If nasal congestion, facial pressure, dark postnasal drainage, and loss of smell persist for months, patients understandably ask the following question: is sinusitis surgery necessary? There is no single answer to this question. The decision for surgery is not based solely on a shadow seen on a CT scan or a few episodes of the common cold; it is made according to the duration of the symptoms, the response to treatments applied, the internal nasal structure, and the impact on the person’s daily life.
The aim of sinus surgery is not to operate on every patient who experiences sinus problems. The aim is to restore the natural ventilation and drainage pathways of the sinuses in cases of chronic inflammation and obstruction that do not improve despite appropriate medical treatment. In properly selected patients, this approach can significantly reduce recurrent attacks and the need for continuous medication while improving quality of life.
Does sinusitis always require surgery?
No. Most cases of acute sinusitis improve with supportive treatment, medications when appropriate, and time. Nasal discharge or a feeling of facial fullness that begins after a cold does not by itself indicate a need for surgery. Viral infections, allergies, migraine, and some dental problems can also cause symptoms similar to sinusitis.
Surgery is considered more often in chronic rhinosinusitis. Chronic rhinosinusitis is generally defined as symptoms related to the nose and sinuses lasting longer than 12 weeks together with evidence of inflammation on examination or imaging. Duration alone is not sufficient. During an ENT examination, evaluation of the inside of the nose with an endoscope and, when necessary, sinus CT imaging are important in understanding the source of the problem.
In some patients, the main problem is not the sinuses themselves but anatomical narrowing inside the nose. Septal deviation, enlargement of the inferior turbinates, polyps, or changes related to previous trauma and surgery may negatively affect sinus ventilation. Therefore, the treatment plan should be created by evaluating not only the sinuses but all structures that affect nasal breathing.
Is sinusitis surgery necessary: In which situations is it considered?
Surgery is generally considered in patients whose symptoms persist despite medical treatment applied for an adequate duration and with appropriate content. Depending on the type of disease, this treatment may include saline nasal irrigation, intranasal corticosteroid sprays, allergy control, antibiotics when necessary, and management of accompanying conditions. The same medication regimen is not appropriate for every patient; antibiotic use in particular should be planned based on a physician’s evaluation.
Conditions that strengthen the indication for surgical evaluation include frequently recurring sinusitis attacks that disrupt daily life, persistent nasal congestion and loss of smell, nasal polyps, chronic postnasal drainage with cough, suspected fungal disease in the sinuses, and significant anatomical obstructions. Findings such as swelling around the eyes, changes in vision, severe headache, high fever, or confusion require urgent evaluation without delay.
CT imaging is a valuable tool in surgical decision-making; however, it is not an indication for surgery on its own. Mild mucosal thickening may be seen without causing any symptoms. Conversely, in a patient with very severe complaints, the main cause of pain may be migraine, a temporomandibular joint problem, or another neurological condition. Distinguishing between these possibilities requires careful examination to avoid unnecessary procedures.
Why may the decision be different in sinusitis with polyps?
Nasal polyps are benign, soft tissues that develop from the nasal and sinus mucosa. They may cause loss of smell and severe obstruction and may occur together with asthma or aspirin sensitivity. Medical treatment may shrink the polyps and reduce symptoms, but in some patients the effect remains limited or the polyps grow again.
In this group, endoscopic sinus surgery may help medications reach the sinus tissues more effectively and open the airways. However, polyp disease may have a tendency to recur. Regular follow-up and preventive medical treatment after surgery are just as important as the operation itself.
What is done during endoscopic sinus surgery?
Today, sinusitis surgery is generally performed endoscopically through the nostrils without making an external incision. Thin camera systems are used to visualize the inside of the nose and the natural openings of the sinuses. Diseased tissues, polyps, or structures that block drainage are carefully corrected to support sinus ventilation.
The extent of surgery varies according to the spread of the disease. In some patients, intervention in a limited sinus area is sufficient, while more extensive planning may be required in cases of widespread polyposis or anatomical changes related to previous operations. If septal deviation or turbinate enlargement is significant, additional procedures may be considered during the same session to improve nasal breathing.
Planning should be especially meticulous in patients who have previously undergone sinus surgery but continue to have symptoms. Normal anatomical landmarks may have changed due to previous surgery. In these cases, detailed evaluation of high-resolution CT imaging, endoscopic examination, and the use of navigation technologies when necessary are important for safe surgery.
Which evaluations are performed before surgery?
A good surgical decision begins with a detailed medical history. The onset of symptoms, the seasons in which they worsen, previously used medications, history of allergies and asthma, smoking, dental treatments, and previous surgeries are reviewed. The location and character of the headache are also important because not every facial pain originates from the sinuses.
Nasal endoscopy is then used to evaluate polyps, discharge, crusting, septal deviation, and drainage pathways. Sinus CT imaging helps to understand the anatomy three-dimensionally, especially in chronic disease and during surgical planning. There are also situations in which images obtained during an active upper respiratory tract infection may be misleading.
The patient’s expectations should be discussed clearly. Sinus surgery may provide benefits for breathing, smell, postnasal drainage, and recurrent infections; however, it does not completely eliminate allergies and does not treat every type of headache. Realistic expectations are one of the fundamental elements of satisfaction.
What should patients expect during the recovery process?
During the first days after surgery, nasal congestion, mild bloody discharge, a feeling of pressure, and fatigue may occur. Most patients can return to light daily activities within a short time; however, sports, heavy lifting, and movements that may create pressure in the nose are postponed for a period according to the physician’s recommendation. It is natural not to feel the full results immediately during the first weeks because of swelling and crusting inside the nose.
An important part of recovery is postoperative care. Cleaning with saline solution, regular use of prescribed sprays or medications, and attending scheduled follow-up appointments contribute to healthy healing of the sinus openings. During follow-up visits, crusts inside the nose can be safely cleaned and treatment can be updated according to the patient’s recovery.
As with every surgical procedure, there are risks such as bleeding, infection, adhesions, recurrence of the disease, and, rarely, complications involving surrounding structures. Because the sinuses are close to sensitive structures such as the eyes and skull base, it is important for the procedure to be performed by an experienced ENT surgeon with appropriate hospital infrastructure and careful imaging-based planning.
If your sinusitis symptoms continue despite treatment, the most appropriate step is not to decide on surgery by yourself or postpone evaluation. A detailed ENT assessment can clarify whether your symptoms are truly sinus-related and whether the most appropriate approach for you is follow-up, medical treatment, or surgery.
