Roughly 300,000 sinus surgeries are performed every year in the U.S. Of those, it’s estimated between 20 and 60 percent are actually revision sinus surgery, meaning the patient has undergone at least one prior surgery. We asked Armon Jadidian, M.D., a fellowship trained sinus and skull base surgery specialist, why second and third revision sinus surgeries are sometimes needed.

What Causes a Need for Revision Sinus Surgery?

Revision sinus surgery is generally the result of an inflammatory chronic sinus condition that persists after the operation is completed. Unlike acute sinusitis, which generally clears up over a period of two to four weeks, chronic sinusitis can linger for three months or longer, its symptoms becoming increasingly severe over time. Furthermore, certain types of chronic sinus conditions may need close monitoring, follow up, and continued medical therapy after surgery to keep the sinuses in a healthy state.

Some patients will not need this aggressive follow up and medical therapy to keep their sinuses in good shape, but the ones who end up back in the operating room for second and third procedures tend to need more medical management after surgery to prevent or prolong the need for additional procedures.

“There are patients that have persistent infections, with polyp regrowth, thick allergic mucus production and blockage of their sinuses that continues or comes back after their initial surgery,” says Dr. Jadidian. “Some of these patients can be salvaged with aggressive medical therapy and treatment in the office, but often times additional surgery is needed to optimize the sinuses, clear out polyps, wash out thick pus, debris, and mucus.”

Surgical statistics report that as many as 70% of polyp patients require additional surgery after their initial operation.

Other patients may present with additional challenges such as scar tissue or thick bone regrowth from previous surgery. This may cause obstruction of the sinuses’ drainage pathways or trapped infection that cannot drain on its own. This adds a secondary problem to resolve in addition to the underlying inflammatory or infectious process.

An Intricate Surgery Requiring an Experienced Hand

One of the greatest challenges of revision sinus surgery is working around anatomy that’s been altered, scar tissue formation, and thick bone regrowth.

“Revision cases take more time and can be more difficult, increasing some of the risks involved in a normal sinus operation ,” says Dr. Jadidian. “The anatomy often times will be distorted, landmarks typically used may be absent, and there can be scarring or thick bone growth blocking off the sinuses.”

That’s why it’s crucial from the get go to work with an experienced sinus surgeon.

“Having trained in a rhinology fellowship, which focuses not only on sinus surgery, but difficult revision type cases, I feel very comfortable taking care of these patients,” says Dr. Jadidian. “I feel I have the ability to offer an additional level of expertise for these more challenging patients in the Central Florida area. Patients that ultimately do require additional sinus surgery can feel comfortable that we do have excellent experience in dealing with those types of cases.”