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Sinusitis: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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Sinusitis: Should I Have Surgery?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your
Summary

Get the facts

Your options

Have surgery to treat long-term (chronic) sinusitis.
Don't have surgery. Take medicines and use home treatment.

Key points to remember

Very few people need surgery for sinusitis. Most people can treat the problem with home care and medicines.
Surgery may be a good choice for people who have long-term (chronic) sinusitis. They may get one infection after another because something blocks the flow of mucus from the sinuses or because of another health problem. Surgery can remove blockages and make the sinus openings bigger. This helps the sinuses drain, preventing more infections.
To be sure that surgery is a good choice, you need to have a CT scan of your sinuses. This test will be done after you have followed what's called "maximum medical treatment" for 4 to 6 weeks. This means that you take medicines and follow home treatment to reduce infection and swelling. That helps your doctor see what's causing your infections.
You may need more than one surgery to fix your sinuses.
After surgery, you still may need to take medicines, such as antibiotics, and follow home treatment for a long time.
If you get chronic sinusitis because of allergies or another problem, you need to get that problem under control before you have surgery. You will have better results from surgery if you use medicine and home treatment after surgery to help to keep that problem under control.

FAQs

What is sinusitis?

Sinusitis is infection or inflammation of the mucous membranes that line the sinuses.

When a mucous membrane gets inflamed, it swells. This can block the normal flow of fluid from the sinuses into the nose and throat. Bacteria and fungi (plural of fungus) are more likely to grow and cause an infection in sinuses that can't drain.

The main cause of sinusitis is a viral infection, usually a cold. Allergies or other problems also can block the nasal passages and lead to sinusitis.

There are two types of sinusitis: acute (short-term) and chronic (long-term). You may have chronic sinusitis if:

You have had more than three sinus infections in 1 year that needed antibiotics to clear up, OR
You have had a sinus infection for more than 8 weeks that antibiotics have not cleared up.

Surgery may be a good choice for some people who have chronic sinusitis.

What can surgery do for sinusitis?

Surgery helps the sinuses drain, preventing infections. The doctor usually makes the sinus openings bigger by removing:

Infected, swollen, or damaged tissue.
Bone, to make a wider opening to let mucus drain from the sinuses.
Growths (polyps) inside the nose or sinuses.

There are two types of sinus surgery:

Endoscopic surgery is the type that is done most often. The doctor puts a thin, lighted tool called an endoscope in the nose to remove small amounts of bone or tissue that block the sinus openings. The doctor also can remove polyps.
Traditional surgery may be done for certain serious problems—such as pus in a sinus, infection of the facial bones, or a brain abscess. The doctor makes an opening into the sinus from inside the mouth or through the skin of the face.

Sometimes another problem inside the nose (such as a deviated septum) also needs to be fixed. This may be done during the same surgery. For more information, see the topic Repair of a Deviated Septum (Septoplasty).

After surgery, the doctor may prescribe:

Antibiotics to help fight infection.
Steroid nasal spray to reduce inflammation and help you heal.
Pain medicine.

When is surgery needed for sinusitis?

Very few people need surgery to treat sinusitis. But you may need surgery if ALL of these are true:

Your doctor says that you have chronic sinusitis.
You've followed what's called "maximum medical treatment" for 4 to 6 weeks. This means that you've taken medicines and followed home treatment for at least 4 to 6 weeks. This treatment includes antibiotics, a steroid nasal spray, and other prescription medicines.
You've had a CT scan of your sinuses after the 4 to 6 weeks of treatment. It is very important to have the CT scan done after this treatment. Reducing the swelling and infection as much as possible lets your doctor see what could be causing your infections.
The CT scan shows that something is keeping your sinuses from draining as they should.

You also may need surgery if:

You have a sinus infection caused by a fungus. Infections caused by fungus cannot be cleared up with antibiotics.
You have a serious problem such as an infection that spreads beyond your sinuses. This is rare.

What are the benefits of sinus surgery?

Sinus surgery can:

Help your sinuses drain, which can prevent sinus infections.
Improve your sense of smell. (But in some cases, scarring from surgery could decrease your sense of smell.)

Endoscopic surgery improves symptoms for about 90 out of 100 people. About 10 out of 100 people find that it doesn't help them.³

Surgery has the best chance of working if you use a steroid nasal spray and do home treatment after surgery to prevent future infections. You may use these treatments for a long time.

What are the risks of sinus surgery?

Sinus surgery can lead to minor or serious problems.

