Patients with persistent or recurrent sinusitis who have not responded to medicinal interventions, therapies, or have a structural component contributing to their sinus blockage may benefit from surgery. Penn Medicine Becker ENT & Allergy Center in New Jersey and Pennsylvania provides sinus surgery as one of its services.
Most patients suffering with signs and symptoms of sinusitis find relief with medical treatments. Nasal steroids, nasal anti-histamines, saline nasal irrigation, oral anti-histamines, and oral anti-leukotrienes along with a vast supply of over-the-counter (OTC) medications are sufficient for most patients with sinus pressure, pain, congestion, smell disturbances, and headaches.
On occasion antibiotics and oral steroids may also be used to treat patients with recurrent sinus infections. For some patients; however, these medications are insufficient to provide long-term relief, and symptoms persist despite prolonged medical therapy. In instances where the sinus function is impeded as a result of structural blockage, surgery may be recommended as a way to remove the blockage and open the sinuses to restore natural drainage.
- What is sinusitis, and what causes it?
- What are the symptoms of acute sinusitis?
- What are the symptoms of chronic sinusitis?
- Would you benefit from sinus relief?
- Anatomy of the Sinuses
- What over the counter medications can help me?
- The Benefits of Sinus Surgery (Functional Endoscopic Sinus Surgery)
- Why choose a sinus specialist?
- Who is a Candidate for a Sinus Surgery?
- When should I see my doctor?
- Your Sinus Surgery Consultation
- What is Functional Endoscopic Sinus Surgery (FESS) and how is it performed?
- Sinus Surgery FAQs
What is sinusitis, and what causes it?
Sinusitis (or technically Rhinosinusitis) refers to inflammation of the nose and sinuses. Contrary to popular belief, sinusitis is an inflammatory – not infectious – disease. While patients may get sinus infections, it is the underlying inflammation that sets the stage for an infection to occur.
There are a number of common causes of nasal irritation and inflammation, including allergens, non-allergic pollutants, cigarette smoke and viruses. These can often lead to obstruction of the osteomeatal complex (sinus drainage pathway) from mucosal swelling and this leads to secondary bacterial sinusitis, which causes additional inflammation.
In addition, anatomic abnormalities such as polyps, tumors, foreign bodies (especially in children), enlarged adenoids, deviated nasal septum, and aerated middle turbinates (concha bullosa), may cause initial obstruction with the same result. It is common to see more than one contributing factor.
Other factors that may contribute to sinonasal inflammation include hormonal reactions associated with pregnancy, aging, medication misuse, medication reactions, and acid reflux.
What are the symptoms of acute sinusitis?
Acute sinusitis can last up to 4 weeks and may be viral or bacterial in origin. Recurrent sinusitis refers to the situation where a patient has repeated acute sinus infections but is relatively symptom free between these infections. Symptoms of acute sinusitis can include:
Diminished Sense of Smell
Post-Nasal Drip & Cough
Fever, Fatigue, and/or Dental Pain
Thick, Green or Yellow Nasal Discharge
What are the symptoms of chronic sinusitis?
Chronic sinusitis sufferers may have the following symptoms for 12 weeks or more:
Nasal Discharge/Discolored Post-Nasal Discharge
Pus in the Nasal Cavity
Diminished Sense of Smell
Fever, Fatigue, and/or Dental Pain
Would you benefit from sinus relief?
At Penn Medicine Becker ENT & Allergy, our New Jersey and Philadelphia Sinus specialists are highly-trained sinus experts who provide individualized treatment plans for patients who need help with their nose, allergies, and sinuses. We combine our experience and training with cutting-edge technology to be true Leaders in Sinus Relief
Many treatment options are available for those who suffer from:
Diminished Sense of Smell
Cough & Post Nasal Drip
Sinus Infection & Sinusitis
Nasal sprays and oral medications may provide partial or complete relief
Allergy testing to show if you can benefit from allergy shots or drops
New technologies allow for short, in-office procedures designed to address sinus-related symptoms
With minimally-invasive oupatient surgery, patients can reclaim normal sinus function
Anatomy of the Sinuses
There are 4 chamber-like sinuses on each side of the face. These are named the Maxillary sinuses (below the eyes), Frontal sinuses (above the eyes), Ethmoid sinuses (between the eyes), and Sphenoid sinuses (all the way in the back). The Ethmoid sinuses may be divided into an anterior (front) and posterior (back) group. The sinuses drain through small openings – called “ostia” – into the nasal cavity. Mucous drains down the nasal cavity and into the throat from where it is swallowed into the esophagus and stomach. Each sinus drains into a specified area. The maxillary, anterior ethmoid and frontal sinuses all drain into the “middle meatus”. The posterior ethmoid sinuses drain into the “superior meatus”, and the sphenoid sinuses drain into the “spheno-ethmoidal recess”.
