Surgical Therapy

Patients with chronic sinusitis refractory to medical therapy should be referred to an otolaryngologist for consideration of surgery. In children with persistent maxillary sinus disease, antral lavage (with or without adenoidectomy) effectively removes purulent material and often provides long-lasting symptom relief. In adults, however, functional endoscopic surgery has largely supplanted other surgical procedures and is effective in 50-80% of patients. Patients with aspirin-sensitive asthma, nasal polyposis, and pansi-nusitis are more likely to have recurrent disease and should be discouraged from undergoing multiple repeat surgical procedures.

Patients suspected of having intracranial complications (e.g., periorbital abscess, brain abscess, or meningitis) of acute sinusitis should be referred for immediate surgical consultation. Cardinal signs and symptoms include high fever, severe headache, proptosis, and changes in mental status.

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