Health Library

The Health Library is a collection of health and wellness resources created for learning and accessibility. Select a topic below for related health information or search for a topic in the search bar for more information on other medical conditions.

Spanish Translation

Top of the pageDecision Point

Sinusitis: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Sinusitis: Should I Have Surgery?

Get the facts

Your options

  • Have surgery to treat chronic (long-term) sinusitis.
  • Don't have surgery. Take medicines and use home treatment.

Key points to remember

  • Very few people need surgery for sinusitis. Most people can treat the problem with home care and medicines.
  • Surgery may be a good choice for some people who have chronic (long-term) sinusitis. If medicines and self-care have not helped with your symptoms, surgery can remove blockages and make the sinus openings bigger. This helps the sinuses drain, which can reduce symptoms like congestion, pain, and nasal discharge.
  • Before deciding about surgery, your doctor will want you to try medicines and home treatment for a period of time to reduce inflammation and swelling. This usually includes nasal washes, nasal steroids, and other medicines.
  • To be sure that surgery is a good choice, you need to have a CT scan of your sinuses. This helps your doctor see where the inflamed tissue is. It also shows the structures inside of your sinuses, which helps guide the surgery.
  • You may need more than one surgery to fix your sinuses.
  • If you get chronic sinusitis because of allergies or another problem, it's best that you get that problem under control as much as you can before you have surgery.
  • Surgery helps the sinuses drain. But to keep the inflammation from coming back, it's still important to do home treatments to help keep your nose and sinuses healthy after surgery.
FAQs

What is sinusitis?

Sinusitis is an inflammation of the mucous membrane inside the nose and sinuses. Sinuses are the hollow spaces in your skull around the eyes and nose.

When the mucous membranes get inflamed, they swell and make more mucus. This can block the normal flow of fluid from the sinuses into the nose and throat. Bacteria and viruses are more likely to grow and cause an infection in sinuses that can't drain.

Allergies and nasal polyps also can block the nasal passages and lead to sinusitis.

There are two types of sinusitis: acute (short-term) and chronic (long-term). You may have chronic sinusitis if:

  • You've had at least two of the following four symptoms for at least 12 weeks: a stuffy or blocked nose, pain or pressure in the head and face, thickened and discolored nasal drainage, or a reduced sense of smell.

AND

  • You have signs of inflammation in your sinuses when the doctor looks at them or when a CT scan shows that they are inflamed.

Surgery may be a good choice for some people who have chronic sinusitis.

What can surgery do for sinusitis?

Surgery helps the sinuses drain, preventing symptoms and infections. The doctor usually makes the sinus openings bigger by removing:

  • Infected, swollen, or damaged tissue.
  • Bone, to make a wider opening to let mucus drain from the sinuses.
  • Growths (polyps) inside the nose or sinuses.

There are two types of sinus surgery:

  • Endoscopic surgery is the type that is done most often. The doctor puts a thin, lighted tool called an endoscope in the nose to remove small amounts of bone or tissue that block the sinus openings. The doctor also can remove polyps.
  • Traditional surgery may be done in rare cases. The doctor makes an opening into the sinus from inside the mouth or through the skin of the face. This surgery may be done if you've had several endoscopic surgeries and are still having symptoms, if you have a sinus tumor, or if your doctor thinks it's necessary because of your sinus structure and symptoms.

Sometimes another problem inside the nose (such as a deviated septum) also needs to be fixed. This may be done during the same surgery.

After surgery, the doctor may recommend:

  • A steroid nasal spray to reduce inflammation and help you heal.
  • Pain medicine.
  • Antibiotics to help fight infection.

When is surgery an option for sinusitis?

Here are some reasons your doctor might suggest sinus surgery as the next step:

  • Your doctor says that you have chronic sinusitis. And you've taken medicines and followed home treatment, but your symptoms have not gone away.
  • The CT scan shows that something, such as nasal polyps, is keeping your sinuses from draining as they should.
  • You have a sinus infection caused by a fungus. Infections caused by fungi cannot be cleared up with antibiotics.
  • You have a serious problem such as an infection that spreads beyond your sinuses. This is rare.

What are the benefits of sinus surgery?

Sinus surgery can:

  • Help your sinuses drain. This can relieve symptoms such as a stuffy or blocked nose, pain, and pressure.
  • Improve your sense of smell. (But in some cases, scarring from surgery could decrease your sense of smell.)

