Top 10 reasons NOT to have sinus surgery (or at least get a second opinion)

Thanks for visiting Sinus411.com, the web site about sinusitis and sinus surgery.

In the course of a month, I see many patients that are considering sinus surgery.  Many have had a CT scan and have been referred to an ENT doctor by a friend or primary care doctor.     When I see them, I evaluate them and perform a thorough history and physical exam.  I may perform nasal endoscopy in the office.  And I usually review a CT scan that the patient already has had performed.

After I have completed this process, which may take from 15-30 minutes, then I start talking about  the diagnosis and treatment recommendations.  Usually there are several diagnoses–sometimes it is sinusitis, and often its some other diagnosis.   Usually there are more than 3 diagnoses, that is more than 3 different problems occurring.   As you can imagine, the discussion of the diagnoses and the medical and/or surgical treatments can take another 10-15 minutes.

After all of that, if they are indeed surgical patients, then we talk about the sinus surgery and schedule it if they wish to proceed with surgery.

And frankly, most of the patients I see for a second opinion do NOT need sinus surgery.    Many have simply not had a thorough assessment of their symptoms, so  the underlying problems have not been identified or treated.

All this is to say, there are a LOT of people who have been recommended to have sinus surgery, who probably don’t need it.

What are some of the most common reasons that I tell patients NOT to have sinus surgery?  We’ll do a “top 10″ list, with #1 being the most important, in my opinion.

#10.    You have recurring acute infections and underlying allergies, but the allergies have not been diagnosed or treated.    If you have underlying nasal allergies and don’t treat them, you will get frequent sinus infections.  If you treat the allergies, you may not need sinus surgery.  If your doctor did not ask questions about allergies, ask the doctor.

#9.   You have sinus infections that require frequent antibiotics, with symptoms that recur when you come off antibiotics, but your CT scan (during an infection) shows minimal changes.   If you have sinusitis, your CT scan during an infection should so LOTs of mucosal thickening or abnormalities.   If it doesn’t see #10 about, about allergies, and also see if you have sicca syndrome (dry eyes and dry mouth).  Patients with Sicca syndrome get dry nose, crusting, and bacterial infections of the nose–not the sinuses.  Opening the sinuses will often just make things worse.

#8   Your CT scan shows mucosal retention cysts only, and you don’t get frequent infections with lots of yellow green nasal discharge.   Mucosal retention cysts are common and of no clinical significance the VAST majority of the time.  Be very careful about proceeding with surgery if there are only cysts.  This is a common mistake.

#7   Your CT scan shows “minimal  mucosal thickening” or “scattered mucosal thickening” consistent with chronic sinusisits (and you don’t get lots of infections with lots of yellow green discharge and nasal blockage).    ”minimal  mucosal thickening” or “scattered mucosal thickening” is potentially consistent with chronic sinusitis, but REALLY, its also consistent with a variant of normal, with the common cold, or with allergies.    If you don’t have a strong history of sinusitis (see this blog to help), and your scan has minimal disease, really question your surgeon about the benefit of surgery.  Maybe ask “could this be something else?”

#6     You have minimal changes on the CT scan (see above) and severe headaches, which rate >7 on a scale of 10 for severity.   If a person has that bad a headache from sinusitis (which is rare) , then they usually have a lot of disease on CT scan.  People with headaches > 7 on a scale of 10  are very likely to have some other sort of headache disorder.  The most common “other headache” is migraines.  Read about migraines, or consider asking  your surgeon “could this be migraines”.

#5    You have a normal CT scan and “chronic sinusitis”.   If you have chronic sinusitis (that is sinusitis lasting more than 3 months), you simply should not have a normal CT scan.   Period.  Read more of this blog.

#4   You have had prior sinus surgery for headaches, and your headaches are not better, and your CT scan shows minimal disease.   Again, ask your doctor it this could be some other headache disorder.  Or ask what your surgeon really thinks the chance of “headache cure is”.  Read about migraines.

#3    Your surgeon did not take a thorough history.    If you go to an ENT doctor with complaints of sinusitis, and the surgeon takes a very brief history (asking only about infections and antibiotics, for instance, but not allergies, asthma, other treatments, other medical conditions), consider a second opinion.  If you think allergies may be a component and your surgeon doesn’t discuss this to your satisfaction, consider getting an allergists opinion.

#2   Your surgeon schedules you for many separate procedures and you don’t understand why each separate procedure is necessary.   For instance, you go to see your surgeon for nasal obstruction (and few infections, or no major problems with yellow green nasal discharge), and your CT scan shows minimal or no sinus disease.   If  your surgeon schedules you for septoplasty, turbinate surgery, and sinus surgery—Get a second opinion!    If the surgeon schedules you for surgery on all 8 sinuses, and your CT scan report shows minimal disease, STOP, and get a second opinion.

#1  You have a gut sense that something isn’t right.   This is very important.   For instance, if the doctor looks at your CT scan, spends 4 minutes talking to you in the exam room, schedules surgery, and leaves you to his staff to negotiate the details, get a second opinion.  The surgeon may be right.  You may need surgery, but you’re not likely to feel comfortable, and there’s a pretty good chance surgery might be avoided.  Get another opinion.

