Ahmad R. Sedaghat, MD, PhD, FACS
How do you know if endoscopic sinus surgery would help your chronic rhinosinusitis symptoms?
Chronic rhinosinusitis (CRS) is an inflammatory condition of the sinuses (think of it as "asthma of the sinuses") in which the affected individual's immune system creates inflammation in the sinuses for some unknown reason, much like the immune system does in the lungs of asthmatics. While asthmatics experience cough, phlegm and wheezing because of the inflammation in their lungs, CRS patients may experience nasal blockage, nasal mucus drainage, facial pressure or pressure and decreased sense of smell/taste due to the inflammation in their sinuses. Like asthma, the first line of treatment for CRS - regardless of whether the CRS is accompanied by nasal polyps or not - is to use topical medications, most commonly topical steroids. While asthmatics use inhalers with steroids in them, which coat the airways in the lungs with steroids to reduce inflammation, we have nasal sprays and nasal irrigations as mechanisms for topical delivery of steroids to the nose and sinuses. Many high quality, randomized controlled trials have shown that intranasal steroids are quite effective for treatment CRS and many patients can get their CRS under control with the appropriate dosing of these medications. In our group's practices, we are very aggressive with medical treatment of our patients and find that a very large fraction of patients can get their CRS symptoms under control with medical regimens that are based on intranasal steroid usage and are scientifically tailored to the patient. However, there is a fraction of patients whose CRS symptoms does not respond completely to medical treatment, including intranasal steroids. For these patients, endoscopic sinus surgery may be an option.
First of all, endoscopic sinus surgery is reserved as the last resort for treatment of CRS and it should not be used as a treatment before appropriate medical management of CRS is attempted. Moreover, a number of studies have shown that the CRS patients who most notice a significant improvement in their sinus and nasal symptoms are the CRS patients who have the greatest severity of symptoms despite appropriate medical management. One way that I explain this to patients is that "I can't make you feel much better than good!" Patients who aren't experiencing a significant burden from their sinus and nasal symptoms generally won't experience much improvement from endoscopic sinus surgery. This makes a lot of sense because someone who feels well before surgery may also feel well after surgery but the change in symptoms will essentially be nil. This is why we do not offer endoscopic sinus surgery to CRS patients for treatment of mild symptoms. On the other hand, if CRS symptoms (nasal blockage, nasal drainage, facial pain or pressure, or decreased sense of smell/taste) are significantly reducing a patient's quality of life or negatively affecting a patient's ability to sleep or to carry out daily activities (like work or school) despite appropriate medical management, then that patient has a high likelihood of experiencing significant improvement in CRS symptoms and quality of life with endoscopic sinus surgery.
Endoscopic sinus surgery has been extensively studied over the last 5 - 10 years. There is quite a bit of research literature and evidence out there that helps us determine which patients may most benefit from endoscopic sinus surgery for CRS. If you are thinking about endoscopic sinus surgery to improve your CRS symptoms, the question that I would suggest that you ask yourself is if your CRS symptoms are significantly reducing your quality of life, affecting your sleep or affecting your ability to work or go to school. If you are on an appropriately strong medical treatment regimen for your CRS and your answer to any of those questions is still yes, then you may be a good candidate for endoscopic sinus surgery.
Feel free to reach out to us if you have any questions about whether endoscopic sinus surgery would be appropriate for your CRS.