Infection in Maxillary Sinus. What Surgery is Available to Fix This?

They have tried me on antibiotics and nothing has worked. I had a CT scan which confirmed the infection and am waiting to see my eNT again. I also have a deviated septum. I have constant Post Nasal drip which causes swelling in my throat. It is horrible. Is surgery the next step? What procedure should I expect and how much will it cost?

Doctor Answers 9

Maxillary Sinusitis (Infeccion del sinus maxilar)

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Thank you for your question.

In my experience, patients with chronic sinus disease fall into 1 of 3 categories:  1)  Those with strictly anatomic problems preventing the proper flow of air and mucous; 2) those with a hypersensitivity (can be allergic or non-allergic) of the mucous membranes that leads to swelling of those membranes and blockage of the sinus passages that woud otherwise allow normal mucous and air flow; and 3) those that have both.

Patients who have a strictly anatomic problem can have that corrected surgically, and the problems should then resolve. 

In patients who have an increased sensitivity, such as allergies, treatment of the underlying cause of the sensitivity is the key.  Often, these patients will require immunotherapy (allergy shots), antihistamines (such as Allegra), or other treatments such as nasal steroids, antibiotics, or Singulair.  These patients will also benefit from a sinus rinse that can help wash out the offending irritants and thereby decrease the inflammation that would otherwie result.  In these patients, surgery is reserved for the situations in which the inflammation has progressed such that the non-surgical treatments are not able to have their full effect.  Opening the sinuses in those cases then allows for the sinus rinses and nasal steroids to be more effective, and helps restore some air and mucous flow, so that the other treatments have a less severe disease process to contend with.  It is important to understand that surgery in these cases is NOT curative - it is intended to improve the efficacy of the non-surgical treatments.  Surgery does not necessarily mean that you won't need the other treatments any more.  It's similar to heart bypass surgery - undergoing a heart bypass doesn't mean that you don't need to watch your diet or exercise any longer.

Another option to consider, if you're a candidate, is balloon sinus dilation.  In many patients, this procedure can be done under local anesthesia in the office.  Most patients return to work the same day or the next.  It's not an option for everyone, but may be something worth trying to see if it works and avoids the need for a more invasive procedure.  It may still be necessary, however, to undergo traditional endoscopic sinus surgery at some later date if the balloon procedure isn't as effective as you need.  Balloon procedures are usually reserved for patients who are symptomatic and have narrowing of the sinus passages, without a frank infection of inflammation of the mucous membranes on the sinus CT scan.

Ultimately, you would be best-served by posing these questions to your ENT surgeon.  If you find that you don't get adequate answers to your questions, then seek a second opinion.  You deserve to be comfortable with the plan of care moving forward, as well as with the surgeon you've selected to carry out that plan.

Best wishes.

Maxillary Sinus Infection Treatment

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Surgery is usually reserved as the last option. If you don't have a long history of allergies and sinus problems or if you haven't exhausted all medical therapeutic options (including antihistamine and nasal steroid sprays) then you should not consider surgery yet. You need to be very thoroughly examined with endoscopes to asses the opening of your sinuses to make sure it's clear, why your sinuses have become blocked and therefore infected. 

Babak Larian, MD
Beverly Hills Facial Plastic Surgeon

Maxillary sinus

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Thanks for your question. From what you have written it seems that you are likely a great candidate for a minimally invasive surgery to open your sinus and improve your septum. I know the prospect of surgery makes many people nervous, however the good news is that the surgery for this type of problem is extremely well tolerated. The vast majority of patients have very little pain and only experience a week or so of congestion. Typically your breathing and feeling of pressure will be markedly improved in around a week or so. I would strongly encourage you too seek out a nasal/sinus surgeon in your area and discuss the options available to you. Hope this helps. 

Julian W. Dixon, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Infected sinus

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Before surgery is offered you must fail aggressive medical management. Although you were on antibiotics where you on the correct ones and for long enough? I always attempt a cultured swab of any pus I see with the endoscope. This culture result can sometimes help in picking the correct antibiotic for your infection and then utilized for at least 3 to 4 weeks straight.  This is done along with steroids, steroid sprays, decongestants, and vigorous saline rinses. If all else fails FESS endoscopic sinus surgery and or balloon sinuplasty  in selected cases and septoplasty are extremely effective and safe in curing this condition and symptoms.  I have done 1000s of these with excellent results.

Frank Scaccia, MD, FACS
Red Bank Facial Plastic Surgeon
4.6 out of 5 stars 14 reviews

Sinus surgery

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Endoscopic sinus surgery is performed on patients when medical management has failed and there is documented polps and chronic infection in the sinuses.  This surgery is billed to the patient's medical insurance, once medical neccessity has been documented.  Please see the link below for more information

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Chronic maxillary sinus infection treatment

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A sinus surgery procedure called "maxillary antrostomy" can be done to help with chronic maxillary sinus infections that fail medical treatment. This type of surgery can be done along with a septoplasty to straighten a deviated septum.

Your ENT should be able to help you decide whether surgery is the next step. It depends o how long you've had symptoms. It sounds like this is a chronic issue, certainly.

You can learn more about sinus surgery at my web reference link below. I've also attached a short video that shows how we are able to endoscopically open up the cheek sinus. Good luck with everything!

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Treatment for maxillary sinusitis

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The bacteriology in chronic maxillary sinusitis is different than the other sinuses, particularly Staphylococcus and anaerobic organisms so it is important to be on antibiotics that cover these.  Sometimes the addition of oral steroids can reduce swelling enough to allow it to drain.  Make sure it is not coming from the teeth.  If antibiotics don't work then irrigating the sinus can flush out the bacteria.  If that doesn't help then it is very easy to restore the maxillary sinus opening something that can easily be done in the office under local anesthesia.  If there is concomitant ethmoid sinusitis that will need to be addressed.  If the septum is pushing over the middle turbinate and uncinate process then it may need to be straightened simultaneously.  Best wishes, Dr. Loury

Mark Loury, MD, FACS
Fort Collins Facial Plastic Surgeon

Maxillary sinus infection

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Maxillary sinus infection is not necessarily a reason for surgery, however, if it is chronic infection, then you may be a candidate for endoscopic sinus surgery or balloon plasty. Sometimes, a change in antibiotic may be the answer but I recommend follow up with your doctor until a final diagnosis is found.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

Sinus Infection That Does Not Respond to Antibiotics May be Fungal

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It is always concerning when a patient that has a CT documented infection does not respond to antibiotics.  It typically will indicate that your physicians are missing something.  One of the more common problems is fungal sinusitis.  Ask your ENT if this may be a possibility.  Other causes include polyps, dental infections or nasal growths.  

It sounds as if you are getting to the end of medical options and surgery would be the next step.  For isolated maxillary sinus disease, opening this sinus alone may be enough.  The cost will vary on the extent of surgery and anesthetic given.

Joseph Campanelli, MD
Portland Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.