When chronic sinusitis continues despite medication or other treatments, it may be time to have the underlying cause evaluated by a sinus specialist. Ongoing congestion, drainage, facial pressure, reduced sense of smell, and recurring sinus infection symptoms can sometimes be related to inflammation, nasal polyps, structural changes, or sinus blockage.
Dr. Mani H. Zadeh is a board-certified otolaryngologist and rhinologist in Los Angeles who evaluates and treats chronic nasal and sinus conditions. His practice provides medical and surgical care for chronic rhinosinusitis, nasal polyps, deviated septum, and other causes of persistent nasal and sinus symptoms.
Surgery is not automatically needed when symptoms continue. A specialist can review previous treatments, perform a nasal examination and endoscopy, and use CT imaging when appropriate to determine whether continued medical care or a procedure may be appropriate.
Why Chronic Sinusitis May Not Improve With Treatment
Chronic sinusitis involves ongoing inflammation of the sinus lining. When inflammation causes swelling around the sinus openings, normal mucus drainage can become impaired. This can contribute to congestion, facial pressure, drainage, and recurring infections.
Several conditions may contribute to ongoing sinus symptoms, including:
- Chronic inflammation
- Sinus blockage
- Nasal polyps
- Deviated septum
- Enlarged turbinates
- Scar tissue
- Recurrent infections
- Other structural changes affecting the nasal passages or sinuses
Nasal polyps can develop because of chronic inflammation and may interfere with normal airflow and sinus drainage. A deviated septum can also narrow the nasal passages and contribute to difficulty breathing through the nose.
Common symptoms of chronic sinus disease include:
- Nasal congestion
- Nasal drainage
- Facial pressure or pain
- Reduced sense of smell
- Recurrent sinus infections
- Difficulty breathing through the nose
Having ongoing symptoms does not automatically mean that surgery is needed. Medical treatment may still have a role depending on the cause. Treatment can include medications, nasal sprays, saline irrigation, allergy treatment, or treatment directed at an infection.
When symptoms continue despite treatment, however, additional evaluation may help identify why the condition has not improved.
Also Read: When is Surgery a Good Idea for Sinusitis?
When Should You See a Sinus Surgeon for Chronic Sinusitis?
Consider an evaluation when symptoms remain after medical treatment, repeatedly return, or interfere with breathing and daily activities.
A specialist evaluation may be especially useful when you have:
- Repeated sinus infections
- Chronic nasal congestion
- Ongoing facial pressure
- Reduced sense of smell
- Drainage that continues despite treatment
- Suspected nasal polyps
- Known structural abnormalities
- Previous sinus surgery with continued symptoms
The physician can also review which treatments you have already tried and how you responded to them. This helps distinguish between a condition that may need another medical approach and one that may benefit from surgery.
Nasal endoscopy
Nasal endoscopy provides a direct view of the nasal passages, sinus openings, and surrounding structures. A slender endoscope is passed through the nostril to examine the nasal cavity. The examination can identify findings such as nasal polyps, inflammation, drainage, scarring, or anatomical narrowing and can provide objective information that helps evaluate chronic or recurrent sinus symptoms.
The examination can usually be completed in the office, and the findings can be discussed during the same visit.
CT imaging
A sinus CT can provide additional information about the anatomy and condition of the sinuses. CT findings can help show areas of disease or obstruction and can be used when planning sinus surgery.
Together, your symptoms, treatment history, nasal examination, endoscopy, and imaging can help determine the appropriate next step.
Seeing a surgeon does not mean that you will need surgery. It provides an opportunity to discuss the available chronic sinusitis treatment options based on your specific findings.
Sinus Surgery for Chronic Sinusitis After Failed Treatment
Sinus surgery may be considered when symptoms persist despite appropriate medical treatment and examination, endoscopy, or imaging shows disease that can be addressed surgically.
What Does Endoscopic Sinus Surgery Treat?
