An otolaryngologist-head and neck surgeon will, for the most part, advocate
surgery when antibiotics and other medical treatments fail to alleviate chronic
sinusitis or multiple episodes of acute sinus infection. Before considering
surgery, the otolaryngologist will typically prescribe four to six weeks of
antibiotics plus sprays, decongestants, and possibly antihistamines and
steroids.
There are circumstances when immediate sinus surgery is warranted. Malignant
tumors in the sinus cavity, although rare, sometimes do not respond to radiation
and chemotherapy and require surgical removal. Surgery may be the only option
for some patients whose sinus condition aggravates other medical problems such
as asthma. Cancer patients, having a poor immune system, will require drainage
at the onset of a sinus infection (to determine the exact organism causing the
infection and aid in choosing the antibiotic).
Surgery for Acute
Sinusitis
Antibiotics are generally effective for most cases of acute sinusitis
resulting in severe facial pain and pressure. Other treatments for lingering
symptoms include sinus irrigation, which requires the placement of an instrument
in the maxillary sinus to flush out that cavity with salt water.
Two types of acute sinus infection require special attention from a
specialist. A severe infection of the frontal (forehead) or sphenoid sinus
(behind the eyes) can be very serious. If oral or intravenous antibiotics are
not effective, surgical drainage of the sinus may be undertaken. The sphenoid
sinus can be accessed surgically through the nose or through an incision under
the eyebrow. The latter procedure requires hospitalization.
Surgery
for Chronic Sinusitis
Most surgeries on the sinuses are conducted to relieve a chronic condition.
In the past, operations on the sinuses were conducted externally through
incisions on the face. Incisions were made under the upper lip through the gum
(the Caldwell-Luc operation) or an external ethmoidectomy, a removal of the
sinuses between the eyes through an incision in the face. However, most surgical
procedures for the sinuses are now carried out using endoscopic sinus
surgery.
Endoscopic Sinus Surgery
Twenty years ago, otolaryngologist -head and neck surgeons would perform
surgery on the individual sinuses that had become infected, leading to the use
of procedures such as the Caldwell-Luc operation.
Since then, the development of endoscopic sinus surgery (ESS) ushered in a
new philosophy allowing the surgeon to target the ostiomeatal complex (OMC), an
area in the anterior ethmoid sinus region. Obstruction in the OMC can lead to
subsequent infection of the maxillary, frontal, and sphenoid sinuses.
Accordingly, endoscopic sinus surgery, a procedure through the nose, removes
thickened and diseased tissue that blocks the OMC. Most of the healthy tissue in
the sinuses is undisturbed allowing rapid recovery.
Endoscopic surgery can also be utilized for removal of polyps and to
straighten the septum thus restoring a normal flow from the sinuses. Unlike
other sinus surgical procedures, endoscopic sinus surgery has minimal and
usually temporary effect on the patient's appearance.
What to expect from endoscopic surgery
The
endoscopic procedure usually lasts from one to three hours and is performed
using general or local anesthesia. Generally, the patient goes home after
surgery unless other medical conditions complicate recovery.
Full recovery may take several weeks. Dry blood, mucus, and crusting in the
nose may occur, presenting symptoms of a severe cold or sinus infection. Nasal
irrigation or salt-water sprays and antibiotic lubricants as recommended by the
surgeon to facilitate normal sinus activity. Proper post-operative care is
essential to prevent scar formation and allow normal healing. The surgeon
performing the procedure will generally perform all required follow-up
procedures.
Patients who depend on their voice for their livelihood should be warned that
endoscopic sinus surgery may have an effect on their resonance. Additionally,
some patients may have underlying nasal mucosal problems that remain after
surgery. This is seen in highly allergic individuals or asthmatics.
The information contained in this fact sheet was drawn from The Sinus
Source Book, written by Deborah Rosin, MD, an otolaryngologist-head and neck
surgeon. The book is published by Lowell House; ISBN 1-56565-643-1.
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