A small number of people have minor problems, such as:
- Scar tissue.
- Bleeding.
- Infection.
- A hole in the tissue between the nostrils (nasal septum).
- Bruising and swelling around the eyes.

Serious but rare problems can include:
- Heavy bleeding.
- Injury to the eye area.
- Inflammation of the tissue that covers the brain (meningitis).
- Leakage of the fluid around the brain.
- Brain injury.
Scarring from surgery could decrease your sense of smell.
The surgery might not work, so you could need a second surgery.

What can you do for sinusitis other than surgery?

Most of the time, you can treat your sinus problem with home care and medicines:

Home treatment

Drink plenty of fluids to help keep the mucus thin.
Hold a warm, damp towel or a warm gel pack to your face for 5 to 10 minutes several times a day.
Breathe warm, moist air from a steamy shower, a hot bath, or a sink filled with hot water. Avoid very cool, dry air. A humidifier can add moisture to the air in your home.
Use saltwater nasal washes to help keep your nasal passages open and to wash out mucus and bacteria. You can buy these saline nose drops at a drugstore or grocery store, or you can make your own at home. You may also find it helpful to gargle with warm salt water.
If you need to blow your nose, do it gently. Blowing your nose too hard may force thick mucus back into your sinuses. Keep both nostrils open when you blow your nose.

Medicines

Take pain relievers, such as acetaminophen or ibuprofen, that you can buy without a prescription.
Use decongestants to reduce the swelling of the mucous membranes. Before you use these medicines, check the label. They may not be safe for young children or for people who have certain health problems. Be careful when using some spray decongestants. They usually shouldn't be used for more than about 3 days, because they can cause more swelling of the mucous membranes after the medicine wears off.
Take antibiotics as directed, if your doctor prescribes them. Antibiotics can treat most short-term (acute) sinusitis when it is caused by bacteria.
Use steroid nasal sprays to reduce inflammation in the nasal passages.
Use mucolytics to thin the mucus in your sinuses.

Why might your doctor recommend surgery for sinusitis?

Your doctor might advise you to have surgery if:

You have many sinus infections that need treatment with antibiotics.
Home treatment doesn't stop your pain and other symptoms.
You've taken medicines and done home treatment for 4 to 6 weeks, and tests show that you have a sinus problem that surgery can fix.

Compare your options

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Have surgery for sinusitis Have surgery for sinusitis

You may be asleep. Or the doctor may numb the area (like at the dentist) and give you medicine to make you sleepy.
You may have some packing in your nose after surgery. Some types dissolve on their own. Gauze packing will need to be removed a few days after surgery.
You still need to take antibiotics and use steroid sprays after surgery to prevent infection.
You may have to sleep with your head raised for a few days.
You can't bend forward for a few days after surgery.

It may clear up your sinus pain and pressure.
Endoscopic surgery improves symptoms in about 90 out of 100 people.³
You may get rid of bad breath caused by sinus infections.

You may have some pain and bleeding for 2 weeks after surgery.
You could have less sense of smell after surgery.
Serious but rare risks can include heavy bleeding, meningitis, and brain injury. But these happen in less than 1 out of 100 sinus surgeries. That means they don't happen more than 99 times out of 100.¹
Surgery might not work. About 10 out of 100 people find that it doesn't help.³
You could need to have another surgery.

Use home care for sinusitis Use home care for sinusitis

You take antibiotics for a bacterial infection.
You use steroid nasal sprays, decongestants, and over-the-counter pain medicines.
You do other self-care, such as washing your nasal passages with saline, putting a warm cloth on your face, and blowing your nose gently.

Home care may get rid of your sinus infections. Antibiotics clear up bacterial infections about 90 out of 100 times.²
You don't have the risks of surgery.
You don't have the pain of surgery or need to deal with follow-up care.
You can decide later to have surgery if home care doesn't help you enough.

Home care might not get rid of your sinus problem.
Antibiotics don't work about 10 out of 100 times.²
It won't fix certain serious problems, such as an infection in the bones of your face or a brain abscess.
Antibiotics can cause side effects, which may include allergic reaction, nausea, and diarrhea.
Steroid nasal sprays can cause side effects, which may include a burning feeling in the nose and nosebleeds.
Spray decongestants can make congestion worse if you use them for more than 3 days.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about choosing surgery for sinusitis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have had one sinus infection after another for the better part of a year. I've been taking antibiotics and using steroids and decongestant nasal sprays for a month now with no results. My doctor just did a CT scan and found out that one of my sinuses is blocked. He says he can fix it with surgery.

