Sinus Surgery

Sinus surgery is generally considered for patients whose symptoms and examination findings indicate that surgery is likely to provide more benefit than nonsurgical treatment alone. An ENT specialist may discuss surgery when a patient has:

• Chronic rhinosinusitis that remains troublesome despite appropriate medical management
• Nasal polyps contributing to persistent inflammation or obstruction
• Blocked sinus drainage pathways associated with documented sinus disease
• Selected cases of recurrent sinusitis where evaluation supports a surgical approach
• Certain forms of sinus disease that require removal of diseased tissue or improved access for ongoing treatment

A surgical consultation does not automatically mean that surgery is necessary. The physician should confirm the diagnosis, review previous treatment, assess the effect of symptoms on quality of life, and discuss the likely benefits, risks, and alternatives. For chronic rhinosinusitis, a CT scan is commonly obtained for surgical planning when surgery is being considered. Imaging findings should be interpreted alongside symptoms and examination findings rather than used as the sole reason for an operation. Learn more about the condition and nonsurgical options on our Sinusitis page and Sinus Treatment page.

Several procedures can improve sinus drainage or treat diseased tissue. The appropriate procedure depends on the patient’s condition and the anatomy of the affected sinuses.

Endoscopic Sinus Surgery

Endoscopic sinus surgery uses a small camera and specialized instruments inserted through the nostrils. The surgeon works inside the nasal passages to access the sinuses, improve drainage pathways, and remove selected diseased tissue when necessary. The procedure typically avoids external facial incisions. The extent of surgery varies according to the location and severity of the disease. Endoscopic sinus surgery may be considered for selected patients with chronic rhinosinusitis, nasal polyps, or other sinus conditions that have not responded adequately to appropriate medical management. The goal is to address the disease that is actually present while preserving healthy tissue where possible. Surgery does not eliminate every underlying cause of chronic inflammation, so continued medical management may still be necessary.

Balloon Sinus Dilation (Balloon Sinuplasty)

Balloon sinus dilation is a minimally invasive procedure that uses a small balloon catheter to widen selected sinus openings. A guidewire and catheter are directed toward the targeted sinus opening. The balloon is then inflated to widen the opening before it is deflated and removed. Unlike procedures that remove tissue, balloon dilation primarily expands the selected drainage pathway. It may be appropriate for certain patients with suitable anatomy and disease patterns. Balloon sinus dilation is not appropriate for every form of sinus disease. Patients with extensive nasal polyps, significant diseased tissue, or certain complex conditions may require a different surgical approach. Your physician can determine whether balloon dilation, endoscopic sinus surgery, or a combination of techniques is appropriate based on the examination and imaging findings.

Image-Guided Sinus Surgery

Image-guided sinus surgery uses computer-assisted navigation to help the surgeon determine the location of instruments in relation to the patient’s sinus anatomy. The system uses preoperative imaging, typically a CT scan, to provide anatomical guidance during surgery. This can be particularly useful in selected complex cases, revision procedures, or situations where the anatomy requires additional navigation support. Image guidance is an aid to surgical navigation, not a replacement for the surgeon’s knowledge, judgment, and direct endoscopic visualization. It is not necessary for every sinus operation. Whether image guidance is appropriate depends on the complexity of the disease, the planned procedure, and the surgeon’s assessment.

Combined or Hybrid Sinus Procedures

Some patients have disease that cannot be adequately addressed by balloon dilation alone. In selected cases, a surgeon may combine techniques to widen drainage pathways and remove diseased tissue where necessary. The procedure should be tailored to the disease present rather than selected solely because one technique is considered less invasive.

Choosing a sinus surgery technique requires an individualized evaluation.

Review of Symptoms and Medical History

The physician reviews the duration and pattern of symptoms, previous sinus infections, nasal obstruction, changes in smell, allergies, existing medical conditions, and response to prior treatments.

Nasal Examination and Endoscopy

A nasal examination may identify swelling, drainage, structural abnormalities, or nasal polyps. Nasal endoscopy provides a closer view of the nasal passages and sinus drainage areas.

CT Imaging

A sinus CT scan may be used to assess the extent and location of disease and help plan surgery. The findings are considered alongside the patient’s symptoms and physical examination.

Discussion of Treatment Options

The surgeon discusses whether continued medical management or surgery is likely to offer the greater benefit. If surgery is appropriate, the discussion should cover the proposed technique, expected outcomes, potential complications, alternatives, and postoperative care. The aim is to select a procedure that addresses the patient’s specific condition and establishes realistic expectations for improvement and ongoing management.

For appropriately selected patients, sinus surgery may improve sinus drainage, reduce the burden of chronic symptoms, and make ongoing topical treatment more effective. Potential benefits depend on the type and extent of disease and the procedure performed. Outcomes vary, and no operation can guarantee complete or permanent relief.

It is important to understand that:

• Surgery does not cure every underlying inflammatory condition.
• Symptoms may persist or return, particularly when chronic inflammation continues.
• Some patients need ongoing saline irrigation, nasal corticosteroids, allergy management, or other medical treatment.
• Balloon dilation is not suitable for every type of sinus disease.
• The risks and recovery requirements vary by procedure and individual health factors.

Potential complications may include bleeding, infection, persistent symptoms, recurrence of disease, and, rarely, injury to nearby structures such as the eye or the tissues surrounding the brain. Your surgeon should explain the risks relevant to your planned procedure. A clear discussion of both the benefits and limitations helps patients make an informed decision.

Preparation depends on the procedure, anesthesia plan, medical history, and the surgeon’s instructions. Before surgery, patients may be asked to:

• Review current medications, supplements, allergies, and relevant medical conditions.
• Discuss medications that may affect bleeding or anesthesia with their healthcare team.
• Complete any recommended preoperative assessment or testing.
• Review fasting instructions if anesthesia or sedation is planned.
• Arrange transportation and assistance if required after the procedure.
• Understand postoperative medication, irrigation, activity, and follow-up instructions.

Do not stop prescribed medications or change their dosage without guidance from the treating clinician. The surgical team will explain the specific preparation requirements based on the procedure and the patient’s circumstances.

Recovery varies depending on the type and extent of surgery. Some patients undergo selected procedures in an outpatient setting, while more extensive procedures may involve different recovery arrangements. Temporary nasal congestion, drainage, mild discomfort, fatigue, and some bleeding can occur during recovery. The amount and duration vary by patient and procedure.

Nasal Care After Surgery

The surgeon may recommend saline irrigation to help clear mucus, crusting, and blood from the nasal passages. Nasal medications may also be prescribed or resumed according to the postoperative plan. Follow the treating physician’s instructions about when to begin irrigation, which medications to use, and how frequently to perform nasal care.

Activity and Return to Work

Patients should follow individualized guidance regarding physical activity, lifting, exercise, travel, and return to work. Restrictions depend on the procedure and the patient’s progress. Avoid strenuous activity for the period specified by the surgical team, particularly when it could increase the risk of bleeding.

Follow-Up Appointments

Postoperative visits allow the surgeon to assess healing, examine the nasal passages, remove crusting or debris when indicated, and adjust ongoing treatment. Follow-up is an important part of care because chronic sinusitis can recur even after a technically successful operation. Continued treatment may be needed to control inflammation and maintain symptom improvement. Contact the surgical team promptly if symptoms worsen unexpectedly. Heavy or persistent bleeding, changes in vision, severe headache, or other concerning symptoms require urgent medical assessment.