Confirm the Diagnosis

Patients with genuine chronic bacterial rhinosinusitis who do not respond to medical treatment are often helped by surgery, unless they are immuno-suppressed, when caution is needed (Fig. 8.1). It is important to make sure as far as possible that your patient has a diagnosis that is likely to respond, at least in part, to surgical intervention. Operating on a patient who has only allergic rhinitis is very unlikely to help them (Fig. 8.2). If their CT is normal or shows turbinate hypertrophy without evidence of sinus disease, retake

Turbinate Hypertrophy

Fig. 8.2 Turbinate hypertrophy without evidence of sinus disease—think twice before operating on these patients.

Fig. 8.1 A patient who has not responded to multiple courses of antibiotics—consider their immunity before operating.

Fig. 8.2 Turbinate hypertrophy without evidence of sinus disease—think twice before operating on these patients.

Optimize the Immediate Preoperative Condition 131

Turbinate Hypertrophy
Fig. 8.3 a Endoscopic view at presentation. b Endoscopic view after maximum medical treatment. Give a cautious prognosis

the history, try more medical management, ask the patient to keep a diary of their symptoms, and wait for a pattern of their symptoms or exacerbating or relieving factors to become clearer. If the problem is tension-type headache, then surgery will not help (although it is interesting to note that in about one-third the alteration in central neuroplasticity that results from surgery leads to an improvement for a few months). One-third of patients with tension-type headache who inadvertently had surgery have an increase in their symptoms and, this is why it is important to make the correct diagnosis and avoid surgery (Jones and Cooney, 2003; Jones, 2004).

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