Endoscopic surgery may improve symptoms in people who have not been helped by medical therapy alone.footnote 1

Surgery has the best chance of working if you do home treatment and go to all of your follow-up appointments. You will likely need to use home treatments for a long time to help keep your sinuses healthy.

What are the risks of sinus surgery?

Sinus surgery can lead to problems.

  • A small number of people have problems such as:
    • Scar tissue.
    • Bleeding.
    • Infection.
    • A reduced sense of smell for a while.
    • Bruising and swelling around the eyes.
  • Serious but rare problems can include:
    • Heavy bleeding.
    • Injury to the eye area.
    • Inflammation of the tissue that covers the brain (meningitis).
    • Leakage of the fluid around the brain.
    • Brain injury.
  • Scarring from surgery could decrease your sense of smell forever.
  • The surgery might not work, so you could need another surgery.

What can you do for chronic sinusitis other than surgery?

Most of the time, you can treat your sinus problem with home care and medicines.

Home treatment
  • Use saline (saltwater) nasal washes. This helps keep your nasal passages open. It also can wash out mucus and allergens. You can buy saline nasal washes (such as a neti pot) at a drugstore or grocery store, or you can make your own at home.
  • Drink plenty of fluids to help keep the mucus thin.
  • Do not smoke. Smoking can make your symptoms worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicine. These can increase your chances of quitting for good.
  • Breathe warm, moist air. You can use a steamy shower, a hot bath, or a sink filled with hot water. Avoid very cool, dry air. A humidifier can add moisture to the air in your home. Follow the directions for cleaning the machine.
Medicines
  • Use a steroid nasal spray to reduce the swelling of the mucous membranes.
  • Take allergy medicines. They may be used to treat nasal allergies (allergic rhinitis) or nasal polyps.
  • Take pain relievers if needed, such as acetaminophen or ibuprofen, that you can buy without a prescription.
  • Take antibiotics as directed, if your doctor prescribes them. Antibiotics can treat most short-term (acute) sinusitis when it is caused by bacteria.

Be safe with medicines. Read and follow all instructions on the label. Some medicines may not be safe for young children or for people who have certain health problems.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have surgery for chronic sinusitis Have surgery for chronic sinusitis
  • You may be asleep. Or the doctor may numb the area (like at the dentist) and give you medicine to make you sleepy.
  • You may have some packing in your nose after surgery. Some types dissolve on their own. Gauze packing will need to be removed a few days after surgery.
  • You may take antibiotics after surgery if your doctor tells you to.
  • You will need to keep doing home treatment like nasal washes and steroid nasal sprays, or your symptoms could return.
  • It may clear up your sinus pain and pressure.
  • It may improve your sense of smell.
  • You may have some pain and bleeding for 2 weeks after surgery.
  • You could have less sense of smell after surgery.
  • Serious but rare risks can include meningitis, eye injury, and brain injury.
  • Surgery might not work.
  • You may need to have another surgery.
Use home care for chronic sinusitis Use home care for chronic sinusitis
  • You use steroid nasal sprays and, if needed, other medicines.
  • You do other self-care, such as cleaning out your nasal passages with saline washes.
  • You take antibiotics for a bacterial infection, if needed.
  • Home care may relieve your symptoms.
  • Antibiotics work well for bacterial infections.
  • You don't have the risks of surgery.
  • You don't have the pain of surgery or need to deal with follow-up care.
  • You can decide later to have surgery if home care doesn't help you enough.
  • Home care might not get rid of your sinus problem.
  • Antibiotics don't work for viral and fungal infections.
  • It won't fix certain serious problems, such as nasal polyps or a deviated septum.
  • Antibiotics can cause side effects, which may include allergic reaction, nausea, and diarrhea.

Personal stories about choosing surgery for sinusitis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have had one sinus infection after another for the better part of a year. I took antibiotics and have been using steroids and nasal washes for a few months now with no results. My doctor just did a CT scan and found out that one of my sinuses is blocked and I have a polyp in my nose. He says he can fix it with surgery.

Pete, age 43

I've had a couple of bouts of sinus infections this year and have had symptoms for a long time, so I asked my doctor about sinus surgery. She said there are some other treatments I can try. I agree, so I'm going to try doing nasal washes and a steroid nasal spray every day.

