To Surgery or Not: Managing Chronic Sinusitis and Treatment Options

Surgery? Medication?

Hello, I initially thought I had a cold that developed into acute sinusitis and then chronic sinusitis.
I have been on medication (including antibiotics) for over three months, from mid-February until now.
During this time, I also experienced ear effusion, and in the second month, I went to a major hospital where surgery was recommended due to the presence of pus in my nasal cavity and some nasal polyps.
However, my family doctor believes I can continue medication and monitor my condition.
Before going to the major hospital, I saw several different doctors.
After visiting the major hospital, I have been consistently seeing a doctor near my home.
Currently, there is no ear effusion, and my nasal discharge is neither yellow nor green, but I still have a runny nose and some phlegm.
My symptoms have improved, and I would like to ask: 1.
Is it better to see the same doctor for the same condition? 2.
Can antibiotics be taken for such a long duration? (I am currently experiencing nausea and changes in bowel movements.) 3.
Is surgery necessary, or should I continue with medication? Thank you.

A Cao, 30~39 year old female. Ask Date: 2019/05/19

Dr. Li Jiaxuan reply Otolaryngology

The acute complications of chronic sinusitis include ocular pressure or brain infection.
In the absence of acute complications, it can generally be treated with medication.
If the medication is unsatisfactory, surgical options may be considered.
It is advisable to consult a trusted specialist for ongoing follow-up.
Thank you.

Reply Date: 2019/05/19

More Info

Chronic sinusitis is a common condition that can significantly impact a person's quality of life. It often arises from an initial acute sinus infection that fails to resolve, leading to persistent inflammation and symptoms such as nasal congestion, facial pain, and post-nasal drip. Your situation, where you have been on antibiotics for over three months, raises several important considerations regarding treatment options and the potential need for surgery.

1. Continuity of Care: It is generally advisable to have continuity of care with the same healthcare provider or team, especially for chronic conditions like sinusitis. This allows for a comprehensive understanding of your medical history, treatment responses, and any changes in your condition. A single provider can better coordinate your care, monitor your progress, and make informed decisions about further interventions. If you have been seeing different doctors, it may lead to fragmented care, where important details may be overlooked or miscommunicated.

2. Long-term Antibiotic Use: Prolonged use of antibiotics can lead to several issues, including antibiotic resistance, gastrointestinal disturbances, and potential side effects such as nausea and changes in bowel habits, as you mentioned. Typically, antibiotics are prescribed for a limited duration, often around 10 to 14 days, unless there is a clear indication for extended treatment. If you have been on antibiotics for three months, it is crucial to reassess the necessity of continuing this treatment. Your symptoms of nausea and gastrointestinal discomfort could be side effects of the antibiotics or related to the underlying sinus condition itself. Discussing these symptoms with your healthcare provider is essential to determine whether a change in treatment is warranted.

3. Surgical Considerations: The decision to proceed with surgery for chronic sinusitis is multifaceted. Surgery is generally considered when medical management fails to provide relief or if there are anatomical issues contributing to the sinus blockage, such as nasal polyps or significant structural abnormalities. In your case, the presence of pus and nasal polyps may indicate that surgery could be beneficial, especially if you continue to experience symptoms despite medical therapy. Surgical options, such as functional endoscopic sinus surgery (FESS), aim to improve sinus drainage and ventilation, potentially leading to significant symptom relief.

In summary, it is crucial to have a thorough discussion with your ENT specialist regarding your ongoing symptoms, the effectiveness of your current treatment, and the potential benefits and risks of surgery. If surgery is recommended, it is typically because the expected benefits outweigh the risks, particularly if your quality of life is significantly affected by your symptoms. Additionally, if you have concerns about the long-term use of antibiotics, your doctor may consider alternative treatments or therapies that can help manage your chronic sinusitis without the need for prolonged antibiotic use.

In conclusion, managing chronic sinusitis often requires a tailored approach that considers the individual’s symptoms, treatment history, and overall health. Open communication with your healthcare provider is key to finding the most effective treatment strategy for your situation.

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