Sinus surgery: when Is It needed and how can It help?

Sinus problems are a common source of discomfort for millions of adults worldwide. Chronic rhinosinusitis (CRS)—persistent inflammation of the sinuses lasting more than 12 weeks—can cause symptoms such as nasal congestion, facial pain, loss of smell, and sleep disturbance, often severely impacting quality of life. While most people respond well to medical treatments like nasal steroids, saline rinses, and antibiotics, a significant number continue to suffer despite these therapies. For these individuals, sinus surgery may offer relief and improve daily functioning. Sinus surgery is not the first step in managing sinus disease. The American Academy of Otolaryngology-Head and Neck Surgery recommends that surgery be considered only after a patient has been properly diagnosed with CRS and has failed to achieve adequate symptom control with medical therapy. This typically means a trial of several weeks of topical intranasal steroids, sometimes combined with short courses of oral steroids or antibiotics, depending on the specific case. Surgery is also indicated for patients who cannot tolerate medical therapy due to side effects or contraindications, or for those who develop complications such as vision loss or severe infection. Objective evidence of disease—such as findings on a computed tomography (CT) scan—should support the decision to operate. The guideline emphasizes that the decision should be individualized, based on the severity of symptoms, impact on quality of life, and the likelihood of benefit from surgery compared to continued medical management. Patients with nasal polyps, bony erosion, fungal balls, or certain subtypes of CRS (such as eosinophilic mucin) are more likely to benefit from surgery. The most common procedure is endoscopic sinus surgery (ESS), performed through the nostrils using a small camera and specialized instruments. This minimally invasive approach avoids external incisions and aims to restore normal sinus drainage by removing obstructions such as polyps or thickened tissue. In some cases, more extensive surgery may be needed to address complications, tumors, or skull base defects. For appropriately selected patients, sinus surgery can lead to significant improvements in symptoms and quality of life. Studies show that most patients experience relief from nasal congestion, facial pain, and other symptoms that previously interfered with daily activities. Improvements are often maintained for years, although some patients may require revision surgery due to recurrence of polyps or disease. Surgery also enhances the effectiveness of ongoing medical therapy. After the sinuses are opened, topical treatments like nasal steroids can reach the affected areas more easily, leading to better long-term control of inflammation. In patients with aspirin-exacerbated respiratory disease, surgery followed by aspirin desensitization can reduce the risk of polyp recurrence. It is important for patients to understand that sinus surgery is not a cure for chronic sinus disease. The procedure aims to reduce symptoms, improve quality of life, and facilitate ongoing medical management. Chronic rhinosinusitis is a long-term condition, and most patients will need to continue some form of medical therapy after surgery. With that said, sinus surgery is a valuable option for adults with chronic rhinosinusitis who do not respond to medical therapy or who develop complications from their chronic disease. When performed for the right reasons and with realistic expectations, it can provide lasting symptom relief and improve quality of life. The decision to proceed with surgery should be based on a thorough evaluation, objective evidence of disease, and a clear understanding of the benefits and limitations of the procedure. For many, sinus surgery represents a turning point in the management of a challenging and persistent health problem. Evan McBeath is a otolaryngology, head and neck surgeon, with ENT Specialists of Northwest Ohio.