Sinus Surgery Success - The Importance of Topical Medical Therapy
For patients who have already undergone sinus surgery, whether it’s balloon sinuplasty or endoscopic sinus surgery, medicated saline irrigations can be an important part of long-term postoperative medical care. Chronic sinusitis is typically the result of a combination of physical obstruction problems and environmental inflammatory problems that lead to a chronic or recurring bacterial or fungal infection. Logically, sinus surgery only serves to resolve the physical or obstruction aspect of the condition.

So, as I like to explain to my patients, if a perfect nasal and sinus procedure is performed on someone who is very sensitive to cigarette smoke, for example, and that person subsequently sits in the smoking section of a restaurant, what do you think will happen? In that situation, even if the nose and sinuses are physically wide open, the smoke will cause inflammation of the nasal and sinus passages and lead to thick post-nasal drip, runny nose, the sensation of pressure in the face, and probably cough and increased congestion.

This is because surgery cannot cure or even directly address inflammatory reactions any more than it can stop you from being sunburned or prevent you from reacting to a bee sting. Inflammation is always a medical problem. So, once surgery opens the nose and sinuses so they can function properly in terms of breathing and mucociliary clearance topical medicines are the key to preventing inflammation long term. This can be achieved by simply adding some Flonase to a store-bought saline sinus rinse, or by sophisticated methods such as using a NasoNeb ™ nasal nebulizer with pharmacy-provided medications.

Benefits of Topical Medications

There are a number of benefits to using these topical medications in a saline rinse after undergoing sinus surgery, rather than as a spray or pill. First, a much higher concentration of the medicine reaches the area of concern when medications are applied topically. Simply put, there is as much Claritin going to your little toe as to your nose when you ingest a pill, and it works through the circulatory system. Secondly, the irrigation and nebulizer can distribute the medication much more thoroughly throughout the sinus and posterior nasal passages than can a nasal spray. Lastly, when applied in a saline rinse, 99% of the saline washes back out of the nose and down the drain. So, effectively, better topical control of inflammation is achieved this way with only a minute percentage of the medication even staying in the body, much less absorbed into the bloodstream. More clinical benefit with much less exposure to long-term systemic medication is an ideal combination.

Common medications to use as preventive measures after sinus surgery include topical steroids such as fluticasone, dexamethasone, mometasone and budesonide. Topical antihistamines such as levocetirizine and azelastine can also be effective. In specific cases, antifungal and antibacterial medications can be used in both a saline rinse and a nasal nebulizer, but our goal is always to prevent the infections rather than wait until they happen and then treat them.

Why We Recommend Surgical Correction

Unfortunately, human anatomy simply does not allow for such topical medications to gain access to the sinuses unless the sinuses have been surgically opened (balloon sinuplasty, turbinate reduction and endoscopic sinus surgery are just a few examples). This is why we recommend surgical correction of any nasal or sinus obstruction before placing a patient on topical nasal and sinus-medicated rinses. It is possible for medicated irrigations to improve symptoms for patients who have not had sinus surgery. However, the benefit is typically restricted to the nasal passages, not the sinuses, so the extra work of doing the irrigations is probably not worth it when simply applying a spray accomplishes the same thing. The good news is that the combination of modern sinus procedures and preventive topical medical therapy provides nearly all patients with lasting sinus relief, and prevents the need for another sinus procedure three to five years later. This is as true for nasal polyposis patients as it is for recurrent sinusitis with allergic rhinitis patients.

Since each nasal and sinus sufferer has a different profile of specific causes for his or her symptoms, we encourage all who are interested to seek out an otolaryngology evaluation before attempting any type of self-treatment. The full benefits of topical saline rinses and nebulized topical therapy are only realized after all obstructive issues are resolved.

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