You’d be amazed how many people experience this #1 reason or any of the others.  Many experts at leading institutions believe that sinus surgery is performed too often.

I hope this blog post will stimulate you to think about your sinus condition and read more.    Remember, these are general guidelines and not medical advice for your particular condition.

If you like this sort of topic, or if you have serious medical conditions and want to optimize your visits with your doctors, you might like the book “How Doctors Think“, by dr. Jerome Groopman.

Jeffrey E. Terrell, MD

Michigan Sinus Center, Ann Arbor, MI

Blog:   www.Sinus411.com

10 comments to Top 10 reasons NOT to have sinus surgery (or at least get a second opinion)

  • [...] Top 10 reasons NOT to have sinus surgery (or at least get a second opinion) [...]

  • Roy

    I’m really tired of sinus issues and don’t know what to do. I live in Mississippi which was recently listed as one of the Top 10 worst places to live for sinus sufferers. I have allergies (mainly trees and dust mites) that are treated with allergy shots. I’ve been seeing an allergist for about 4 years. 3 years ago, after 2 rounds of antibiotics, my right maxillary sinus was still completely blocked and I had trouble breathing on really stuffy days. Was sent to ENT who recommended surgery; he cleaned out both maxilary cavities, corrected a deviated septum on left side, reduced turbinates on both sides and drilled a hole in right maxillary sinus to help with drainage. For about the first 18 months all was well, now things are starting to get worse. CONSTANT sinus drainage which goes straight to the throat (always clearing my throat). When I get congestion, I’m unable to blow it out like I used. I use a nasal irrigation when things get bad and it helps a little. I’m now on my second round of antibiotics from this last infection (2 days into it) and I fear that surgery is just around the corner. Do you have any suggestions on what to do to stop this constant flow of mucus. I take Mucinex DM, Zrytec, Nasacort AQ, and Chlortrimeton regularly and they only help a little. I realy just want a head transplant or to have my sinuses coated with a stainless steel lining so I don’t have to deal with this any more.

  • Teresa

    My 10-year-old son had a CT scan (not sure if it was normal). Anyway, the results showed his right side sinuses are completely blocked. He’s getting no air on that side. There is some build up on the left side but not bad. The ENT doc says that surgery is the only option. He says it’s the worst case he’s ever seen for a child. He is suggesting the surgery where they use the balloon to open the passageways so that the sinuses can drain. It’s a 1 hour outpatient procedure. My son is scared and so am I. I just want to make sure this is our only option at this point. What do you think?

    Thank you!

    • admin

      If you are uncertain, I’d consider a second opinion. Sounds like something going on there, but its impossible to tell without all the information–that you would get with a second opinion, in perspon. Good luck. Tell us how it goes?

  • sonu kumar

    I m suffering from sinus since 7 to 8 years…….every time I feel uncomfortable when i taking breath, it is not happens only in cold season it happens all season with me …..in cold season i feel more uncomfortable in breathing due to sinus it close my nose ……….due to sinus my mind is not working ,i am not doing any work ,study ………please suggest me what should I do,I think for surgery it will be helpful or not ,and suggest me any best doctor in india (delhi)…… I am very nervous about my carrer,my study is going to vein day by day……plz suggest me as soon as possible ……

  • Naga Suman

    My CT SCAN findings are as below

    Moderate to gross mucosal thickening is seen in both frontal, both maxillary, both ethmoid and right sphenoid sinuses.

    Minimal mucosal thickening is seen in left sphenoid sinus.
    septum shows minimal deviation to right.
    right middle turbinate shows partial paradoxical curve.
    Osteomeatal units are obliterated on both sides

    Doctor is suggesting for a surgery. Please let me know if I really need it or not.

    • admin

      A CT scan alone is never a good enough reason to have sinus surgery.
      I usually want patients to have symptoms of sinus infections (lots of yellow green discharge , at the same time as worse nasal blockage) or some other reason (like polyps).

      Second opinions are perfect when you are in doubt. I can’t give second opinions, but this sounds like a good time to look for one.

  • Frances

    Hi,
    Thanks for this. I agree with number 7 about minimal changes but i have a question. My ct shows just mild mucosal thickening in left maxillary sinus, however it also shows also a deviated septum? Does that make it more reason for me to consider surgery or no? I have constant dull frontal headaches which sometimes get bad and involve eye pressure behind right eye (deviation is to right) and I get frequent sinus infections (at least 4 a year). my nose always feels blocked and im constantly sniffing and clearing my throat. yay post nasal drip. Do you think id benefit from FESS and Septoplasty?

    • admin

      Hi,
      A deviated septum is usually not an additive reason to be getting frequent sinus infection. Usually. There are rare exceptions.
      A book on headaches is a great idea, usually.

  • admin

    Sounds like a moderate amount, generally speaking. This could be due to a cold, but if someones symptoms were longstanding, its likely “real” sinus disease.

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