When is Surgery a Good Idea for Sinusitis?

Sinusitis is the inflammation of the tissue lining the sinuses. When the lining swells, mucus has nowhere to go, resulting in congestion, facial pain and pressure, and headaches. 

For many people, sinusitis responds well to medication, saline rinses, and addressing underlying triggers like allergies. But for others, these only provide temporary relief. In cases like these, surgery can be the most effective option.

While symptoms of sinusitis can feel unbearable, this doesn’t necessarily mean surgery is right for you. And on the flip side, because your symptoms seem manageable doesn’t mean surgery isn’t worth considering. 

This decision requires a thorough evaluation by a specialist who can look at your symptoms, history, anatomy, and how you’ve responded to previous treatments before giving you an honest, informed recommendation.

That specialist is Mani Zadeh, MD. With extensive expertise in diagnosing and treating all forms of sinusitis, Dr. Zadeh is the right person to help you figure out whether surgery is right for you. Here, he explains what surgery for sinusitis involves, who tends to be a good candidate, the different procedures available, and what you can expect from the process.

Why do some cases of sinusitis not respond to medication?

The standard starting point for treating sinusitis is medication. However, if you have chronic sinusitis, treatment may be more complicated. 

By definition, chronic sinusitis means your symptoms have persisted for 12 weeks or longer despite treatment. In many chronic cases, there’s a physical reason the sinuses can’t drain properly, and medication can’t fix a structural issue.

If you’ve undergone appropriate and sustained medical treatment, including nasal sprays, saline irrigation, antibiotics, and allergy management, without achieving significant relief, surgery may be the next step.

Who is a good surgical candidate?

Dr. Zadeh determines who is a good surgical candidate by first carrying out a CT scan of your sinuses to identify where blockages are occurring, whether you have polyps, and whether any other structural abnormalities are contributing to the problem. 

People with recurring nasal polyps are strong candidates. Polyps tend to grow back after medical treatment, and surgery can remove them more thoroughly and widen the sinus openings. Similarly, people with a significantly deviated septum often see substantial improvement in sinusitis symptoms with surgical correction.

Surgery is not appropriate for acute sinusitis that hasn’t been given enough time or treatment to resolve on its own. It’s also not the first step for someone who hasn’t yet tried the standard medical treatments. 

The most common surgical options

The most widely performed procedure for chronic sinusitis is Functional Endoscopic Sinus Surgery (FESS). FESS is done using a small camera called an endoscope and passed through your nostrils, so there are no external incisions and no visible scarring. Most people go home the same day.

FESS is a well-established, minimally invasive procedure with a strong track record, and most people describe recovery as manageable. Your sinuses need time to heal properly after the procedure, and follow-up care is important.

Another option that has become increasingly popular is balloon sinuplasty. Rather than removing tissue, this procedure uses a small balloon catheter inserted into the blocked sinus opening, which is then gently inflated to widen it. It’s even less invasive than FESS and can often be performed in-office under local anesthesia. 

Balloon sinuplasty tends to be most effective for people whose primary issue is blocked drainage. For people whose sinusitis is linked to a deviated septum, a septoplasty, which is a procedure to straighten and reposition the septum, may be recommended either on its own or alongside FESS.

What to expect during recovery

In the first week, you can expect some congestion, mild discomfort, and a feeling of stuffiness as your sinuses begin to heal. Most people are back to light activity within a week, though strenuous exercise and anything that puts physical pressure on your face is off-limits for several weeks.

Follow-up appointments are critical. After FESS, in particular, Dr. Zadeh needs to monitor your healing, clear any debris or crusting from inside the sinuses, and make sure everything is opening up properly. Saline rinses help keep your nasal passages clear, support healing, and reduce the risk of infection. 

Sinusitis surgery isn’t right for everyone, but if you’re an ideal candidate, it can be life-changing. If you’re dealing with sinusitis that isn’t responding to treatment, schedule a consultation with Dr. Zadeh today.