Warning Signs of Sinusitis That May Require Surgery

Sinusitis is a condition where the lining of the nasal cavity and sinuses becomes inflamed, leading to nasal congestion, runny nose, facial pain, and a potential impact on quality of life. Most patients respond well to medication, but in some severe or chronic cases, surgery may be necessary.

What is Sinusitis?

Sinuses are air-filled cavities located around the nasal cavity. There are four pairs: Maxillary sinuses, Frontal sinuses, Ethmoid sinuses, and Sphenoid sinuses. Normally, sinuses have small openings that connect to the nasal cavity to allow drainage of mucus and air. When the lining becomes inflamed, these openings can become blocked, leading to mucus buildup and bacterial growth, resulting in sinusitis symptoms.

There are 2 main types of sinusitis:

1. Acute Sinusitis: Symptoms appear suddenly and last less than 4 weeks, usually caused by a viral or bacterial infection.
2. Chronic Sinusitis: Symptoms last more than 12 weeks or recur frequently. Causes may include bacterial or fungal infections, structural nasal issues, allergies, or other respiratory conditions.

Signs and Symptoms of Sinusitis

• Nasal congestion: Difficulty breathing through the nose
• Runny nose: Discharge may be clear, cloudy, yellow, or green
• Post-nasal drip: Causes throat irritation, chronic cough, or sore throat
• Facial pain or pressure: Often occurs in the cheeks, forehead, between the eyebrows, around the eyes, or temples
• Upper tooth pain: Especially in the upper molars
• Reduced or lost sense of smell
• Sore throat, cough
• Fever, fatigue
• Ear pain or fullness (due to Eustachian tube involvement)

When Might Sinusitis Require Surgery?

Sinusitis treatment typically begins with medications such as antibiotics, decongestants, antihistamines, nasal steroids, and saline irrigation. However, if medication is ineffective or complications arise, surgery may be necessary. Doctors consider the following factors:

1. Chronic Sinusitis Refractory to Medical Treatment:

   • Symptoms last longer than 12 weeks despite appropriate and complete medical treatment
   • Frequent flare-ups that significantly affect quality of life
   • Detected structural abnormalities in the nasal cavity and sinuses (e.g., deviated septum, nasal polyps, narrowed sinus openings) that medication cannot resolve

2. Severe Complications:

   • Infection spread: Infection from the sinuses may spread to nearby areas such as
     • Eye socket: Causes redness, pain, visual disturbances, or bulging eyes, which can be an emergency and may lead to blindness
     • Brain: Infection may spread to the brain or meninges, causing meningitis or brain abscess, both of which are life-threatening
   • Sinus abscess or infected bone around the sinuses (Osteomyelitis)

3. Large Nasal Polyps:

   • Polyps large enough to block nasal or sinus passages, preventing medication from reaching the area and causing severe nasal obstruction and loss of smell
   • Recurrent polyps despite medical treatment

4. Fungal Sinusitis:

   • Certain fungi can cause a fungus ball or invasive fungal infection that destroys tissue, requiring surgical removal

5. Suspicion of Abnormal Mass or Tumor:

   • If an abnormal mass is detected in the sinuses, possibly a tumor or cancer, surgery may be needed for diagnosis and treatment

The most common sinus surgery performed today is Endoscopic Sinus Surgery (ESS), a minimally invasive procedure where a small endoscope and specialized instruments are inserted through the nostrils without any external facial incisions

Objectives of ESS:

• Enlarge blocked sinus openings to improve mucus and air drainage
• Remove trapped mucus, fungal debris, or pus from the sinuses
• Remove nasal polyps or inflamed tissue causing the issue
• Correct nasal structural abnormalities such as a deviated septum (if significantly contributing)

References

• Bangkok Hospital: Sinusitis That Never Gets Better – Is It Time for Surgery?
• Bangkok Hospital: Who’s at Risk of Sinusitis and How to Prevent It
• Samitivej Hospital: Chronic Sinusitis – Should You Consider Surgery?
• Samitivej Hospital: Sinusitis
• Chulalongkorn Hospital, Thai Red Cross (Sriphat Medical Center): Sinusitis
• Vibhavadi Hospital: Sinusitis