Sinus surgery for chronic sinusitis is performed through the nasal passages using an endoscope. Rather than making an external facial incision, the surgeon uses an endoscope and specialized instruments to access the affected sinus areas.
The purpose is to address the affected sinus pathways and improve drainage.
Endoscopic sinus surgery for chronic sinusitis is not a single procedure that is performed the same way for every patient. The surgical approach is selected according to the sinuses involved and the findings from the examination and CT scan.
For patients with nasal polyps, for example, surgery may include removal of the polyps. Other patients may need treatment directed at specific sinus drainage pathways.
For selected procedures, Dr. Zadeh may use CT-based image-guided navigation, which correlates surgical instruments with the patient’s CT imaging to provide additional anatomical guidance during surgery.
What If Chronic Sinusitis Still Doesn’t Improve?
Treatment for chronic sinusitis that does not improve depends on why symptoms continue.
Some patients may continue with medical management. Others may be considered for balloon sinuplasty, particularly when the anatomy and type of disease are appropriate for that procedure. Endoscopic sinus surgery may be considered when there is disease or obstruction requiring surgical treatment. Dr. Zadeh offers medical management, balloon sinuplasty, FESS, revision sinus surgery, and nasal polyp surgery.
Can sinus surgery help chronic sinusitis after medication fails?
It may help selected patients when chronic rhinosinusitis persists despite appropriate medical treatment and evaluation identifies disease or obstruction that can be addressed surgically. The decision depends on the diagnosis, anatomy, previous treatment, and objective findings rather than simply how many medications a patient has tried.
Also Read: What Endoscopic Sinus Surgery Fixes That Medication Cannot
What to Expect From a Sinus Surgeon Evaluation
An evaluation with a sinus surgeon for failed sinusitis treatment begins with an understanding of what you have experienced and what treatments you have already tried.
Review of symptoms and previous treatment
Your physician may ask about congestion, drainage, facial pressure, smell changes, infections, and how long the symptoms have been present.
Your previous treatment may also be reviewed, including medications, nasal sprays, antibiotics, saline care, allergy treatment, or previous procedures.
When bacterial infection is suspected in selected patients, a sinus culture may be used to help identify an organism and guide antibiotic selection. Whether culture is appropriate depends on the patient’s symptoms, examination, treatment history, and endoscopic findings.
Nasal examination and endoscopy
A nasal examination provides information about the nasal passages and surrounding structures. Nasal endoscopy provides a closer view of the nasal cavity and sinuses.
CT imaging when appropriate
CT imaging can provide a detailed view of sinus anatomy and areas affected by disease. It can also help with surgical planning when a procedure is being considered.
Discussing treatment choices
Once the cause of the symptoms has been assessed, the physician can discuss medical treatment, balloon sinuplasty, endoscopic sinus surgery, or another appropriate approach.
Patients considering surgery should have an opportunity to discuss the procedure, expected recovery, potential risks, benefits, and alternatives before making a treatment decision.
A sinus specialist with a focus on nasal and sinus disorders can be particularly helpful for patients whose symptoms have continued despite previous treatment or who have already undergone sinus surgery.
Recovery and Long-Term Management After Sinus Surgery
Recovery following endoscopic sinus surgery varies depending on the procedure and the patient’s individual circumstances.
Dr. Zadeh performs nasal and sinus surgery under general anesthesia. After surgery, patients spend time in a recovery room before going home. Most patients are able to leave a few hours after surgery once they have recovered from anesthesia.
Early recovery can include:
- Nasal drainage
- Congestion
- Swelling inside the nasal passages
- Temporary discomfort
- Blood-tinged drainage
Dr. Zadeh’s postoperative information notes that blood-tinged drainage may continue for approximately 10 to 14 days and that swelling can temporarily affect the nasal passages.
Follow-up appointments allow the surgeon to monitor healing and provide postoperative care instructions. Nasal care may also form part of the recovery process.
Long-term sinus management
Surgery can address physical obstruction and improve sinus drainage, but it does not necessarily eliminate every cause of chronic inflammation.
