I'm scheduled to have Sinus Surgery on the 13th of March. My neighbor had it done 7 yrs. ago. She told me her horror stories and now I am getting very nervous. What advancement's have been made from surgery done 7 yrs. ago? She said that they drilled through her bones to get to the sinuses, she has constant drainage that makes her sick to her stomach, and she has just as many problems now that she had then. My left Maxillary is blocked, left ethmoid and sphenoid are imflammed. This has been an on going problem for the last 9 months, antibiotics haven't done the trick( or they are reoccuring). So I am in much pain and have alot of fatigue. Not really looking forward to the surgery, but had hope of feeling better. Now I'm wondering if I should have it done at all. If she has so many problems now and had alot with the surgery, is it even worth it? Please if you could answer the difference between surgery now and surgery then. Also about the nasal packing, she said that it was miserable and that when they took it out she passed out. Just sign me scared in the south!
Reply: ----------------
Modern sinus surgery generally involves the use of endoscopes that are inserted through the nostrils. The indication for sinus surgery is most often to remove irreversibly diseased lining in the sinus cavities and to restore normal drainage pathways in sinuses that are chronically obstructed. Surgery is generally recommended when long-term non-surgical care is ineffective and when persistent symptoms combined with x-ray evidence of persistent mucosal disease is seen. This generally means sustained long-term antibiotic therapy (if possible based on cultures), decongestants, topical steroid sprays, saline irrigations, and elimination of environmental factors such as cigarette smoke, allergies, etc. have not resulted in resolution of chronic sinus symptoms after a few months. The typical symptoms of chronic sinusitis include head congestion, post-nasal drainage, facial pressure, alteration in sense of smell and/or taste, etc. CT scans are the preferred x-ray upon which to assist in determining the possible need for surgery - (generally speaking regular x-rays provide insufficient information and MRI scans are too sensitive).
Contemporary sinus surgery typically involves the use of endoscopes that are passed through the nostrils. Most of the time, chronic sinus disease is the result of obstruction in the sinuses located between the eyes known as the ethmoid sinuses. There total size approximates the size of a matchbox and the inside somewhat resembles a honeycomb. The intent of surgery is to enlarge the normal drainage pathway and remove diseased tissue within these pathways while preserving normal tissues and structures. Through the ethmoid sinuses, one can establish proper drainage for the other sinuses. Occasionally, such sinus surgery needs to be combined with septoplasty when the nasal septum (the middle partition which separates the nasal passage into right and left) if the septum contributes to obstruction of the sinuses.
The risks of this surgery are related to the location of the ethmoid sinuses which are located immediately below the front part of the brain and between the eye sockets. The bone separating the sinus from these structures is thin and if injured can result in complications in adjoining structures. Fortunately, in experienced surgeon's hands, significant complications are rare.
Many times, some type of sinus packing is utilized for a short period (1-3 days). I generally do not pack the nasal passages however. Therefore patients I have operated on can pass some air through the nose albeit they are fairly stuffy for a week or so.
With proper indications for surgery, appropriately performed surgery, and careful post-operative management, endoscopic sinus surgery is highly effective in the treatment of chronic sinus disease.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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