What are the long-term solutions for chronic sinusitis?

Question

Hi doctor,

My sinuses have been experiencing severe issues, with constant pressure and congestion. I cannot smell anything again. The steroid spray helps somewhat, but the symptoms always return.

It feels like I am breathing through a sponge. I get headaches around my eyes and forehead, especially in the mornings. Sometimes my nose even bleeds when I use the spray too often. I have been doing saline rinses every night, but they do not provide enough relief.

My doctor said surgery is an option if this keeps recurring. Should I consider that? I am so tired of living with a blocked nose all year round. I miss being able to smell my coffee or perfume.

I am also curious to know if allergies are exacerbating the issue. Should I get tested again? I want something that brings long-term relief.

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concern.

Ongoing congestion, facial pressure, reduced sense of smell, persistent headaches, partial relief from steroid sprays, and frequent nasal bleeding are strong indicators that your chronic sinusitis with polyps is not adequately controlled with maximal medical therapy, such as steroid sprays and saline rinses.

Sinus surgery is often considered when symptoms persist despite these treatments and significantly impact your quality of life, which is your situation.

Endoscopic sinus surgery (ESS), with or without polyp removal, has shown durable relief in over 75 % of patients. Many experience improvements in quality of life and nasal function that can last for up to a decade.

About one in four patients with polyps may require repeat surgery within ten years, but most report significant improvement and say they would choose surgery again if necessary.

ESS also enables the more effective delivery of topical medications after surgery, thereby reducing the recurrence and severity of future symptoms.

It is reasonable to discuss sinus surgery (ESS with polyp removal) with your ENT (ear, nose, and throat) specialist as the next step for long-term relief, since medical therapy alone is not providing lasting benefits and is impacting your daily life.

Additionally, it may be beneficial to undergo a nasal endoscopy and possibly repeat allergy testing to clarify your current polyp status and the role of allergies. This information will help guide your personalized surgical and medical plan.

Continue gently using saline rinses and ensure you use the correct technique with your steroid spray to minimize nasal trauma and bleeding. Plan your next steps accordingly.

Proper surgical intervention, combined with allergy management (as determined by current testing), including the consideration of allergy immunotherapy (allergy shots), can help reduce polyp recurrence and symptoms.

This approach offers the best chance for regaining your sense of smell, alleviating facial discomfort, and maintaining open nasal passages, allowing you to breathe and enjoy life more fully.

I hope this information is helpful.

Please let me know if you have any further questions, and I would be happy to assist you.

Thank you.

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