An otolaryngologist, commonly known as an Ear, Nose, and Throat (ENT) specialist, diagnoses and treats conditions of the sinuses, head, and neck. When sinus blockage becomes severe and long-lasting, the ENT intervenes to re-establish proper drainage. They manage issues ranging from chronic infections to structural problems that prevent the natural flow of mucus from the air-filled cavities. Drainage methods vary, starting with medication and progressing to surgical techniques when necessary.
When Specialist Intervention Becomes Necessary
A referral to an ENT is warranted when typical sinus symptoms persist despite initial medical care from a primary physician. Chronic sinusitis, the condition most often requiring specialist drainage, is defined by symptoms lasting 12 weeks or more. These persistent symptoms include thick nasal discharge, nasal obstruction, facial pain or pressure, and a reduced sense of smell. Recurrent acute sinusitis, defined as four or more distinct episodes of acute infection within a single year, also signals the need for specialist evaluation.
The ENT uses specific diagnostic tools to identify the underlying cause of the blockage. Nasal endoscopy, which involves inserting a thin tube with a light and camera into the nose, allows for a direct view of the nasal passages and sinus openings. A Computed Tomography (CT) scan provides detailed images of the sinus cavities and bone structures, revealing structural issues, severe inflammation, or nasal polyps. These steps confirm whether the problem is purely inflammatory or involves an anatomical obstruction that prevents drainage.
ENT’s Initial Approach to Sinus Blockage
Before recommending any procedure to physically drain the sinuses, ENTs employ medical management to reduce inflammation and encourage natural drainage. This initial approach includes prescription-strength medications delivered directly to the nasal lining. Nasal steroid sprays, such as fluticasone or mometasone, are used for several weeks to decrease the swelling of the mucous membranes. Reducing this inflammation is often enough to reopen the narrowed drainage pathways without the need for structural intervention.
If inflammation is severe, a short course of oral corticosteroids may be prescribed for a rapid, systemic reduction in swelling. If a bacterial infection is confirmed, a long-term course of antibiotics might be used to clear the persistent inflammation. Patients are also encouraged to perform high-volume saline nasal irrigations using devices like a squeeze bottle or neti pot. These irrigations mechanically flush out thick mucus and debris from the nasal passages.
Surgical Techniques for Sinus Drainage
When medical treatments have been exhausted and chronic sinusitis symptoms continue, surgical intervention is considered to structurally improve sinus drainage. The most common approach is Functional Endoscopic Sinus Surgery (FESS), a minimally invasive procedure performed entirely through the nostrils. The goal of FESS is to enlarge the natural drainage openings, known as ostia, allowing for better mucus flow and air circulation.
The surgeon uses an endoscope, a thin tube equipped with a camera, to navigate the nasal passages and visualize blocked areas. Specialized instruments precisely remove any obstructing tissue, such as bone, swollen lining, or nasal polyps. By widening these passages, the surgery restores the sinuses’ ability to drain effectively. This also allows topical medications like nasal sprays to reach the affected areas more efficiently after the procedure.
An alternative, less invasive option is Balloon Sinuplasty, which does not involve removing bone or tissue. This technique uses a soft, flexible catheter to guide a small balloon into the blocked sinus opening. The balloon is inflated to expand the sinus passage, restructuring the surrounding bone and widening the opening. Once dilated, the balloon is deflated and removed, leaving the sinus pathway permanently widened to promote natural drainage. This procedure often results in a faster recovery than traditional FESS and can sometimes be performed in an office setting under local anesthesia.
Recovery and Maintaining Sinus Health
Following a sinus drainage procedure, recovery typically involves a few weeks of restricted activity. In the first few days, patients commonly experience temporary congestion, drainage, and mild discomfort, similar to a bad cold. Most patients are advised to avoid strenuous activity, heavy lifting, and bending over for about one week to prevent increased pressure and bleeding.
Post-operative care relies on frequent saline nasal irrigations, often recommended several times a day, to wash away crusting, dried blood, and mucus. This mechanical cleansing prevents scarring and infection in the newly opened sinus passages. Patients should avoid blowing their nose forcefully for at least the first week and should sneeze with their mouth open to protect the surgical site. Long-term maintenance involves continued use of saline rinses, managing allergies, and regular follow-up appointments with the ENT.