Chronic Sinusitis After 4 Sinus Surgeries. Can Anything Else Be Done?

Question

I am 24 years old, and have had 4 sinus surgeries, latest one being January 2012. Now, 7 months later, I have intense sinus headaches and sinus congestion again. My septum was fixed on the first one along with endoscopic, the second one was endoscopic, and the last 2 i believe were a combination of endo and balloon, also removal of polyps. Is this something I will just have to live with for the rest of my life? Can anything else be done?

Garrett H. Bennett, MD · Answer

Chronic sinusitis can be chronic for a reason. Even if the sinuses are open, the mucosa may be damaged and the sinuses may not drain normally. Nasal polyps can block sinuses, and scar tissue and swelling can close off the very narrow frontal sinuses. Biofilms are a bacterial layer recently discovered in the sinuses that can damage the delicate tissue of the nose. Your doctor may prescribe "Wilson's Solution" which is a combination of saline, steroid, and baby shampoo to help wash away the biofilm. Too much surgery on the nose can cause "empty nose syndrome" that can feel like chronic sinusitis. I would get another opinion from a sinus surgery expert. Ask to see and have your CAT scans explained to you.

Julian W. Dixon, MD · Answer

Thanks for your question. First I am sorry to hear you are having a hard time with this issue. You are not alone, many people experience the same frustrating recurrence of symptoms. Generally I counsel patients with severe chronic sinusitis that the best outcome is 5-10 years of decreased symptoms, managed with sprays and occasional steroids; in-between sinus surgeries. That is the unfortunate nature of this disease is that a surgery every 10 years or so is not unreasonable. It does seem as if you  are having interventions more frequently. I would recommend finding a surgeon who can also educate you regarding the ancillary treatments, such as medicated irrigations, acupuncture, and even medical cannabis. There are many "out of the box" therapies available for chronic sufferers, however it can be difficulty to find a provider who will spend the time to discuss your options with you. Hang in there and good luck.

Frank Scaccia, MD, FACS · Answer

It depends on the  type of sinus condition you have. For those with severe pan sinusitis/polyps and Samters syndrome a perfect cure is difficult. Otherwise an evaluation and treatment by a highly trained ENT sinus specialist can sometimes find and correct the problem for once and for all  I find revision septoplasties and revision sinus cases very challenging but rewarding and have helped many with this.

Joseph Campanelli, MD · Answer

Sinus surgery is usually very successful in eliminating sinus problems. Sometimes, despite our best efforts, symptoms persist. When this happens, it is usually because of a problem known as biofilm. This can be very difficult to eliminate and usually does not get better with more surgery. Other issues that can lead to persistent symptoms include acid reflux, sinus migraines and fungal sinusitis. It may be time to seek another opinion. The best place to start is with the American Rhinologic Society. These are ENT doctors who have a special interest in the nose and sinuses.

Mark Loury, MD, FACS (retired) · Answer

Continued infection after sinus surgery can be from poorly controlled allergy, acid reflux, immune deficiency, low vitamin D, cystic fibrosis and its variants, aspirin sensitivity syndrome, recurrent nasal polyps, fungal sinusitis. Other systemic conditions with nasal manifestations such as Wegeners granulomatosis, sarcoidosis, ciliary defects may also cause ongoing symptoms. With intense headaches migraine must be considered. Unfortunately if the openings into the frontal sinuses were damaged it may be hard to restore them. May be useful to visit with a nationally recognized expert in sinus disease. Hope things work out. Dr. Loury

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