Chronic sinusitis in Nigeria: when is sinus surgery the answer?

Acute or chronic sinusitis?

Most sinusitis follows a cold and clears within two to three weeks, without antibiotics. That is acute sinusitis, and it does not need surgery. Chronic sinusitis means the lining of the sinuses stays inflamed for more than twelve weeks, with symptoms such as:

• A blocked or stuffy nose
• Thick discharge from the front of the nose or down the back of the throat
• Pressure or pain in the face
• A reduced sense of smell

What to try first

Surgery is not the first treatment. Most people improve with steady medical treatment, used properly for several weeks:

• Salt-water rinses once or twice a day, using boiled and cooled water or sachets made for the purpose, never tap water straight
• A steroid nasal spray or drops every day, with the right technique, for at least a few months
• Treating allergy where it plays a part
• Sometimes a short course of steroid tablets or an antibiotic, decided by a doctor
• Avoiding decongestant sprays beyond a week, and avoiding smoke

When surgery makes sense

An ENT specialist examines the nose with a small camera and arranges a CT scan of the sinuses. Surgery is usually discussed when:

• Symptoms continue despite a proper course of medical treatment
• Nasal polyps keep blocking the nose despite steroid treatment
• The CT scan shows blocked sinus drainage that matches your symptoms
• There are complications, or a growth that needs a sample taken

What endoscopic sinus surgery involves

The operation is done under general anaesthetic, through the nostrils, using a thin camera. The surgeon opens the blocked drainage channels and removes polyps and diseased tissue, so the sinuses can drain and sprays can reach them. There is usually no cut on the face. Many people go home the same day or the next.

Afterwards the nose is blocked and crusty for a few weeks, and you rinse with salt water several times a day to clear it. Follow-up visits let the surgeon clean the nose and check healing. Bleeding, infection and, rarely, injury to the eye area or the base of the skull are risks your surgeon will explain.

Surgery is not a cure on its own. The lining can stay inflamed, and polyps can return, so most people need to keep using a steroid spray long term.

Red flags: get help urgently

Go to emergency care the same day if you have sinus symptoms with:

• Swelling or redness around the eye, or the eye bulging
• Double vision or changes in vision
• A severe headache, a stiff neck, confusion or drowsiness
• A high fever and feeling very unwell

One-sided symptoms need checking

Symptoms on only one side of the nose, such as blockage, bloody discharge, or numbness of the face or teeth, are less likely to be ordinary sinusitis. They should be checked by an ENT specialist soon, rather than treated with more sprays at home.

Common questions