When medical treatments fail to relieve sinus congestion and swelling, you might consider surgery. While many sinus problems cannot be cured with an operation, these procedures can resolve symptoms and improve quality of life by reducing inflammation and ensuring nasal spray medications can be used more successfully.
Most sinus surgeries at Rush are performed minimally invasively, and patients typically go home the same day.
Do I need sinus surgery?
Sinus inflammation and pain can often be relieved by treating the underlying cause. For instance, your doctor may prescribe antibiotics if you have a bacterial infection. In addition, allergy-related congestion can be treated with antihistamines and other medication, as well as with allergy shots.
You may want to consider surgery if you have chronic sinus problems that recur frequently, last for months, or are worsened by structural problems in your nose.
Which conditions can be relieved with sinus surgery?
Many sinus surgeries are performed to address the following issues:
- Sinusitis, including pediatric sinusitis: Often caused by allergies or colds, sinusitis occurs when lining of the sinuses (the hollow spaces around the nose) become swollen and painful. When sinusitis lasts longer than 12 weeks it is considered chronic. Endoscopic surgery may be a treatment option for chronic sinusitis if medical therapy is not effective.
Rhinosinusitis: Rhinosinusitis is when the lining of the sinuses and lining of the nasal passages (nose) become inflamed. It is considered acute when it lasts less than four weeks and chronic when it lasts more than 12 weeks.
- Fungal rhinosinusitis is caused by a fungal infection of the paranasal sinuses. There are several types, including fungal ball, allergic fungal sinusitis and invasive fungal sinusitis.
- Refractory rhinosinusitis, also called drug-resistant rhinosinusitis, is when medical therapy fails to improve rhinosinusitis symptoms.
- Nasal polyps: These tiny polyps, or growths, are noncancerous. They do, however, obstruct the sinuses, which can contribute to sinusitis or rhinosinusitis. Sinonasal polyposis is when a person has multiple nasal polyps.
- Deviated septum: When the bony structure that divides the nose is off center and restricts breathing in one nostril, it is called a deviated septum.
- Enlarged nasal turbinates, or turbinate hypertrophy: When turbinates, which are structures inside the nose, become inflamed they can obstruct breathing.
- Sinus tumors, including all forms of sinus cancer: Whether or not they are cancerous, sinus tumors may warrant surgery.
- Aspirin exacerbated respiratory disease (AERD), also known as aspirin-induced asthma, is a chronic condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Often, people with AERD have chronic sinus infections and do not respond to standard asthma treatments. AERD can also cause you to lose your sense of smell.
Eye and brain problems: Endoscopic sinus surgery is also used to reach and fix problems in the eyes and brain, including the following:
- Excessive eye tearing
- Blocked tear ducts
- Bulging eyes due to Graves' disease
- Cerebrospinal fluid (CSF) leaks, which occur when tissue around the brain is torn and spinal fluid leaks out
- Encephaloceles, a rare birth defect that causes the brain to protrude through openings in the skull, such as through the nose
- Growths or injuries affecting the optic nerve at the back of the eye
If you have any of these issues or want a second opinion, we encourage you to schedule a consultation with the Rush Sinus Program. Our experts will do a thorough second opinion evaluation and determine whether sinus surgery is right for you.
Types of sinus surgery
ENT physicians with the Rush Sinus Program are fellowship trained in rhinology, and this specialized training gives them the expertise to handle the most severe sinus problems and perform complex sinus surgeries. They are able to offer patients the latest treatment advances and provide comprehensive care for the full range of sinus issues.
For certain complex conditions, sinus surgery is combined with skull base surgery.
Endoscopic sinus surgery
ENT surgeons at Rush can operate inside the sinuses and surrounding areas, using an endoscope, or a telescope with a tiny video camera at the tip. Guided by computer images of the inside of the nose and sinuses, surgeons use special instruments and devices to remove blockages.
Specific types of endoscopic sinus surgery, sometimes called functional endoscopic sinus surgery (FESS), include the following:
- Septoplasty: This is the formal name for endoscopic surgery to correct a deviated septum.
- Endoscopic resection of sinus tumors: Traditionally, removing sinus tumors has required incisions in both the face (by an ENT surgeon) and skull (by a neurosurgeon). Many of these tumors can now be removed directly through the nostril, without an incision, reducing complications and enabling faster recovery.
- Revision sinus surgery: When patients have persistent symptoms after an initial sinus surgery, they may benefit from a second opinion. In some cases, that leads to a second, or revision, surgery.
- Frontal sinus surgery: Because the frontal sinuses are near the brain and eyes, it is wise to seek out ENT surgeons, like those at Rush, with specific experience and skills to perform these intricate endoscopic surgeries.
- Balloon catheter dilation, or sinuplasty: When clinically appropriate, our surgeons can endoscopically unclog sinus blockages by inflating tiny balloons. This approach typically causes less damage to sinuses, and may speed recovery.
- Orbital decompression: Thanks to a procedure called endoscopic orbital decompression, bulging eyes can be endoscopically treated through sinuses, protecting vision and relieving cosmetic concerns.
- Turbinate reduction surgery: Used to treat turbinate hypertrophy. Our surgeons endoscopically sculpt the inflamed turbinate to make it easier to breathe.
- Endoscopic repair of encephaloceles and CSF leak: These problems can often be corrected endoscopically via the sinuses and nasal passages.
- Optic nerve decompression: With an endoscopic nerve decompression procedure, our surgeons can correct or prevent vision loss when a growth or injury is putting pressure on the nerve at the back of the eye.
- Dacryocystorhinostomy, or tear duct surgery: When excessive tearing is caused by blockage of the nasolacrimal duct in the eye, our surgeons can fix this on an outpatient basis.
Traditional sinus surgery
At times, surgeons may need to make small incisions on the face (for example, near the lip or eyebrow) to access and remove blockages in the sinuses. And removing more invasive sinus tumors may still require an incision in the skull (craniotomy).
When this is necessary, our experienced surgeons take care to make these incisions as inconspicuous as possible.
Customized post-surgical treatment
At Rush, pathologists provide detailed histopathology reports on tissue removed during surgery, which help to determine the presence of inflammatory cells, infections and other underlying problems. Our physicians use this profile to tailor each patient's post-surgical treatment.
For example, patients with allergic sinusitis may have a high number of eosinophils cells, which are a sign of inflammation. When patients' histopathology reports show a strong eosinophil presence, they may want to consider more aggressive allergy treatments.
Why choose Rush for sinus surgery?
- Innovative surgical advances: When applicable, Rush sinus surgeons use the latest techniques and devices, including dissolvable sinus stents, to help widen sinus passages and keep them open.
- Expedited second opinions: Our team aims to see patients seeking second opinions within one to three business days.