Question: What is the appropriate medical therapy for
Answer: Once the diagnosis of sinusitis is made,
medical therapy is instituted. The exact therapy chosen by your doctor
will depend upon the underlying cause. Therapy is aimed at relieving
obstruction of the nose and sinuses, particularly at the osteomeatal
complex. In addition, therapy is targeted in such a way as to treat any
infection that may be present.
In general, medical management of sinusitis may include one or more
of the following:
Antibiotics, topical and systemic decongestants, topical nasal
lavage, nasal saline sprays, humidification, mucolytics,
decongestants, and steroids.
Medical therapy must be undertaken under a doctor's care. Some medications for sinusitis
must not be taken if a patient has other medical conditions. For example, if a patient has high
blood pressure, or if a patient is pregnant, certain medications must not be taken.
Most cases of chronic sinusitis treated by otolaryngologists are
successfully treated with medical therapy. When medical therapy fails, the surgical alternative is a consideration.
Question: When is surgical intervention (FESS) considered?
Surgical intervention for chronic sinusitis is reserved
for those patients in whom maximal medical therapy has failed. Functional
endoscopic sinus surgery has become the most widely accepted approach for patients
undergoing surgical intervention for chronic sinusitis. The goal is to return the sinuses to as
near a normal anatomic state as possible. This surgery is intended to correct conditions
that impede mucocilary clearance of the sinuses, especially through the osteomeatal
complex. Respect of the normal drainage patterns of the sinuses and elimination or
improvement of obstruction of these drainage pathways promotes the resolution of
mucosal hypertrophy and infection and the return to a normal disease-free state.
Question: How many sinus surgical procedures are
performed each year in the United States?
Some estimates suggest that more than 200,000 sinus surgical procedures are performed each
Question: When should I consider surgery?
Answer: When anatomic abnormalities exist and are contributing to your
sinusitis, and when other therapies have failed, these abnormalities can be surgically corrected.
allow otolaryngologists to diagnose and treat these problems more
easily than in the past, allowing them to be more proactive in the management of anatomic nasal
Question: When is surgical management indicated?
Answer: Surgical management of sinusitis is considered when medical
management fails to relieve the patient of the symptoms of sinusitis, when the patient's
unrelieved by medical therapy, is also associated with lower respiratory tract problems such as
chronic bronchitis and asthma, and when complications of sinusitis are present or threatening.
In general, patients who fail maximum medical therapy are potential candidates
for surgical management.
Question: What are the surgical options?
Answer: FESS (or functional endoscopic sinus surgery) has essentially
replaced the traditional "old-fashioned" procedures for the conservative surgical management of sinus disease.
Functional endoscopic sinus surgery (FESS) is
aimed at restoring patency and normal mucociliary flow of the natural sinus openings.
With nasal endoscopes the narrow anatomical region of the sinus drainage pathways can be visualized and
accurately approached surgically.
FESS has brought dramatic positive improvement in
the surgical treatment of sinusitis.
Question: What is the key underlying concept behind
minimally invasive, functional endoscopic sinus surgery (FESS)?
Answer: The osteomeatal complex, or OMC - the small compartment
located in the region between the middle turbinate and the lateral nasal wall in the middle
represents the key region for drainage of the anterior ethmoid, maxillary and frontal sinuses.
Obstruction of the OMC causes a vicious cycle of events that lead to chronic sinusitis.
Functional endoscopic sinus surgery opens these natural sinus openings to restore normal sinus
Question: Tell me more about Functional Endoscopic Sinus
Answer: In FESS, an endoscope is used in the nose to view the nasal and sinus cavities. This generally
eliminates the need for an external incision. The endoscope allows for better visualization of
diseased or problem areas. This endoscopic view, along with detailed X-ray studies, may
reveal a problem that was not evident before.
FESS focuses on treating the underlying cause of the problem.
ethmoid area is usually opened, which allows for visualization of the maxillary, frontal and
sphenoid sinuses. The sinuses can then be viewed directly and diseased or obstructive tissue
removed if necessary. The surgery is commonly
performed on an outpatient basis.
Careful postoperative care is essential to the success of this surgery. The patient will be
provided postoperative care instructions. It is very important that
the patient follow these instructions, as well as any other instructions given by the surgeon, to
promote healing and decrease the chance of complications.
Question: Will endoscopic sinus surgery cure sinus
Answer: Overall, the majority of patients have had significant
improvement with the combination
of surgery and continued medical management. FESS performed as a result of medical
therapy failures in acute and chronic sinusitis is associated with a success rate of 75 to 95%
according to sources in the literature.
Sinusitis is a chronic problem, and while your symptoms may improve or even disappear
after surgery, the patients nose and sinuses still have the potential to be irritated by pollen,
dust, pollution, etc It should be realized that some medical therapy is usually continued after
surgery, especially if allergy or polyps play a role in the sinus disease. This is necessary to
control or prevent recurrence of disease.
It is possible that the disease may not be cured by the
operation, or that the disease may recur at a later time. If this should happen, subsequent
surgical therapy may be required.