There are many specific issues to consider when sinus surgery is recommended by your otolaryngologist. Most patients I see for a “second opinion” about their sinuses do in fact have sinuses that justify surgery. However somewhere along the way the goals and expectations of surgery have been forgotten. Here are the questions you should be asking:
1. Which of my symptoms can be improved by sinus surgery? I generally tell patients that the “frequency and severity” of their sinus infections will be greatly reduced by surgery. This will help with fatigue, thick nasal discharge, facial/head pressure, and nasal “congestion” to some extent. Many of the allergy symptoms like watery runny nose and postnasal drip, burning eyes, and ear pressure may not change at all. For this reason many sinus surgeons are recommending allergy treatments as an adjunct to sinus surgery. I am also very cautious in claiming to fix headaches with surgery (some with migraine-type pain may actually worsen). Finally, nasal blockage due to enlarged turbinates or a deviated septum is treated with a different surgery, so be sure your surgeon has a plan for the blocked nasal breathing also.
2. Which sinuses of mine are affected, and which ones are you going to operate on? We technically break the sinuses up into 10 different sinus cavities – the frontal sinus, anterior ethmoid sinus, posterior ethmoid sinus, maxillary sinus, and sphenoid sinus (1 per side). Most sinus surgeons agree that only sinuses with inflammation should be operated on. Furthermore, it is important to know the frontal sinuses are more likely than others to “scar closed” after surgery, so there are special concerns for frontal sinus surgery. Also, in my opinion extensive ethmoid sinus surgery has the highest risk for serious complications related to the eye and spinal fluid.
3. Do I have classic nasal polyps? This is an important distinguishing feature because it is predictive for whether or not this will be your last surgery. Polyps are caused by long-standing inflammation. Without controlling the inflammation polyps will eventually return. Control may be had with allergy testing, aspirin desensitization or long term medications. Despite medical advances, polyps remain difficult; there are many “polyp patients” who have undergone numerous sinus surgeries by very good surgeons because their polyps simply keep growing back.
4. Do I have special anatomic considerations that make me more risky? Many times a CT scan will show an area of thin bone over the eye sockets or below the brain cavity. These areas can be risky to operate around, and you and the surgeon should be aware.
5. Do you (the surgeon) routinely use nasal packing? What kind? There is always a risk that you may experience excessive bleeding and require extra packs. However the days of “yards and yards of gauze” are gone. Most surgeons use either some form of dissolvable “hemostatic spacers” or small carefully placed removable sponges. In general the less packing the more risk of a nosebleed afterwards (most patients would rather have a light nose bleed than a ton of packing!)
6. Do you (the surgeon) perform post-operative debridement? Most surgeons perform between 1 and 4 scheduled procedures to remove clots, crusts, and developing scar tissue from the surgical areas. I think that most patients benefit from this extra care to reduce the risk of the sinuses “closing back up”.
With the above questions your should be armed to communicate effectively with your sinus surgeon. And remember there is almost never a need to “rush” toward sinus surgery. Take your time and get your questions answered.