Some patients may continue to need medical treatment after surgery. Managing allergies, inflammation, nasal polyps, or other underlying conditions may remain part of long-term care.
The purpose of surgery is to address the sinus disease that can be treated surgically. It should not be presented as a guarantee that chronic sinusitis will never return.
Also Read: Is Sinus Surgery Your Solution? Understanding the Path to Relief
Why Choose a Sinus Specialist in Los Angeles
Patients looking for a sinus surgeon in Los Angeles can consider a physician whose practice has a focused interest in nasal and sinus disorders.
Dr. Mani H. Zadeh is a board-certified otolaryngologist and rhinologist in Century City, Los Angeles. His clinical focus includes chronic rhinosinusitis with and without nasal polyps, deviated septum, turbinate conditions, endoscopic sinus surgery, revision sinus surgery, balloon sinuplasty, and nasal polyp surgery.
His training includes an undergraduate degree from UCLA, a medical degree from the University of California, San Diego, and residency training in otolaryngology-head and neck surgery at Columbia University College of Physicians and Surgeons. He is board-certified in otolaryngology-head and neck surgery and has a subspecialty focus in rhinology.
For patients with ongoing sinus symptoms, the practice provides nasal endoscopy, sinus CT imaging, sinus cultures, balloon sinuplasty, and sinus surgery.
If chronic sinusitis continues despite treatment, schedule an evaluation with Dr. Zadeh in Century City, Los Angeles. A specialist evaluation can help determine why symptoms are persisting and whether continued medical care, balloon sinuplasty, endoscopic sinus surgery, or another treatment approach may be appropriate.
FAQs
When should you see a sinus surgeon for chronic sinusitis?
Consider a specialist evaluation when symptoms continue or repeatedly return despite medical treatment, particularly when there is suspected sinus blockage, nasal polyps, structural disease, or recurrent infection. A nasal examination, endoscopy, and CT imaging when appropriate can help identify the cause.
When is sinus surgery needed after failed treatment?
Surgery may be considered when chronic sinusitis does not improve with medical treatment and examination or imaging shows disease that can be addressed surgically. Not everyone with chronic sinusitis requires surgery.
Can sinus surgery help chronic sinusitis after medication fails?
It can help selected patients when ongoing chronic sinusitis is associated with disease or obstruction that can be treated surgically. Endoscopic surgery can address affected sinus pathways, diseased tissue, nasal polyps, or other sources of obstruction when appropriate.
Is endoscopic sinus surgery safe?
Endoscopic sinus surgery is performed through the nasal passages using an endoscope and specialized instruments. As with any surgical procedure, there are potential risks, and patients should discuss their individual medical history, the proposed procedure, risks, benefits, alternatives, anesthesia, and recovery with their surgeon before treatment.
Dr. Zadeh may use CT-based image-guided navigation for selected sinus procedures when additional anatomical guidance is appropriate.
How do you know if you need surgery for chronic sinusitis?
Symptoms alone cannot determine whether surgery is appropriate. Your physician may review your treatment history, perform a nasal examination and endoscopy, and use CT imaging when appropriate. These findings can help determine whether continued medical treatment, balloon sinuplasty, endoscopic sinus surgery, or another approach is appropriate.
Conclusion
When chronic sinusitis continues after medication or other treatments, the next step is not necessarily surgery. A specialist evaluation can help determine whether ongoing symptoms are related to inflammation, infection, nasal polyps, structural changes, sinus blockage, or another condition.
For selected patients, endoscopic sinus surgery can address diseased or obstructed sinus areas and improve drainage. Other patients may benefit from continued medical care or balloon sinuplasty. The appropriate sinusitis treatment depends on the diagnosis, anatomy, treatment history, and findings from examination and imaging.
If you are dealing with chronic sinusitis after failed treatment, recurring infections, ongoing congestion, facial pressure, or other symptoms, an evaluation with a sinus specialist can help clarify the available chronic sinusitis treatment options.