Pete, age 43

I've had a couple of bouts of sinusitis this year, so I asked my doctor about sinus surgery. She said there are some stronger antibiotics and other treatments I should try. I agree that it's better to try the medicines.

Misti, age 32

My doctor fired all the medicines at this infection that she could, and I took them just the way she told me to, but nothing seemed to work. After she looked at my CT scan, my doctor thinks what I've got may be a fungal infection. That would explain why the antibiotics I've tried haven't helped. I hate the idea of having the surgery, but I have tried everything else.

Marona, age 54

I have pretty bad sinusitis, and I've had it a few times over the years. The last time I got it, my doctor prescribed antibiotics and showed me how to wash out my sinuses with salt water, and that worked. I'm going to try that again, and my doctor says there are some other things we can try, too, like nasal sprays and allergy medicines.

Jonathan, age 29

If you need more information, see the topic Sinusitis.

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have sinus surgery

Reasons to use home treatment

I want to do everything I can to stop my sinus infections.

I want to avoid surgery if at all possible.

More important

Equally important

More important

I'm not afraid of the risks of surgery.

I don't want to take any chance on problems from surgery.

More important

Equally important

More important

The pain and pressure in my sinuses is making me miserable.

I can control the pain and pressure with medicines.

More important

Equally important

More important

I'm tired of not breathing well.

I can still breathe well.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Home treatment

Leaning toward

Undecided

Leaning toward

Your summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

What matters to you

Credits and references

Credits

Author	Healthwise Staff
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Donald R. Mintz, MD - Otolaryngology

References

Citations

Joint Council of Allergy, Asthma, and Immunology (2005). The diagnosis and management of sinusitis: A practice parameter update. Journal of Allergy and Clinical Immunology, 116(6 Suppl): S13–S47.
Gwaltney JM (2005). Sinusitis. In GL Mandell et al., eds., Principles and Practices of Infectious Diseases, 6th ed., pp. 772–782. Philadelphia: Elsevier Churchill and Livingstone.
Shah AR, et al. (2008). Acute and chronic sinusitis. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, section 4, pp. 273–281. New York: McGraw-Hill.

Sinusitis: Should I Have Surgery?

You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery to treat long-term (chronic) sinusitis.
Don't have surgery. Take medicines and use home treatment.

Key points to remember

Very few people need surgery for sinusitis. Most people can treat the problem with home care and medicines.
Surgery may be a good choice for people who have long-term (chronic) sinusitis. They may get one infection after another because something blocks the flow of mucus from the sinuses or because of another health problem. Surgery can remove blockages and make the sinus openings bigger. This helps the sinuses drain, preventing more infections.
To be sure that surgery is a good choice, you need to have a CT scan of your sinuses. This test will be done after you have followed what's called "maximum medical treatment" for 4 to 6 weeks. This means that you take medicines and follow home treatment to reduce infection and swelling. That helps your doctor see what's causing your infections.
You may need more than one surgery to fix your sinuses.
After surgery, you still may need to take medicines, such as antibiotics, and follow home treatment for a long time.
If you get chronic sinusitis because of allergies or another problem, you need to get that problem under control before you have surgery. You will have better results from surgery if you use medicine and home treatment after surgery to help to keep that problem under control.

FAQs

What is sinusitis?

Sinusitis is infection or inflammation of the mucous membranes that line the sinuses .

When a mucous membrane gets inflamed, it swells. This can block the normal flow of fluid from the sinuses into the nose and throat. Bacteria and fungi (plural of fungus) are more likely to grow and cause an infection in sinuses that can't drain.

The main cause of sinusitis is a viral infection, usually a cold. Allergies or other problems also can block the nasal passages and lead to sinusitis.

There are two types of sinusitis: acute (short-term) and chronic (long-term). You may have chronic sinusitis if:

You have had more than three sinus infections in 1 year that needed antibiotics to clear up, OR
You have had a sinus infection for more than 8 weeks that antibiotics have not cleared up.

Surgery may be a good choice for some people who have chronic sinusitis.

What can surgery do for sinusitis?

Surgery helps the sinuses drain, preventing infections. The doctor usually makes the sinus openings bigger by removing:

Infected, swollen, or damaged tissue.
Bone, to make a wider opening to let mucus drain from the sinuses.
Growths (polyps) inside the nose or sinuses.

