Do I Need Surgery for Chronic Sphenoid Sinusitis? Risks and Recovery Explained

Does chronic sinusitis require surgery?

Hello, Doctor.
I was recently diagnosed with right-sided sphenoid sinusitis due to a fungal infection.
I went to see a doctor because I was experiencing headaches, and a CT scan revealed that I have sphenoid sinusitis, although my headache is on the left side.
However, the doctor still recommended surgery for clearance.
Is surgery absolutely necessary? Is the risk of surgery very high? Is postoperative care very complicated? Thank you for your help.

Fu Tai Tai, 60~69 year old female. Ask Date: 2019/05/10

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, although not all symptoms may be present.
Diagnostic methods include endoscopy and imaging studies.
If acute sinusitis persists despite antibiotic treatment for more than two weeks, it is advisable to consult an otolaryngologist for bacterial culture.
If a "more virulent" bacteria is identified, a stronger antibiotic may be required.
It is recommended 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 treatment exceeds 2-3 months and sinusitis remains unresolved, it is highly likely to be "chronic" sinusitis, necessitating further examination.
If needed, surgical intervention may be required, and it is advisable to seek evaluation from an otolaryngologist.
If you strongly suspect chronic sinusitis with a fungal infection and exhibit clinical symptoms, surgery is typically the standard recommendation.
The sphenoid sinus is indeed deeper and carries some risks of cranial base involvement and bleeding; however, advancements in sinus surgery techniques and related instruments have significantly reduced the likelihood of side effects.
It is best to discuss further with your surgeon.
Wishing you peace and good health.

Sincerely,
Dr.
Chi Chao-Yun
Director, Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare

Reply Date: 2019/05/10

More Info

Chronic sphenoid sinusitis, particularly when associated with a fungal infection, can be a challenging condition to manage. The sphenoid sinuses are located deep within the skull, making them less accessible than other sinus cavities. This anatomical location can complicate both diagnosis and treatment. Your symptoms, including headaches, are common in cases of sinusitis, but the specific recommendation for surgery often depends on several factors, including the severity of the infection, the presence of complications, and the response to medical treatment.

Do You Need Surgery?
Surgery is typically considered when:
1. Medical Management Fails: If you've been treated with antibiotics or antifungal medications and your symptoms persist or worsen, surgery may be necessary to remove the infected tissue and allow for proper drainage.

2. Complications: If there are signs of complications, such as the infection spreading to nearby structures (e.g., the eyes or brain), surgery becomes more urgent.

3. Quality of Life: If chronic symptoms significantly impair your daily activities or quality of life, surgical intervention may be warranted to alleviate these issues.

Risks of Surgery
Surgery for chronic sphenoid sinusitis, particularly in the case of fungal infections, does carry risks. These include:
1. Infection: As with any surgical procedure, there is a risk of postoperative infection.

2. Bleeding: The proximity of the sphenoid sinuses to major blood vessels increases the risk of bleeding during surgery.

3. Vision Problems: Given the location of the sphenoid sinuses near the optic nerve, there is a risk of vision changes or loss.

4. Cerebrospinal Fluid Leak: In rare cases, surgery can lead to a leak of cerebrospinal fluid, which can have serious consequences.

5. Anesthesia Risks: General anesthesia carries its own set of risks, particularly for individuals with certain pre-existing health conditions.

Recovery and Postoperative Care
Postoperative care is crucial for a successful recovery. Here are some considerations:
1. Follow-Up Appointments: Regular follow-ups with your ENT specialist are essential to monitor healing and detect any potential complications early.

2. Nasal Care: You may be advised to use saline nasal sprays or rinses to keep the nasal passages moist and promote healing.

3. Avoiding Irritants: It's important to avoid smoke, strong odors, and other irritants that could exacerbate your condition.

4. Medications: You may need to continue antifungal or antibiotic medications post-surgery to ensure that the infection is fully resolved.

5. Activity Restrictions: You may need to limit physical activity for a period after surgery to allow for proper healing.

Conclusion
In conclusion, whether or not you need surgery for chronic sphenoid sinusitis depends on the specifics of your case, including the severity of your symptoms and the effectiveness of prior treatments. While surgery can be associated with risks, it may also provide significant relief and improve your quality of life if conservative measures fail. It is essential to have a thorough discussion with your ENT specialist about the potential benefits and risks of surgery, as well as what to expect during recovery. Your health and well-being should always be the priority, and making an informed decision with your healthcare provider is key.

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