A sinus sufferer chooses surgery

March 17, 2008|Judy Foreman

After years of suffering from chronically inflamed and infected sinuses, I finally decided I'd had enough. I chose to do what 500,000 other Americans do every year - have sinus surgery.

It wasn't an easy decision. I had to balance my need for a fix against my fear of surgery and research that raised questions about the procedure.

I was miserable. My sinuses, those supposedly hollow spaces around the nose, had become clogged by scar tissue and the build-up of thickened mucus from decades of infections and inflammation. My nose drained so poorly that nearly every time I got a cold, I got a bacterial infection superimposed on the viral one, leaving me sick and tired for weeks.

I had already tried everything short of surgery. I was religious about nasal lavage - rinsing out the sinuses with salt water every day. I had acupuncture. I took endless decongestants, antihistamines, and nasal steroids, contributing to the $5.8 billion a year that Americans spend on sinus treatments, according to the American Academy of Otolaryngology-Head and Neck Surgery Foundation.

For 80 percent of people with chronic sinusitis, these treatments keep sinusitis under control. For me, they didn't, which meant bout after bout of sinus infections with all the attendant facial pain, post nasal drip, congestion and - my most-hated symptom - fatigue.

But I was a wuss about the surgery, which removes swollen tissue so the sinuses can drain. The mere idea of someone poking sharp instruments up my nose near my optic nerve and brain, even if I was under general anesthesia at the time, was appalling. Sure, the risk of going blind in one eye was teeny - less than one 10th of 1 percent - and the risk of the surgeon puncturing the brain, allowing brain fluid to leak out, was also about 1 percent. But these risks weren't zero. Nor did I relish the idea of the less dramatic, more common risks: infection, bleeding, and post-op congestion.

And I wasn't sure whether the surgery would work - it doesn't help everyone with sinus issues.

A review of three randomized controlled trials published this year by the Cochrane Collaboration, an international group that evaluates healthcare data, was not encouraging. It found that a common type of sinus surgery was no better than medications.

But I chose not to put too much faith in those studies - perhaps because there were only three of them, but also because my doctor was planning a somewhat different procedure than the ones examined in the studies. Besides, the studies did say the surgery was safe, which allayed my fears. I also just wanted to believe there was something that could help me.

Still, I waffled until early this year, when I saw a new analysis of 28 observational studies of 3,427 patients published online in the journal, The Laryngoscope.