When a feeling of pressure in the face, nasal congestion, dark-colored postnasal discharge, and reduced sense of smell continue for weeks, the problem is not always a simple upper respiratory tract infection. In patients with recurrent or persistent complaints despite medical treatments, sinus surgery may be an important treatment option aimed at restoring the natural ventilation and drainage of the sinuses. However, the decision for surgery is not made only according to a finding seen on tomography; the duration of the complaints, examination, endoscopic evaluation, and the person’s general health condition are considered together.
When does sinusitis require surgical evaluation?
The sinuses are air-filled cavities located within the bony structures around the nose. The narrow channels through which these cavities open into the nose may become blocked because of swelling, infection, polyps, anatomical narrowing, or adhesions related to previous surgeries. When drainage is impaired, secretions accumulate inside the sinus; this may lead to chronic inflammation, a feeling of pressure, and a cycle of recurrent infections.
Most acute sinusitis improves with appropriate medical treatment. Surgery is considered more often in chronic rhinosinusitis lasting longer than 12 weeks or in attacks that recur frequently during the year. Persistent nasal congestion, loss of smell, head and facial pain, postnasal drip, and impaired sleep quality may significantly affect daily life.
Other conditions that may suggest the need for surgery include nasal polyps, fungal sinusitis, structural problems causing mucus accumulation in the sinuses, and infections carrying a risk of complications near the eye socket or skull base. It should also be emphasized that not every headache is caused by sinusitis. Migraine, tension-type headache, jaw joint problems, and neurological causes may lead to similar complaints. Therefore, correct diagnosis is the first step in avoiding an unnecessary procedure.
How is evaluation performed before sinus surgery?
A comprehensive evaluation begins by listening to the patient’s complaints in detail. How long the complaints have continued, which treatments have been tried, history of allergies, asthma, aspirin sensitivity, smoking, and previous nose surgeries directly affect planning.
With nasal endoscopy, narrow areas inside the nose, polyps, sites of discharge, crusting, and septal deviation are evaluated. Paranasal sinus computed tomography shows in detail which parts of the sinuses are affected, anatomical variations, and the boundaries of surgery. Tomography alone is not an indication for surgery; it becomes meaningful together with examination findings and the patient’s complaints.
In some patients, allergy evaluation, additional examination for lung diseases, or consultation with the relevant specialty for dental-origin sinus problems may be necessary. Especially in people who have previously undergone sinus surgery, normal anatomical planes may have changed. Therefore, more careful surgical mapping is required in revision surgeries.
Nasal deviation and sinus disease may occur together
Septal deviation, meaning deviation of the middle partition inside the nose, may reduce airflow and negatively affect sinus ventilation in some patients. When septoplasty needs to be performed during the same operation, the aim is not only to reduce nasal congestion but also to provide safe access to the sinus regions and support functional airflow. If a procedure involving the external appearance of the nose is planned, functional and aesthetic goals should be evaluated in a way that does not negatively affect one another.
Which method is used?
Today, the most commonly performed approach is endoscopic sinus surgery. In this method, thin optical systems are advanced through the nostrils; no external incision is made. Under magnified visualization, the surgeon evaluates diseased tissue, polyps, or structures blocking the natural openings of the sinuses. The aim is to open the ventilation and drainage pathways while preserving the normal anatomy of the sinuses as much as possible.
The extent of the procedure varies from patient to patient. In some people, intervention in a limited sinus area is sufficient, while in widespread polyp disease, treatment of multiple sinuses may be required. Balloon sinus dilation is a method that may be considered in certain anatomical narrowings and selected patients. However, it is not always a suitable option in the presence of polyps, extensive inflammatory tissue, fungal disease, or widespread sinus involvement.
The use of navigation systems with imaging guidance during surgery may provide additional safety and precision, especially in cases with altered anatomy, widespread disease, or the need for revision. The choice of technology to be used is made according to the extent of the disease and the risk profile of the surgery.
The day of surgery and the early recovery process
Sinus surgeries are generally performed under general anesthesia. The duration of the procedure varies according to the number of sinuses to be treated, the presence of polyps, and the need for additional surgery. Many patients may be discharged on the same day or after a short period of hospital observation; however, the follow-up plan may differ in cases with accompanying health problems or extensive procedures.
During the first days after surgery, nasal congestion, mildly bloody discharge, a feeling of fullness in the face, and fatigue may occur. During this period, avoiding forceful nose blowing, staying away from heavy exercise for a while, and following the prescribed care recommendations are important for healing. Nasal irrigation with saline helps remove crusts and secretions. Medications to be given are determined according to the patient’s disease, allergy status, and the extent of the procedure performed.
An important part of healing is attending postoperative follow-up visits regularly. During endoscopic follow-up examinations, crusts may be cleaned, healing tissues may be monitored, and treatment may be adjusted when necessary. Surgery should not be considered a one-time solution that completely eliminates the need for medication in every patient with chronic sinusitis. Especially in people with allergies, asthma, or a tendency to develop polyps, long-term nasal care and medical follow-up are decisive in preserving the result achieved.
Why should risks be discussed individually?
As with every surgical procedure, sinus surgery carries risks such as bleeding, infection, adhesions, healing taking longer than expected, and recurrence of the disease. Because the sinuses are located close to the eye socket and skull base, rare but important complications are also evaluated in detail during surgical planning. The rates of these risks may vary according to the extent of the disease, previous surgeries, anatomical characteristics, and accompanying diseases.
A good surgical plan does not only describe the technical procedure. It considers the patient’s expectations, the true source of the complaints, the need for medical treatment, and the follow-up process together. As in Prof. Dr. Gediz Murat Serin’s approach, detailed evaluation by an experienced ENT specialist forms the basis of safe decision-making, especially in complex cases or cases involving previous surgery.
If your sinus complaints affect your quality of life, the aim is not only to correct the imaging result, but to determine a personalized treatment pathway that helps you breathe more comfortably, sleep better, and return to daily life with greater comfort.