Misti, age 32

My doctor had me try different medicines to treat this infection, and I took them just the way she told me to, but nothing seemed to work. After she looked at my CT scan, my doctor thinks what I've got may be a fungal infection. That would explain why the antibiotics I've tried haven't helped. I don't like the idea of having the surgery, but I have tried everything else.

Marona, age 54

I've had sinus symptoms for months now. The pain and stuffiness and postnasal drip are no fun. I have allergies too. My doctor showed me how to wash out my sinuses with salt water. She says that will help. I'm going to try that every day. And she says there are other medicines we can try too, like nasal sprays and allergy medicines.

Jonathan, age 29

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have sinus surgery

Reasons to use home treatment

I want to do everything I can to stop my sinus symptoms.

I want to avoid surgery if at all possible.

More important
Equally important
More important

I'm not afraid of the risks of surgery.

I don't want to take any chance on problems from surgery.

More important
Equally important
More important

The pain and pressure in my sinuses is making me miserable.

I can control sinus symptoms with medicines and home care.

More important
Equally important
More important

I'm tired of not breathing well.

I can still breathe well.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Home treatment

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Do most people need surgery to treat sinusitis?
2, Do you need to try several weeks of medicines and other treatment before you and your doctor decide about surgery?
3, Will you probably still have to take medicines and use nasal sprays after surgery?

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

Credits and References

Credits
AuthorHealthwise Staff
Primary Medical ReviewerPatrice Burgess MD - Family Medicine
Primary Medical ReviewerAdam Husney MD - Family Medicine
Primary Medical ReviewerKathleen Romito MD - Family Medicine
Primary Medical ReviewerMartin J. Gabica MD - Family Medicine
Primary Medical ReviewerLesley Ryan MD - Family Medicine
Primary Medical ReviewerCharles M. Myer III MD - Otolaryngology

References
Citations
  1. Patel ZM, et al. (2017). Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: A systematic review and meta-analysis. International Forum of Allergy and Rhinology, 7(2): 119–127. DOI: 10.1002/alr.21872. Accessed January 13, 2022.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Sinusitis: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have surgery to treat chronic (long-term) sinusitis.
  • Don't have surgery. Take medicines and use home treatment.

Key points to remember

  • Very few people need surgery for sinusitis. Most people can treat the problem with home care and medicines.
  • Surgery may be a good choice for some people who have chronic (long-term) sinusitis. If medicines and self-care have not helped with your symptoms, surgery can remove blockages and make the sinus openings bigger. This helps the sinuses drain, which can reduce symptoms like congestion, pain, and nasal discharge.
  • Before deciding about surgery, your doctor will want you to try medicines and home treatment for a period of time to reduce inflammation and swelling. This usually includes nasal washes, nasal steroids, and other medicines.
  • To be sure that surgery is a good choice, you need to have a CT scan of your sinuses. This helps your doctor see where the inflamed tissue is. It also shows the structures inside of your sinuses, which helps guide the surgery.
  • You may need more than one surgery to fix your sinuses.
  • If you get chronic sinusitis because of allergies or another problem, it's best that you get that problem under control as much as you can before you have surgery.
  • Surgery helps the sinuses drain. But to keep the inflammation from coming back, it's still important to do home treatments to help keep your nose and sinuses healthy after surgery.
FAQs

What is sinusitis?

Sinusitis is an inflammation of the mucous membrane inside the nose and sinuses. Sinuses are the hollow spaces in your skull around the eyes and nose.

When the mucous membranes get inflamed, they swell and make more mucus. This can block the normal flow of fluid from the sinuses into the nose and throat. Bacteria and viruses are more likely to grow and cause an infection in sinuses that can't drain.

Allergies and nasal polyps also can block the nasal passages and lead to sinusitis.

There are two types of sinusitis: acute (short-term) and chronic (long-term). You may have chronic sinusitis if:

  • You've had at least two of the following four symptoms for at least 12 weeks: a stuffy or blocked nose, pain or pressure in the head and face, thickened and discolored nasal drainage, or a reduced sense of smell.

AND

  • You have signs of inflammation in your sinuses when the doctor looks at them or when a CT scan shows that they are inflamed.

Surgery may be a good choice for some people who have chronic sinusitis.

What can surgery do for sinusitis?

