Acute sinusitis is typically first treated with medications or nasal irrigation before more invasive sinus surgery options are explored. However, if a patient experiences recurrent acute sinusitis that is unresponsive to these treatments over time, the ENT physician may consider surgery to open up the nasal passages and drain the sinuses.
Diagnostic Workup Before Sinus Surgery
Before considering sinus surgery options, the ENT will first take a detailed clinical history and perform a thorough diagnostic workup to determine the underlying cause of the recurrent acute sinusitis. This workup may include:
- CT imaging of the sinuses
- Nasal physiology testing
- Olfactory testing
- Blood tests
This helps identify any structural or physiological factors contributing to the recurrent infections prior to surgery.
Current Sinus Surgery Techniques
If surgery is indicated, the current main techniques used are:
Functional Endoscopic Sinus Surgery (FESS)
FESS involves inserting a thin endoscope into the nasal passageways to visualize the sinuses and remove any obstructive or diseased tissue. This is done entirely through the nostrils without any external incisions. FESS is less invasive than traditional sinus surgery methods and can be done on an outpatient basis.
Image-guided surgery uses CT imaging integrated with infrared technology to guide the surgical instruments in real-time. This improves safety and navigation, especially for patients with complex sinus anatomy or previous surgery.
In summary, sinus surgery is considered for recurrent acute sinusitis unresponsive to medical therapy only after a full diagnostic workup. FESS and image-guided techniques allow for maximally effective and minimally invasive treatment of the sinuses.