There are two types of sinus surgery:

Endoscopic surgery is the type that is done most often. The doctor puts a thin, lighted tool called an endoscope in the nose to remove small amounts of bone or tissue that block the sinus openings. The doctor also can remove polyps.
Traditional surgery may be done for certain serious problems—such as pus in a sinus, infection of the facial bones, or a brain abscess. The doctor makes an opening into the sinus from inside the mouth or through the skin of the face.

Sometimes another problem inside the nose (such as a deviated septum ) also needs to be fixed. This may be done during the same surgery. For more information, see the topic Repair of a Deviated Septum (Septoplasty).

After surgery, the doctor may prescribe:

Antibiotics to help fight infection.
Steroid nasal spray to reduce inflammation and help you heal.
Pain medicine.

When is surgery needed for sinusitis?

Very few people need surgery to treat sinusitis. But you may need surgery if ALL of these are true:

Your doctor says that you have chronic sinusitis.
You've followed what's called "maximum medical treatment" for 4 to 6 weeks. This means that you've taken medicines and followed home treatment for at least 4 to 6 weeks. This treatment includes antibiotics, a steroid nasal spray, and other prescription medicines.
You've had a CT scan of your sinuses after the 4 to 6 weeks of treatment. It is very important to have the CT scan done after this treatment. Reducing the swelling and infection as much as possible lets your doctor see what could be causing your infections.
The CT scan shows that something is keeping your sinuses from draining as they should.

You also may need surgery if:

You have a sinus infection caused by a fungus. Infections caused by fungus cannot be cleared up with antibiotics.
You have a serious problem such as an infection that spreads beyond your sinuses. This is rare.

What are the benefits of sinus surgery?

Sinus surgery can:

Help your sinuses drain, which can prevent sinus infections.
Improve your sense of smell. (But in some cases, scarring from surgery could decrease your sense of smell.)

Endoscopic surgery improves symptoms for about 90 out of 100 people. About 10 out of 100 people find that it doesn't help them.³

Surgery has the best chance of working if you use a steroid nasal spray and do home treatment after surgery to prevent future infections. You may use these treatments for a long time.

What are the risks of sinus surgery?

Sinus surgery can lead to minor or serious problems.

A small number of people have minor problems, such as:
- Scar tissue.
- Bleeding.
- Infection.
- A hole in the tissue between the nostrils (nasal septum).
- Bruising and swelling around the eyes.

Serious but rare problems can include:
- Heavy bleeding.
- Injury to the eye area.
- Inflammation of the tissue that covers the brain (meningitis).
- Leakage of the fluid around the brain.
- Brain injury.
Scarring from surgery could decrease your sense of smell.
The surgery might not work, so you could need a second surgery.

What can you do for sinusitis other than surgery?

Most of the time, you can treat your sinus problem with home care and medicines:

Home treatment

Drink plenty of fluids to help keep the mucus thin.
Hold a warm, damp towel or a warm gel pack to your face for 5 to 10 minutes several times a day.
Breathe warm, moist air from a steamy shower, a hot bath, or a sink filled with hot water. Avoid very cool, dry air. A humidifier can add moisture to the air in your home.
Use saltwater nasal washes to help keep your nasal passages open and to wash out mucus and bacteria. You can buy these saline nose drops at a drugstore or grocery store, or you can make your own at home. You may also find it helpful to gargle with warm salt water.
If you need to blow your nose, do it gently. Blowing your nose too hard may force thick mucus back into your sinuses. Keep both nostrils open when you blow your nose.

Medicines

Take pain relievers, such as acetaminophen or ibuprofen, that you can buy without a prescription.
Use decongestants to reduce the swelling of the mucous membranes. Before you use these medicines, check the label. They may not be safe for young children or for people who have certain health problems. Be careful when using some spray decongestants. They usually shouldn't be used for more than about 3 days, because they can cause more swelling of the mucous membranes after the medicine wears off.
Take antibiotics as directed, if your doctor prescribes them. Antibiotics can treat most short-term (acute) sinusitis when it is caused by bacteria.
Use steroid nasal sprays to reduce inflammation in the nasal passages.
Use mucolytics to thin the mucus in your sinuses.

Why might your doctor recommend surgery for sinusitis?

Your doctor might advise you to have surgery if:

You have many sinus infections that need treatment with antibiotics.
Home treatment doesn't stop your pain and other symptoms.
You've taken medicines and done home treatment for 4 to 6 weeks, and tests show that you have a sinus problem that surgery can fix.

