By Daniel Larson, MD
It is often the case that patients with chronic sinusitis who had prior surgery show up in our office with recurrent or persistent symptoms. Often, these surgeries were done many years ago and patients have suffered under the assumption that since the first surgery did not help, then nothing would. LUCKILY, THIS IS NOT THE CASE!
There are many reasons that symptoms may return after a prior sinus/nasal surgery:
1. The first surgery may have been limited
The first surgery may have been limited to certain areas of the nose or sinuses and did not address certain key areas. We see this commonly in patients who had a prior septoplasty and turbinate reduction – this surgery often fails to improve deeper sinus drainage or nasal valve collapse.
2. Scar tissue formation
Poor healing or persistent infection following the first surgery may have led to scarring that caused the sinuses to close off again. An exciting, new device that has recently become available is the Propel® sinus stent.
More Information on Propel® Sinus Stent
3. Antiquated surgery
Some early forms of sinus surgery in the 80’s and 90’s may have caused more symptoms since by opening the wrong areas of the sinuses. Surgery has improved dramatically since this time and has become much less invasive. Nasal gauze packing is no longer used.
4. Underlying sinus disease (nasal polyps)
If the type of sinus disease you have is more severe (see “what causes sinusitis”), then the chance of the polyps growing back is more likely. It is important to understand that the goal in certain cases of sinus surgery is to open the sinuses to improve the delivery of medicines into the sinus cavities to control polyp regrowth.
5. Under treated allergies
Sinus surgery improves nasal breathing and other symptoms, but does not cure allergies to pollen, dust or animals! Ongoing treatment with medicine or immunotherapy (allergy shots or drops) may be needed for long-term control.
6. Biofilms
Biofilms develop in certain types of sinusitis when bacteria (most commonly S. Aureus or P. Aeruginosa) form thick mats of film/plaques that are resistant to many antibiotics. Often, long term treatment with sinus irrigations (sometimes with additives) is necessary to control symptoms.
Bottom Line: Do not be discouraged if you still have symptoms after a prior sinus surgery – there are many more treatments available now!