Chronic Sinusitis Surgery: Weighing Options and Risks for Relief

Chronic Sinusitis Surgery

Hello, Doctor.
I previously inquired about chronic sinusitis, and I recently underwent a sinus CT scan, which confirmed inflammation.
Reflecting on the past two years, I have had similar CT scans, all showing inflammation, but the CT results indicated that it was not severe, with most sinus cavities appearing clear.
There was also minimal yellow discharge during endoscopy.
However, I am currently experiencing pain behind my eyes, pain at the back of my head, and pain in the center of my forehead, with symptoms being most severe in the morning and after napping, followed by some relief.
Nonetheless, I feel fatigued throughout the day, experiencing post-nasal drip that I can only swallow back, as I cannot blow it out.
Sometimes, I feel unsteady on my feet (not vertigo).
Symptoms worsen with colds and cold weather.
All these symptoms align perfectly with chronic sinusitis.
The doctor did not indicate that surgery is necessary.
The issue is that I feel stuck (internal medicine, neurology, psychiatry, cardiology, and ophthalmology have all returned normal results).
As far as I know, in medicine, there are a few cases of chronic sinusitis that are not visible through endoscopy or CT, such as so-called negative pressure sinusitis or slight sinus pathology, where sometimes only the sinus ostium is swollen (although the doctor mentioned that those who have not had surgery cannot see the ostium because it is obstructed by tissue).
Additionally, the doctor mentioned that the middle and superior turbinates are well-developed with many air pockets, and surgery could be considered.
I would like to ask the following: 1.
Given that my symptoms are extremely painful every day and almost entirely match chronic sinusitis, should I consider surgery to open the sinus ostium? Are there any potential complications? I feel uneasy since the doctor does not recommend it.
2.
Although the middle and superior turbinates are well-developed with large air pockets, my headaches are dull and pressure-like rather than severe, even when I have a cold.
Furthermore, the middle turbinate has undergone anesthetic testing, so it should not be turbinate syndrome.
The doctor also mentioned that addressing the superior turbinate might affect my sense of smell, which makes me hesitant.
3.
Overall, I personally feel that sinus surgery should be performed, but I would prefer not to address the turbinates, or at most, just the middle turbinate.
I am uncertain if this decision is good or bad.
Thank you, Doctor.

JS, 40~49 year old female. Ask Date: 2018/09/15

Dr. Ji Zhaoyun reply Otolaryngology

Hello, common symptoms of sinusitis include nasal congestion, yellow-green nasal discharge, fever, facial pain, foul smell, and changes in smell, but not all symptoms may appear.
Diagnostic methods include endoscopy and imaging studies.
If acute sinusitis persists despite antibiotic treatment for more than two weeks, it is recommended to consult an otolaryngologist for bacterial culture.
If a more virulent strain of bacteria is identified, a stronger antibiotic may be necessary.
It is advisable to purchase a nasal irrigation device (containing isotonic saline) and perform rinsing 1-2 times daily to enhance the treatment of sinusitis.
Additionally, avoid staying up late, refrain from smoking, and individuals with diabetes should control their blood sugar levels.
If sinusitis has not improved after 2-3 months of treatment, it may be classified as chronic sinusitis, requiring further examination, and if necessary, surgical intervention should be considered.

Regarding the symptoms you mentioned—"there is rarely yellow discharge during endoscopy, but currently there is pain behind the eyes, pain in the back of the head, and pain in the forehead, with symptoms being most severe in the morning and after a nap, then alleviating, but feeling fatigued throughout the day, with post-nasal drip that can only be swallowed back and cannot be expelled, and sometimes feeling unsteady (not vertigo).
Cold weather and colds exacerbate the condition"—these symptoms do not sound typical for chronic sinusitis.
It is recommended to interpret the symptoms in conjunction with endoscopy and CT reports.
If the primary diagnosis is not chronic sinusitis, undergoing sinus surgery may not yield significant improvement in symptoms.
Wishing you peace and health.
Director of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare, Chi Chao-Yun.

Reply Date: 2018/09/15

More Info

Chronic sinusitis can be a debilitating condition, and the decision to undergo surgery is often complex and requires careful consideration of various factors. Based on your symptoms and the information provided, it seems that you are experiencing significant discomfort, including facial pain, nasal drainage issues, and fatigue, which are common in chronic sinusitis.
1. Considering Surgery: Given that your symptoms are persistent and affecting your quality of life, it may be worth considering surgery to open the sinus passages, especially if conservative treatments have not provided relief. Endoscopic sinus surgery is a common procedure that aims to improve sinus drainage and function. While surgery can provide significant relief for many patients, it is essential to understand that it is not without risks. Potential complications can include bleeding, infection, and changes in smell. However, these risks are generally low, and many patients experience substantial improvement in their symptoms post-surgery.

2. Understanding the Role of Nasal Turbinates: The nasal turbinates (including the middle and superior turbinates) play a crucial role in regulating airflow and humidifying the air we breathe. If your doctor has indicated that your turbinates are enlarged, this could contribute to your symptoms. While addressing the turbinates surgically can help, it is important to consider the potential impact on your sense of smell. If your symptoms are primarily related to sinus drainage rather than turbinate hypertrophy, it may be reasonable to focus on sinus surgery first and reassess the need for turbinate intervention later.

3. Making an Informed Decision: It is understandable to feel apprehensive about surgery, especially if your doctor has not strongly recommended it. It may be beneficial to seek a second opinion from another ENT specialist who can review your case and imaging studies. This can provide you with additional insights and help you feel more confident in your decision. Additionally, discussing your concerns openly with your current physician can help clarify the rationale behind their recommendations and address any fears you may have about potential outcomes.

4. Alternative Treatments: Before committing to surgery, consider exploring other treatment options. These may include nasal corticosteroids, saline irrigation, or even allergy management if allergies are contributing to your sinus issues. Sometimes, a combination of medical management and lifestyle changes can lead to significant improvements without the need for surgery.

5. Long-term Management: Chronic sinusitis often requires ongoing management, even after surgery. This may include regular follow-ups with your ENT specialist, continued use of nasal sprays, and maintaining good nasal hygiene. Understanding that chronic sinusitis can be a long-term condition may help you set realistic expectations for your treatment journey.

In conclusion, while surgery can be an effective option for chronic sinusitis, it is essential to weigh the potential benefits against the risks and to consider all available treatment options. Engaging in open discussions with your healthcare providers and seeking additional opinions can empower you to make the best decision for your health and well-being.

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