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

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.

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.