As sinusitis encompasses various types eg acute, recurrent, chronic, with polyps, without polyps and has multiple different causes a simple answer is not possible.
What I do tell my patients in that the overall understanding of sinusitis has changed and the technique and technology for sinus surgery has improved so dramatically that the role of surgery is now more prominent and often plays a role earlier in the treatment course rather than as a ‘last chance’ option.
We now know that a small proportion of patients have a simple pattern of bad anatomy causing obstruction resulting in infections and by correcting the bad anatomy you can “cure” the problem but for most patients surgery allows access to the sinuses allowing us to continue to deliver topical medications, allow the contents of the sinuses to drain rather than stagnate and allow us to monitor the disease. What we are seeing is that this group has an enormous benefit when it comes to quality of life improvement
Soler and Smith in a recent review in the Otolaryngologic Clinics of North America concluded that “An abundance of evidence exists supporting the efficacy of Endoscopic Sinus Surgery to improve long-term Quality Of Life outcomes in patients with Chronic Rhino-Sinusitis.”
Otolaryngol Clin N Am 43 (2010) 605–612
So my approach is to offer maximal medical treatment and then re review the patient at their very best. If there is still clinical evidence of sinusitis then they are often offered surgery.
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