Sinus surgery is a type of medical procedure that is performed when a patient’s paranasal sinuses located within the bones around the nose and face present problems that don’t go away with other treatment. Usually, sinus problems are first treated with medicine and other non-surgical remedies.
Sometimes, though, these do not resolve the problem. If the sinuses do not improve following other treatments, an ear-nose-and-throat doctor, or ENT specialist, may decide that an operation would be best to remove the tissue that is inflamed and causing problems.
What are the sinuses and why would they need to be operated on?
Sinuses are open spaces in and between the bones of the face. They serve as air passageways, humidifiers, and filters, and as resonant chambers for the voice.
In some patients, the sinuses get obstructed, which in turn can lead to restricted breathing and other potentially frustrating effects. This can happen for a variety of reasons, including polyps (benign growths in the nose) or swelling. Or there may be anatomical issues: the patient may have been born with an unusually narrow nasal passage, or may have a deviated septum, meaning the wall between the nostrils is not straight and is blocking airflow.
In these cases—when doctors need to correct an issue within the sinus cavity—surgery can be beneficial.
What is sinus surgery like?
Sinus surgery has gotten much more sophisticated and less invasive over time. In years past, sinus surgery involved incisions to the face, lots of nasal packing with gauze for bleeding control, and a lengthy recovery.
In modern “endoscopic” sinus surgery, there are typically no external incisions made; rather, the doctor uses a slim instrument called an endoscope to perform the surgery via the nostril. The endoscope has a tiny lighted camera so the doctor can see what he or she is doing. This can lead to less pain and potentially a shorter recovery.
Sinus surgery physically removes blockages and widens the sinus openings, making it a very effective treatment for sinus symptoms. However, inflammation may return and scarring may occur following surgery. Both of these may block the sinuses once again and some patients require additional sinus surgery. Today, new technology exists to help prop open the sinuses following surgery and assist in the healing process.
The PROPEL® sinus stent, for example, has been proven to improve the effectiveness of sinus surgery by holding the sinuses open and treating the underlying inflammation. The PROPEL sinus stent is a small device coated with an anti-inflammatory medicine. During sinus surgery, the surgeon clears the diseased tissue and places PROPEL sinus stent inside the sinuses. The spring-like design allows it to conform to the unique shape of the sinus, securely prop the sinuses open, and deliver medicine directly to the diseased tissue. It helps improve the results of sinus surgery by decreasing the chance of post-surgical scarring and inflammation and reducing the need for oral steroids. It is designed to dissolve within 45 days. For more information on the benefits and risks of PROPEL sinus stent, please visit the safety information page.
How is sinus surgery performed?
Before surgery, the ear-nose-throat doctor, also called the ENT specialist, will make sure that other treatment options have been tried and that the patient is a good candidate for sinus surgery.
At this point, the ENT doctor will likely order a CT scan (a type of X-ray) to create an image of the sinus cavities, in order to plan for the surgery.
Once all tests have been performed and pre-surgery preparations have taken place, the scheduled operation begins. The patient may be placed under general anesthesia. This means the patient is unconscious and isn’t aware of what’s going on while the surgery is in progress. In some cases, the patient is placed under local anesthesia, meaning the face is numb and no pain is felt, but the patient is conscious or mildly sedated.
Once anesthesia has taken effect, the surgeon inserts an endoscope and other thin instruments through the nostril to remove tissue that is blocking the passage of air. In some procedures, a balloon is inserted and inflated; this also opens up the sinuses.
Results may vary
Each person’s anatomy is different, and that goes for the sinuses too. The particular issues affecting your sinuses are going to be unique, and although the techniques are standard, the finer details of the operation will be specific to you.
If you have sinus problems and you think sinus surgery might be useful in helping you move past them, consult with an ENT specialist. This is the type of doctor specifically trained to explain what is happening with your sinuses, what can be done about it, and what techniques might be best for you.
 Schaitkin, et al. Endoscopic Sinus Surgery: 4-Year Follow-up on the First 100 Patients. Laryngoscope 103: October 1993: 1117–1120.
 Han JK, Marple BF, Smith TL et. al., Int. Forum Allergy Rhinol. 2012; 2:271-279