Sinus Surgery Types for Chronic Sinusitis

When does chronic sinusitis require surgery?

Chronic sinusitis is defined as sinus inflammation lasting 12 weeks or longer despite attempts at treatment 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Definition of chronic sinusitis (12+ weeks); surgical indications after failure of medical therapy; role of CT and nasal endoscopy in pre-surgical workup; criteria for ENT referral. The standard approach begins with non-surgical measures: topical nasal corticosteroid sprays, saline irrigation, management of contributing allergies, and targeted antibiotics when a bacterial infection is confirmed.

Surgery is generally considered when 1Ref 1Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015).Clinical Practice Guideline (Update): Adult Sinusitis.Definition of chronic sinusitis (12+ weeks); surgical indications after failure of medical therapy; role of CT and nasal endoscopy in pre-surgical workup; criteria for ENT referral: - Symptoms remain significantly disruptive after appropriate medical therapy (typically 12+ weeks of treatment) - CT scan of the sinuses shows persistent anatomical blockage — thickening of the sinus lining, polyps, or structural problems — that medical therapy cannot resolve - Recurrent acute sinusitis episodes occur despite preventive treatment - There is a complication of sinusitis such as a mucocele, abscess, or spread of infection

The decision is made by an ENT (otolaryngologist) after a thorough evaluation that includes a nasal endoscopy to look inside the nasal passages and a sinus CT scan.

What is functional endoscopic sinus surgery (FESS)?

FESS is the most widely used surgical approach for chronic sinusitis. It is performed entirely through the nostrils — there are no external cuts or incisions. The surgeon uses a thin, lighted camera (endoscope) and small instruments to:

• Remove tissue, bone, or polyps that are blocking sinus openings
• Enlarge the natural drainage pathways of the sinuses
• Improve the flow of mucus and allow topical treatments (sprays, rinses) to reach the sinus lining more effectively

FESS is done under general or local anesthesia and typically takes 1–3 hours depending on how many sinuses are involved and the complexity of the anatomy. Most people go home the same day.

Recovery involves several weeks of saline irrigation, follow-up endoscopic debridements (cleaning of the surgical site in the office), and nasal steroid sprays. The sinuses fully heal over several months.

What is balloon sinuplasty?

Balloon sinuplasty is a less invasive option that uses a small flexible balloon catheter, similar in concept to cardiac angioplasty. The balloon is inserted into the blocked sinus opening and inflated to widen the passage, then removed. No tissue is cut or removed.

Advantages include faster recovery and less bleeding compared to FESS. However, it is most appropriate for: - Milder chronic sinusitis without significant polyps or complex anatomy - Specific sinuses (maxillary, frontal, and sphenoid sinuses more commonly than ethmoid)

When significant tissue removal is needed — for example, to address polyps or complex ethmoid disease — FESS remains the standard. Your ENT will determine which approach matches your anatomy.

What about nasal polyps — does that change the surgery?

Yes. Nasal polyps are soft, noncancerous growths on the lining of the sinuses or nasal passages that develop in response to chronic inflammation. They block airways and sinus drainage and often require direct removal. FESS can address polyps alongside opening blocked sinus passages.

Polyps frequently recur. Managing underlying inflammation — particularly with high-dose topical nasal steroids, and in some cases biologic medications like dupilumab — is important for preventing recurrence after surgery. If polyps are the dominant issue, your ENT and allergist may collaborate on a treatment plan.

What is the difference between sinus surgery and antibiotics?

Antibiotics treat bacterial infections — they have no effect on the underlying anatomical or inflammatory processes that cause chronic sinusitis. Research confirms that most acute sinusitis episodes are viral, and even bacterial cases often resolve without antibiotics 2Ref 2Lemiengre MB, van Driel ML, Merenstein D, Liira H, Mäkelä M, De Sutter AI (2018).Antibiotics for acute rhinosinusitis in adults.Cochrane evidence that most acute sinusitis resolves without antibiotics — contextualizes why antibiotics address infection but not the anatomical obstruction that drives chronic disease. Antibiotics are used selectively when clinical criteria suggest bacterial infection is driving symptoms.

Surgery, by contrast, addresses structural obstruction. It does not cure chronic sinusitis by itself — the underlying inflammatory tendency persists — but it restores proper drainage and allows topical treatments to work far more effectively. Surgery and ongoing medical management work together.

How do I prepare to talk to an ENT about sinus surgery?

Before your appointment: - Keep a symptom log tracking how long symptoms have lasted, what makes them worse, and what treatments you have already tried - Bring documentation of prior antibiotic courses and nasal medications - Ask your primary care clinician for a referral and any imaging already done

At the ENT visit, useful questions include: - Do you recommend FESS, balloon sinuplasty, or a combination? - How many of my sinuses are involved? - Do I have polyps, and does that change the approach? - What is the recovery timeline and what restrictions should I expect? - What ongoing treatment will I need after surgery to prevent recurrence?

Gale can help you prepare for and coordinate a referral to an ENT specialist.