What is it?
Sinus symptoms may persist or return in some patients after a previous surgery. This may be related to factors concerning the previous surgery, the nature of the disease itself and its tendency to persist or recur over time, or a combination of both.
Why do symptoms persist or return?
The causes vary from person to person.
Factors related to the previous surgery:
- Some sinuses or their openings may not have been opened widely enough, which can lead to ongoing inflammation or poor drainage.
- Scarring, adhesions, or delayed complications after surgery, such as a mucocele, can cause sinus blockage or the return of symptoms.
Factors related to the nature of the disease:
- Recurrence of nasal polyps.
- Severe inflammation that tends to persist or recur.
- Contributing factors such as allergy, particularly aspirin sensitivity, or an untreated source of inflammation, such as dental infections.
- General health conditions that may affect sinus drainage and ventilation, or immune function.
In many cases more than one mechanism may overlap, so assessment depends on understanding what was done previously alongside evaluating the current nature of the disease.
How is it evaluated?
- Review of previous surgical reports and any available imaging.
- Nasal endoscopy to assess the sinus openings and check for inflammation, polyps, scarring, adhesions, or discharge.
- CT scan of the sinuses when needed.
- Determining whether symptoms are due to persistent or recurrent sinusitis, or another cause.
This assessment helps identify the cause of persistent symptoms and select the most appropriate treatment, rather than assuming the patient automatically needs another surgery.
Treatment
Treatment depends on the cause of the symptoms and the examination findings.
In some cases, symptoms can be improved by adjusting medical treatment, and some cases may benefit from additional treatments depending on the type of inflammation and any contributing factors.
If symptoms persist despite appropriate treatment, or if assessment shows obstruction, narrowing, or scarring, revision endoscopic sinus surgery may be necessary to reopen the sinuses and improve drainage.
Surgery after a previous operation requires careful planning because of anatomical changes that may have occurred in the nose and sinuses.