The sinuses are lined by a mucous-producing mucosa. The mucosa produces over one liter of mucous daily, so it is imperative that the drainage pathways remain clear and open. When the sinus lining swells – from allergies, irritants (dust, chemicals), infections – the drainage openings narrow, and mucous production increases leading to a back-up. If the situation persists it can lead to infection (acute rhinosinusitis) or long-term swelling and sinus dysfunction (chronic rhinosinusitis).
In situations where structural blockage is determined to be a significant causative factor of sinus blockage, inflammation, or infection, surgical correction may be recommended. Below please find descriptions of sinus surgery along with answers for associated frequently asked questions.
What over the counter medications can help me?
For patients suffering from sinus issues for fewer than 7 days, here is a list of some over the counter medications that can help alleviate symptoms:
Tylenol Cold & Sinus
Advil Cold & Sinus
Claritin, Zyrtec or Allegra (Oral antihistamines)
As always, these medications must be used with care, and in accordance with recommended uses and precautions.
Topical decongestants are not recommended for chronic sinusitis. When topical decongestants are used for more than three to five days, a “rebound effect” with worsened symptoms will typically result.
Oral decongestants may raise blood pressure, and patients and their doctors should monitor blood pressure and may need to discontinue oral decongestants if blood pressure is affected. Oral decongestants may also impact other conditions such as prostate hypertrophy, and glaucoma, and the medication labels must be carefully adhered to.
Since higher concentrations are present in the bloodstream, systemic decongestants are more likely to produce side-effects. These include high blood pressure, anxiety and sleeplessness, and the “jitters.” Decongestants can also cause blurry vision (in patients who suffer from glaucoma) and difficulty urinating in patients with prostate problems.
Patients should let their doctor know if they are currently taking any medications for depression, since these medications can have serious adverse effects when they interact with either topical or systemic decongestants. Mucolytics, Anti-Fungals and Macrolides, and others.
The Benefits of Sinus Surgery (Functional Endoscopic Sinus Surgery)
Patients who suffer from persistent or recurrent signs and symptoms of sinusitis which have not responded to medical interventions and therapies, and who have a structural component contributing to their sinus blockage may benefit from surgical intervention. Patients typically report significant improvement in their sinus-related symptoms after surgery. This includes decrease in sinus-related facial pressure, congestion, nasal obstruction, rhinorrhea, and headache. Multiple studies support improvement in patient-reported quality of life measures, as well as objective findings on nasal endoscopy and CT scans. Published data demonstrates that even patients with other factors (co-morbidities) which might impact outcomes – asthma, smoking, allergies, prior sinus surgery – experience significant improvement after sinus surgery. In some cases, patients may still need medications (ie-nasal steroid sprays, nasal anti-histamines, saline irrigations, etc) to treat and manage the underlying disease process (sinusitis); however, unlike before surgery the medications are typically more effective since the sinuses will be open and accessible to topical medicines.
Why choose a sinus specialist?
Many people live with sinus-related issues and don’t realize that effective treatment is available. While you have the option to use over-the-counter medications to help ease your symptoms, you may find greater relief if you can identify and methodically treat the underlying source of your problem. A quick but thorough evaluation is the starting point for a comprehensive treatment plan to provide maximum, sustained relief for your nose, sinus and allergy-related symptoms. Patients are often surprised to learn that what has become a normal way of living can be relieved through something as simple as allergy treatment, or a mild in-office procedure like Balloon Sinuplasty.
Without a thorough evaluation, it is impossible to understand exactly what is causing your sinus-related issues. Schedule an appointment with a sinus specialist, and ask about allergy testing if you have not recently been tested.
Who is a Candidate for a Sinus Surgery?
Your physician will typically look for the least invasive means to help you manage your sinusitis symptoms and decrease the impact of sinus inflammation on your quality of life. In most cases, this will involve a series of medical treatments such as prescribed and over-the-counter oral pills, topical sprays, and irrigations. Ancillary tests – CT scans, allergy testing, etc – may be ordered to identify the root cause of your sinus swelling. In cases where medications do not provide sufficient, sustainable, long-term relief, and where there is felt to be a structural component to the sinus blockage, surgery may be considered. Opening the small sinus ostia is performed as a means to restore natural sinus drainage and to allow the sinus lining to return to its normal, healthy state.
