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Breathe freely: Sinus surgery can help

If aggressive use of medications fails, your doctor may suggest sinus surgery. The goal of surgery is to improve drainage and reduce blockages.

When sinuses become infected, medicine is the first line of defense. Nose drops, saline washes, steroid sprays, antibiotics and other medications often help reduce swelling and control infections.

But some people develop sinus problems that become chronic. Months—or years—of headaches, pain and misery can follow. Uncontrolled infections can travel to sensitive areas near the sinuses, including the eyes and brain.

So if aggressive use of medications fails, your doctor may suggest sinus surgery.

Tammy Robertson, RN, had sinus surgery 12 years ago and saw noticeable results. She works as a nurse for Stephen Chandler, MD, who sees patients at Montgomery Otolaryngology.

Earlier this year, Robertson’s sinus symptoms started acting up again.
 
“I was throwing up and coughing real bad,” Robertson said. “I thought it was acid reflux. It turns out it was my sinuses.”

Robertson had developed a fungus in her sinuses that was causing her symptoms.

“I had sinus surgery again in February,” she said. “After the surgery, I feel a whole lot better.”

The goal of surgery

If sinuses don’t drain properly, pus and other secretions can build up and become infected. Air also needs to move freely through the sinuses; if it cannot, a vacuum is created. Any of these conditions can lead to pressure and pain.

The goal of surgery is to improve drainage and reduce blockages so that the complex pathways between the sinuses and the nose work better. Surgery helps by:
  • Enlarging the natural openings of the sinuses
  • Correcting anatomical problems
  • Removing growths, called polyps

Types of surgery

Today sinus surgery is usually done entirely through the nose, with no external scars. Surgeons use techniques that cause much less pain and downtime than older surgical techniques.

Sinus surgery options include:
  • Functional endoscopic sinus surgery (FESS), which involves inserting a very thin, lighted tool called an endoscope through the nose. This allows the surgeon to see the sinuses. Using microinstruments, small amounts of bone or tissue are removed to enlarge and clear blocked areas to improve drainage. Sometimes the inside anatomy of the nose needs to be repaired too.
  • Image-guided surgery, which involves a multidimensional mapping system, CT scans and infrared signals to guide surgeons through the sinus passages. The signals and scans help surgeons know exactly where to fix the sinus passages.
  • Balloon catheter sinuplasty, a minimally invasive technique that uses a soft, flexible wire threaded through the nose to reach the sinuses. A small balloon that follows the wire is then gradually inflated to gently reshape the blocked areas.

Used alone, sinuplasty doesn’t require cutting, so it preserves the original nasal tissue. But depending on the location, extent and cause of sinus problems, doctors may use a hybrid approach, combining sinuplasty with other sinus surgery techniques for the best results.

“The procedure is an extension of general rhinology surgery, a refinement of a technique that’s been utilized for several years,” said Dr. Chandler. “I began doing the procedures about three years after they were approved and have been doing them now for almost eight years. It’s a good procedure.”

What’s the prognosis?

Robertson was able to return to work within two days postsurgery. While that is faster than usual, patients typically return to their regular activity within a few days after sinus surgery, reported the American Rhinologic Society.

According to the National Institute of Allergy and Infectious Diseases, most people have fewer symptoms and better quality of life after sinus surgery, although surgery may not completely eliminate sinusitis.

As with any surgery, there are risks involved with sinus surgery. Your doctor will consider many factors before recommending surgery, including your medical history and nasal anatomy.
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