinuses don’t want it there, either.
• Use high-volume saline rinses: Keeping the sinuses moist is key. Dry sinuses means crustier scabbing, which can cause problems as you heal. We recommend most patients use a saline rinse four to five times daily during recovery to clear unwanted particles and moisturize the nose. Make sure you thoroughly clean these devices before and after each use to avoid introducing new bacteria to the sinuses.

Properly maintaining the sinuses after surgery will better prepare you for your one-week post-op visit, during which we will do debridement, or clearing the sinuses of any residual gunk from surgery. Pulling off a moist scab is much more comfortable than removing a dry one.

Sinus surgery can be life changing for patients with chronic sinusitis and nasal polyps. I’ve had a fair number of patients tell me it’s one of the best health decisions they’ve made. It helps control sinusitis and significantly reduces sinus pressure and pain, which leads to dramatic improvement in sleep and overall quality of life.