When should I see my doctor?
If you are suffering from a cold for more than 10 days, or if your symptoms worsen after the first 7 days, you should consider seeing a sinus specialist. Many sinus doctors reserve spots for same-day appointments to accommodate sick patients. If you are not feeling better 3 to 5 days after starting antibiotics for a sinus infection, you should let your prescribing physician know.
Your Sinus Surgery Consultation
A visit to your New Jersey or Philadelphia ENT doctor or a telemedicine consultation will include a thorough review of your symptoms, as well as a history of any medications and other treatments that you have tried in the past. Your physician will look for medications that you have not tried, or perhaps medications you have tried that may be worth trying again in combination with other treatments. A focused exam – typically including a brief nasal endoscopy – will be performed to assess the status of the nose and sinus anatomy, and to identify any obvious abnormalities that might be contributing to your sinus condition. Prior testing will be reviewed, and further testing may be ordered. Once a complete assessment has been performed, a treatment plan will be developed and reviewed with you. This may include surgery, or perhaps an additional trial of medications to see if success can be achieved without surgery. If you decide with your physician that surgery such as endoscopic sinus surgery is an appropriate next step, details about the particular procedures to be performed will be discussed, and any and all questions answered.
What is Functional Endoscopic Sinus Surgery (FESS) and how is it performed?
FESS is surgery designed to open blocked sinuses and restore natural drainage pathways. The past decade has seen significant evolution in the surgery, so that it is now typically performed as a minimally-invasive, outpatient procedure. Small (4mm) endoscopes are placed in a patient’s nostrils to access and visualize the sinuses. These endoscopes are available with a variety of angled lenses to allow maximal visualization of the sinuses. Using specially designed surgical instruments the sinus ostia are identified and enlarged. Obstructing tissue and bone are carefully removed taking care to preserve the sinus lining which will usually return to its natural, healthy state once surgical healing is completed. In many cases, your surgeon will perform your sinus surgery using an Image Guidance Navigation System –a type of specialized GPS system which allows real-time tracking of surgical instrumentation in 3 dimensions. Also, dissolvable sutures are often used to keep the operated structures in place while they heal. Small absorbable spacers may also be placed for this purpose, as well as dissolvable implants which give off medications for several weeks to assist in the healing process. In addition, an ENT specialist will provide a guide to a successful recovery from sinus surgery.
Why Choose Our Specialists?
- Dr. Daniel G. Becker, Founder and Medical Director of The Penn Medicine Becker ENT & Allergy Center, is a highly trained, board-certified specialist who graduated magna cum laude from Harvard College in 1986.
- Dr. Samuel S. Becker, Director of Rhinology at The Penn Medicine Becker ENT & Allergy Center, is a highly trained, board-certified specialist who graduated from Amherst College in 1991 and attended medical school at the University of California San Francisco.
- Dr. Kenneth Rosenstein is a highly trained, board certified otolaryngologist who attended medical school at Mcgill University, and completed his residency training at the prestigious New York Eye and Ear Infirmary.
- Dr. Naomi Gregory is a highly trained, board certified otolaryngologist who specializes in the diagnosis and treatment of diseases of the ear, nose, and throat. Dr. Gregory completed medical school at the Philadelphia College of Osteopathic Medicine in Philadelphia PA.
- Dr. Michael Lupa, MD is a highly trained, board certified otolaryngologist with additional training in sinus surgery and allergy treatment as well as advanced skull base surgery. He studied Biology at Tufts University and went on to complete medical school at Case Western University School of Medicine in Cleveland, Ohio.
- Dr. Robert Mignone is a highly trained, board-certified otolaryngologist-head and neck surgeon who attended medical school at New York College of Osteopathic Medicine.
- Dr. Aubrey McCullough is a highly trained otolaryngologist, facial plastic and head and neck surgeon who completed medical school at Midwestern University Arizona College of Osteopathic Medicine.
- Dr. Luke Kim is an otolaryngologist who specializes in the diagnosis, medical management, and surgical treatment of diseases of the ear, nose, and throat. Dr. Kim graduated with honors and with distinction from Cornell University and completed his medical studies at the Perelman School of Medicine at the University of Pennsylvania.
Additional procedures besides Sinus Surgery
In some cases, additional anatomical structures may contribute to a patient’s symptoms and should be addressed in order to maximize outcomes. Septal deviation, enlarged turbinates, enlarged adenoids, concha bullosa are all adjacent structures that may impact a patient’s nose and sinus related health. If surgery on these structures is recommended, it can usually be performed during the same operation. Your surgeon will of course discuss what is most suitable for your particular situation.
