Experiencing facial pain, a heavy forehead when looking down, and a persistent runny or stuffy nose can significantly disrupt daily activities. These symptoms can be related to sinusitis, an inflammation of the lining of the sinus cavities surrounding the nose and face. Inflammation of the sinus mucosa can cause swelling, excess mucus production, and impaired drainage of mucus from the sinus cavities.
When diagnosed with sinusitis, one of the biggest fears that often arises in patients' minds is the thought of surgery. However, does sinusitis always require surgery?
The answer is that sinusitis does not always require surgery.
The good news is that most cases of sinusitis don't require surgery . Sinusitis treatment is always carried out in stages, starting with non-surgical (conservative) methods.
ENT specialists will generally categorize sinusitis first based on its duration and severity:
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Acute Sinusitis (lasting less than 4 weeks)
Inflammation of the sinus mucosa that lasts for a relatively short time. In many cases, this condition can improve with appropriate medical treatment and care.
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Chronic Sinusitis (lasting more than 12 weeks)
Inflammation that lasts a long time and often recurs, can be triggered by nasal polyps, a crooked nasal bone structure ( deviated septum ), or severe allergies.
First Aid: Drug Therapy (Conservative)
Before considering surgical options, an ENT specialist will provide initial medical treatment tailored to the underlying cause.
Some of the treatments that can be provided include:
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Avoid triggers
Patients with allergies may be advised to avoid exposure to triggers, such as dust, cigarette smoke, or certain allergens.
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Regulate lifestyle and environment
Maintaining environmental cleanliness, ensuring the air is not too dry, getting enough fluids, and maintaining good physical condition can help support respiratory health.
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Nasal irrigation (washing the nose with saline/NaCl solution)
Helps clear mucus, dirt, and allergens from the nasal cavity and helps maintain the condition of the nasal mucosa .
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Corticosteroid nasal spray
Used to help reduce swelling and inflammation of the nasal mucosa and sinuses, especially in chronic inflammatory conditions or those related to allergies.
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Antihistamine
It can be given to patients with allergic components to help control symptoms such as sneezing, runny nose, and itching.
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Other drugs
Doctors can prescribe additional medications based on the cause and symptoms experienced by the patient. Medication should be used according to the doctor's recommendations, especially if the symptoms persist or recur frequently.
When is Sinus Surgery Necessary?
Surgery is not the primary option for all patients, but it can be the next step in treatment if conservative therapy does not provide optimal results or there are certain conditions that require surgery.
In chronic sinusitis, doctors will generally evaluate the patient's response after optimal conservative therapy. If, after approximately 8–12 weeks of appropriate therapy, symptoms persist or show insufficient improvement, the doctor may consider surgery , after a thorough evaluation.
In addition to response to therapy, surgery may be considered if conditions such as:
1. Conservative Therapy Does Not Bring Improvement
Symptoms persist or are bothersome even though the patient has undergone medical therapy consistently and according to the doctor's recommendations.
2. There is a blockage or structural abnormality
Nasal polyps, enlarged turbinates, deviated septum, or other anatomical abnormalities that interfere with ventilation and mucus flow from the sinus cavity are found.
3. There is a sinus condition that requires surgery.
In certain conditions, for example the presence of masses, tissue abnormalities, or sinus problems that cannot be optimally treated with conservative therapy, the doctor may consider surgery.
4. Complications Occur
Sinus inflammation can lead to complications involving surrounding areas, such as the eye sockets or structures surrounding the brain. These conditions require immediate medical evaluation and treatment.
If, after a thorough evaluation, the doctor determines that surgery is necessary, the patient doesn't need to worry. Currently, the world of ENT medicine has adopted a minimally invasive surgical technology known as FESS (Functional Endoscopic Sinus Surgery) . The FESS technique uses a special endoscopic instrument inserted through the natural nostrils to open and improve sinus drainage without making incisions in the external facial skin.
Don't be afraid of surgery. Prioritize proper diagnosis and treatment.
Sinusitis doesn't always require surgery. Most cases can be treated with medical therapy tailored to the cause and the patient's condition. Surgery is usually considered if drug therapy is ineffective, there's a structural obstruction, or certain conditions require surgery.
If you experience persistent nasal congestion, facial pain, impaired sense of smell, or recurring sinusitis, consult an ENT-BKL specialist at EMC Alam Sutera Hospital for a proper diagnosis and treatment. Not all sinusitis ends in surgery; the most important thing is to identify the cause and receive appropriate therapy.
The article was written by Dr. M. Firman, Sp.THT-KL (Ear, Nose, and Throat Specialist (ENT) Head and Neck Surgery (BKL) EMC Alam Sutera Hospital).