Surgery helps the sinuses drain, preventing symptoms and infections. The doctor usually makes the sinus openings bigger by removing:

  • Infected, swollen, or damaged tissue.
  • Bone, to make a wider opening to let mucus drain from the sinuses.
  • Growths (polyps) inside the nose or sinuses.

There are two types of sinus surgery:

  • Endoscopic surgery is the type that is done most often. The doctor puts a thin, lighted tool called an endoscope in the nose to remove small amounts of bone or tissue that block the sinus openings. The doctor also can remove polyps.
  • Traditional surgery may be done in rare cases. The doctor makes an opening into the sinus from inside the mouth or through the skin of the face. This surgery may be done if you've had several endoscopic surgeries and are still having symptoms, if you have a sinus tumor, or if your doctor thinks it's necessary because of your sinus structure and symptoms.

Sometimes another problem inside the nose (such as a deviated septum) also needs to be fixed. This may be done during the same surgery.

After surgery, the doctor may recommend:

  • A steroid nasal spray to reduce inflammation and help you heal.
  • Pain medicine.
  • Antibiotics to help fight infection.

When is surgery an option for sinusitis?

Here are some reasons your doctor might suggest sinus surgery as the next step:

  • Your doctor says that you have chronic sinusitis. And you've taken medicines and followed home treatment, but your symptoms have not gone away.
  • The CT scan shows that something, such as nasal polyps, is keeping your sinuses from draining as they should.
  • You have a sinus infection caused by a fungus. Infections caused by fungi cannot be cleared up with antibiotics.
  • You have a serious problem such as an infection that spreads beyond your sinuses. This is rare.

What are the benefits of sinus surgery?

Sinus surgery can:

  • Help your sinuses drain. This can relieve symptoms such as a stuffy or blocked nose, pain, and pressure.
  • Improve your sense of smell. (But in some cases, scarring from surgery could decrease your sense of smell.)

Endoscopic surgery may improve symptoms in people who have not been helped by medical therapy alone.1

Surgery has the best chance of working if you do home treatment and go to all of your follow-up appointments. You will likely need to use home treatments for a long time to help keep your sinuses healthy.

What are the risks of sinus surgery?

Sinus surgery can lead to problems.

  • A small number of people have problems such as:
    • Scar tissue.
    • Bleeding.
    • Infection.
    • A reduced sense of smell for a while.
    • Bruising and swelling around the eyes.
  • Serious but rare problems can include:
    • Heavy bleeding.
    • Injury to the eye area.
    • Inflammation of the tissue that covers the brain (meningitis).
    • Leakage of the fluid around the brain.
    • Brain injury.
  • Scarring from surgery could decrease your sense of smell forever.
  • The surgery might not work, so you could need another surgery.

What can you do for chronic sinusitis other than surgery?

Most of the time, you can treat your sinus problem with home care and medicines.

Home treatment
  • Use saline (saltwater) nasal washes. This helps keep your nasal passages open. It also can wash out mucus and allergens. You can buy saline nasal washes (such as a neti pot) at a drugstore or grocery store, or you can make your own at home.
  • Drink plenty of fluids to help keep the mucus thin.
  • Do not smoke. Smoking can make your symptoms worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicine. These can increase your chances of quitting for good.
  • Breathe warm, moist air. You can use a steamy shower, a hot bath, or a sink filled with hot water. Avoid very cool, dry air. A humidifier can add moisture to the air in your home. Follow the directions for cleaning the machine.
Medicines
  • Use a steroid nasal spray to reduce the swelling of the mucous membranes.
  • Take allergy medicines. They may be used to treat nasal allergies (allergic rhinitis) or nasal polyps.
  • Take pain relievers if needed, such as acetaminophen or ibuprofen, that you can buy without a prescription.
  • Take antibiotics as directed, if your doctor prescribes them. Antibiotics can treat most short-term (acute) sinusitis when it is caused by bacteria.

Be safe with medicines. Read and follow all instructions on the label. Some medicines may not be safe for young children or for people who have certain health problems.