Sinus Surgery FAQs
Where your sinus surgery is performed depends on the specifics of your surgery, as well as your general health and medical status. Most sinus surgery in the United States is typically performed at an Ambulatory Surgery Center (ASC). In some cases, sinus procedures are performed in the office setting. In more complex cases, or in patients with health conditions (cardiac disease, pulmonary disease, patients on blood thinners, etc) where it is preferable that they be observed and/or monitored in a hospital setting overnight, surgery may be performed in a standard hospital operating room.
In most cases FESS is performed under general anesthesia with the patient “asleep”. In some circumstances – typically in an office-based setting – surgery may be performed with a patient awake under “local” anesthesia. Details of what is most suitable for your surgery should be discussed with your surgeon.
In past decades, the entire nasal cavity was packed at the end of surgery. Patients describe extreme discomfort with packing. Today, there are few surgeons that still pack the nose; however, it is important to ask your surgeon to be sure. Some surgeons may use pre-fabricated packs left in for a day, or silastic splints left in for a day to a week. In most cases, no packing is used by surgeons at Penn Medicine Becker ENT & Allergy. But it is always best to discuss with your surgeon to confirm.
Sinus surgery for chronic sinusitis is performed in a minimally-invasive fashion with the sinuses accessed with small endoscopes placed in the nostrils. There should be no change to the facial or nasal appearance after surgery. This includes no black eyes or bruises.
Maybe. Sinus surgery involves opening the sinuses and taking steps to keep them open. In some cases, structures may be sutured to ensure that they do not move after surgery, and heal in the “open” position. In most cases, when sutures are used during sinus surgery, they are dissolvable sutures that do not need to be removed.
An allergy describes a specific way that your body reacts to certain foreign substances. For example, if you are allergic to dust mites, then when you breathe in “dustmite particles” they are recognized by specific allergy receptors in your nose. When they recognize the “intrusion” of dustmite particles, they cause the release of substances that are meant to fight the presence of these particles. These include the release of histamine and other substances that create an inflammatory response. These responses were designed as a defense against the “foreign intruder” – that is to say, the dustmite particles. However, this allergy response has the unfortunate consequence of causing unpleasant symptoms such as a scratchy throat, watery eyes, runny nose, sneezing (to expel the intruder) and so forth. Therefore, we often take anti-allergy medicines to tone down this response and relieve the symptoms of allergy and allergic response.
If you have allergies, your nose may react to allergy-inducing substances in the air, such as dust, grasses, weeds, or mold. Allergic nasal and sinus swelling may in turn lead to sinusitis.
Sinusitis is a bit more generic, it is simply inflammation in your nose and sinus cavities from any cause. Allergy can be one cause of inflammation, hence the term allergic rhinosinusitis, or sinusitis with an allergic component. However, there are a number of other factors that can contribute to sinusitis such as sensitivity to pollution, cigarette smoke, infection, and so forth.
By leaving your infected sinuses untreated, you will live with unnecessary discomfort and pain. In rare cases, patients with untreated sinus infections have suffered from meningitis, brain abscess, and eye infections.
Most patients describe mild discomfort after sinus surgery. While patients are typically given a low-dose narcotic to use during the first few days after surgery, many report that they do not take the narcotics and that their post-operative pain and discomfort is adequately managed with OTC pain relievers like Tylenol (Acetaminophen).
This is very patient-dependent, but most patients take off a few days from work. Heavy lifting and vigorous exercise typically should be avoided for 1-2 weeks; however, details should be discussed with your surgeon.
In some cases, opening the sinus passages alone restores the sinuses to their natural state and patients do well with minimal to no medications. In other cases, patients may still experience sinus swelling and infections; however, with the sinuses open, topical medications can reach the sinus lining and effectively reduce inflammation and treat infection with less medication (especially oral medications) than would have been needed before the sinuses were opened. Medication needs may vary person to person and even season to season, but in general it is hoped that after surgery patients will experience improved management of their sinus symptoms with decreased medication utilization.
There are few limitations on eating after sinus surgery. Eating may be impacted in some cases by nausea after anesthesia, but for the most part, patients can eat what and when they feel up to it. Of course, details should be discussed with your surgeon and answers may vary based on your particular medical history, medications, anesthesia, and procedure.
If you live in the states of New Jersey or Pennsylvania, Penn Medicine Becker ENT & Allergy Center offers sinus surgery among its services. For a full list of services, please visit our Locations page.