Sinus Surgery – Pros and cons

Surgeon during sinus operation
The most successful outcome of an operation in the area of the sinuses is difficult to predict. The advantages and disadvantages should be carefully considered.

What can Surgery do for a Chronic Sinusitis?

The medical history of patients with chronic sinusitis is often drawn-out and marked by frequent set-backs. Many expect a quick cure from sinus surgery. Rightly so? 

The usual therapies and medicines for chronic sinusitis such as nasal douche, cortisone containing nasal sprays and antibiotics give the affected area often only limited relief. In hope of putting an end to their suffering, many patients with chronic sinusitis undergo surgery. But what exactly can a sinus operation do?

Which Surgery Helps with Chronic Sinusitis?

A chronic inflammation of the sinuses can affect several areas and have different causes, which in turn require different surgical measures. Therefore each case must be individually evaluated before surgery.

The aim of sinus surgery is to restore the undisturbed secretion flow of the sinuses in the nose and to allow ventilation of the sinuses. The fundamental disturbance of the secretion flow which lies at the base of a chronic sinusitis determines the choice of surgery. The following surgical measures can contribute to the alleviation of the aliments:

  • Removal of the inflammed tissue
  • Reduction of the nasal concha
  • Removal of benign tumors, which can develop in the sinuses (adenoids)
  • Straightening of a crooked nasal septum
  • Sinus puncture

Which Surgical Methods are there?

Nowadays the reduction of the nasal concha is rarely done. Also puncture, with which the inflamed sinus is broached to allow ichor to flow out, has been almost completely replaced by newer methods. It is painful, does not remove the cause and only alleviates the patient temporarily.

Today the most prevalent surgery for chronic sinusitis is an endoscopic surgery of the paranasal sinuses (ESPS).  The surgeon uses an endoscope, with which he/she penetrates through the nostrils to the problem area. Here he/she removes constrictions or sources of irritation such as adenoids, to ensure ventilation and secretion flow in the sinuses.

The endoscopic surgery is in comparison to earlier methods very gentle and hardly painful. In most cases the patient can leave the clinic after only one day. With the removal of the adenoids the risk indeed remains that the adenoids can grow back, the surgery, however, can be repeated without any problems.

Also the problem of a crooked nasal septum can be remedied with an endoscopic surgery. The mucus membrane is carefully detached and cartilage or bone is straightened with a nasal septum surgery.

An alternative method to endoscopic sinus surgery is the so-called balloon dilation (also: sinuplasty). This is an ambulant surgery which is mostly applied in simple cases of chronic sinusitis. With the help of a catheter a balloon is inserted into the nose which is slowly blown up at the entrance to the sinuses. Constricted openings which prevent an undisturbed mucous flow can thereby be expanded.

The balloon dilation is, in comparison, a simple intrusion and associated with a low complication rate. However, should enlarged adenoids be present, then the balloon dilation is not suitable. In addition there are no scientific studies available which prove the long-term benefit of this surgery.

Finally there is still the possibility to reduce the swollen mucus membrane by means of laser technology. With the help of such a surgery, the swelling of the mucus membrane, in the case of an infection, is to be reduced. Thereby one hopes for a milder course of the infection phase, because it does not so quickly come to congestion in the area of the sinuses.

Sinus Surgery – Pros and Cons

Surgeries in the area of the sinuses are extremely challenging surgical measures which should be carefully considered.

Pros

  • a sinus surgery can contribute to an improvement of quality of life
  • in 80% of the cases a sinus surgery improves the state of health of the patient
  • today’s surgical methods are gentle and allow for a quick recovery
  • in particular for patients by which the sinusitis treatment with medicine did not take effect surgery offers an alternative

Cons

  • in many cases the aliments return after surgery
  • adenoids can be removed, but after some time also grow back
  • studies about the long-term effects of surgeries for inflamed sinuses are not yet available
  • the danger of irreversibly damaging the important structures for the moistening of the nasal passage
  • many patients complain of dry mucous membranes after surgery
  • in about 1% of cases neighboring structures are damaged, which, for example can lead to meningitis, an eye infection or even blindness
  • dangers are especially present with surgeries in the area of the frontal sinuses
  • an impairment of the ability to smell and the onset of bleeding are temporary results of surgery in about 10% of cases

Conclusion

Surgery is not a miracle cure for chronic inflammation of the sinuses: it can alleviate the frequency and severity of the symptoms – a complete disappearance of the symptoms is most likely not to be expected. Patients therefore must also be therapeutically cared for even after surgery.

Nevertheless surgery can alleviate the symptoms of sinusitis or temporarily eliminate them. Surgery should be taken into consideration in particular when therapy of sinusitis with medicine does not bring any improvement.

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