2. Compare your options

Have surgery for chronic sinusitis Use home care for chronic sinusitis
What is usually involved?
  • You may be asleep. Or the doctor may numb the area (like at the dentist) and give you medicine to make you sleepy.
  • You may have some packing in your nose after surgery. Some types dissolve on their own. Gauze packing will need to be removed a few days after surgery.
  • You may take antibiotics after surgery if your doctor tells you to.
  • You will need to keep doing home treatment like nasal washes and steroid nasal sprays, or your symptoms could return.
  • You use steroid nasal sprays and, if needed, other medicines.
  • You do other self-care, such as cleaning out your nasal passages with saline washes.
  • You take antibiotics for a bacterial infection, if needed.
What are the benefits?
  • It may clear up your sinus pain and pressure.
  • It may improve your sense of smell.
  • Home care may relieve your symptoms.
  • Antibiotics work well for bacterial infections.
  • You don't have the risks of surgery.
  • You don't have the pain of surgery or need to deal with follow-up care.
  • You can decide later to have surgery if home care doesn't help you enough.
What are the risks and side effects?
  • You may have some pain and bleeding for 2 weeks after surgery.
  • You could have less sense of smell after surgery.
  • Serious but rare risks can include meningitis, eye injury, and brain injury.
  • Surgery might not work.
  • You may need to have another surgery.
  • Home care might not get rid of your sinus problem.
  • Antibiotics don't work for viral and fungal infections.
  • It won't fix certain serious problems, such as nasal polyps or a deviated septum.
  • Antibiotics can cause side effects, which may include allergic reaction, nausea, and diarrhea.

Personal stories

Personal stories about choosing surgery for sinusitis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have had one sinus infection after another for the better part of a year. I took antibiotics and have been using steroids and nasal washes for a few months now with no results. My doctor just did a CT scan and found out that one of my sinuses is blocked and I have a polyp in my nose. He says he can fix it with surgery."

— Pete, age 43

"I've had a couple of bouts of sinus infections this year and have had symptoms for a long time, so I asked my doctor about sinus surgery. She said there are some other treatments I can try. I agree, so I'm going to try doing nasal washes and a steroid nasal spray every day."

— Misti, age 32

"My doctor had me try different medicines to treat this infection, and I took them just the way she told me to, but nothing seemed to work. After she looked at my CT scan, my doctor thinks what I've got may be a fungal infection. That would explain why the antibiotics I've tried haven't helped. I don't like the idea of having the surgery, but I have tried everything else."

— Marona, age 54

"I've had sinus symptoms for months now. The pain and stuffiness and postnasal drip are no fun. I have allergies too. My doctor showed me how to wash out my sinuses with salt water. She says that will help. I'm going to try that every day. And she says there are other medicines we can try too, like nasal sprays and allergy medicines."

— Jonathan, age 29

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have sinus surgery

Reasons to use home treatment

I want to do everything I can to stop my sinus symptoms.

I want to avoid surgery if at all possible.

More important
Equally important
More important

I'm not afraid of the risks of surgery.

I don't want to take any chance on problems from surgery.

More important
Equally important
More important

The pain and pressure in my sinuses is making me miserable.

I can control sinus symptoms with medicines and home care.

More important
Equally important
More important

I'm tired of not breathing well.

I can still breathe well.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Home treatment

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Do most people need surgery to treat sinusitis?

  • Yes
  • No
  • I'm not sure
That's right. Very few people need surgery. Medicines and home care usually are enough.

2. Do you need to try several weeks of medicines and other treatment before you and your doctor decide about surgery?

  • Yes
  • No
  • I'm not sure
That's right. Before deciding about surgery, your doctor will want you to try medicines and home treatment for a period of time to reduce inflammation and swelling. This usually includes nasal washes, nasal steroids, and other medicines.

3. Will you probably still have to take medicines and use nasal sprays after surgery?

  • Yes
  • No
  • I'm not sure
That's right. You will likely have to do nasal washes, use steroid nasal sprays, and take other medicines after surgery. They can help you heal and keep your symptoms from coming back.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
Credits
ByHealthwise Staff
Primary Medical ReviewerPatrice Burgess MD - Family Medicine
Primary Medical ReviewerAdam Husney MD - Family Medicine
Primary Medical ReviewerKathleen Romito MD - Family Medicine
Primary Medical ReviewerMartin J. Gabica MD - Family Medicine
Primary Medical ReviewerLesley Ryan MD - Family Medicine
Primary Medical ReviewerCharles M. Myer III MD - Otolaryngology

References
Citations
  1. Patel ZM, et al. (2017). Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: A systematic review and meta-analysis. International Forum of Allergy and Rhinology, 7(2): 119–127. DOI: 10.1002/alr.21872. Accessed January 13, 2022.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.