2. Compare your options

	Have surgery for sinusitis	Use home care for sinusitis
What is usually involved?	You may be asleep. Or the doctor may numb the area (like at the dentist) and give you medicine to make you sleepy. You may have some packing in your nose after surgery. Some types dissolve on their own. Gauze packing will need to be removed a few days after surgery. You still need to take antibiotics and use steroid sprays after surgery to prevent infection. You may have to sleep with your head raised for a few days. You can't bend forward for a few days after surgery.	You take antibiotics for a bacterial infection. You use steroid nasal sprays, decongestants, and over-the-counter pain medicines. You do other self-care, such as washing your nasal passages with saline, putting a warm cloth on your face, and blowing your nose gently.
What are the benefits?	It may clear up your sinus pain and pressure. Endoscopic surgery improves symptoms in about 90 out of 100 people.³ You may get rid of bad breath caused by sinus infections.	Home care may get rid of your sinus infections. Antibiotics clear up bacterial infections about 90 out of 100 times.² You don't have the risks of surgery. You don't have the pain of surgery or need to deal with follow-up care. You can decide later to have surgery if home care doesn't help you enough.
What are the risks and side effects?	You may have some pain and bleeding for 2 weeks after surgery. You could have less sense of smell after surgery. Serious but rare risks can include heavy bleeding, meningitis, and brain injury. But these happen in less than 1 out of 100 sinus surgeries. That means they don't happen more than 99 times out of 100.¹ Surgery might not work. About 10 out of 100 people find that it doesn't help.³ You could need to have another surgery.	Home care might not get rid of your sinus problem. Antibiotics don't work about 10 out of 100 times.² It won't fix certain serious problems, such as an infection in the bones of your face or a brain abscess. Antibiotics can cause side effects, which may include allergic reaction, nausea, and diarrhea. Steroid nasal sprays can cause side effects, which may include a burning feeling in the nose and nosebleeds. Spray decongestants can make congestion worse if you use them for more than 3 days.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Sinusitis.

Personal stories about choosing surgery for sinusitis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have had one sinus infection after another for the better part of a year. I've been taking antibiotics and using steroids and decongestant nasal sprays for a month now with no results. My doctor just did a CT scan and found out that one of my sinuses is blocked. He says he can fix it with surgery."

— Pete, age 43

"I've had a couple of bouts of sinusitis this year, so I asked my doctor about sinus surgery. She said there are some stronger antibiotics and other treatments I should try. I agree that it's better to try the medicines."

— Misti, age 32

"My doctor fired all the medicines at this infection that she could, and I took them just the way she told me to, but nothing seemed to work. After she looked at my CT scan, my doctor thinks what I've got may be a fungal infection. That would explain why the antibiotics I've tried haven't helped. I hate the idea of having the surgery, but I have tried everything else."

— Marona, age 54

"I have pretty bad sinusitis, and I've had it a few times over the years. The last time I got it, my doctor prescribed antibiotics and showed me how to wash out my sinuses with salt water, and that worked. I'm going to try that again, and my doctor says there are some other things we can try, too, like nasal sprays and allergy medicines."

— Jonathan, age 29

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have sinus surgery

Reasons to use home treatment

I want to do everything I can to stop my sinus infections.

I want to avoid surgery if at all possible.

More important

Equally important

More important

I'm not afraid of the risks of surgery.

I don't want to take any chance on problems from surgery.

More important

Equally important

More important

The pain and pressure in my sinuses is making me miserable.

I can control the pain and pressure with medicines.

More important

Equally important

More important

I'm tired of not breathing well.

I can still breathe well.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Home treatment

Leaning toward

Undecided

Leaning toward

Credits

Author	Healthwise Staff
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Donald R. Mintz, MD - Otolaryngology

References

Citations

Joint Council of Allergy, Asthma, and Immunology (2005). The diagnosis and management of sinusitis: A practice parameter update. Journal of Allergy and Clinical Immunology, 116(6 Suppl): S13–S47.
Gwaltney JM (2005). Sinusitis. In GL Mandell et al., eds., Principles and Practices of Infectious Diseases, 6th ed., pp. 772–782. Philadelphia: Elsevier Churchill and Livingstone.
Shah AR, et al. (2008). Acute and chronic sinusitis. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, section 4, pp. 273–281. New York: McGraw-Hill.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Top of Page

Last Updated:August 3, 2010

Author:Healthwise Staff

Medical Review:Kathleen Romito, MD - Family Medicine & Donald R. Mintz, MD - Otolaryngology

© 1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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