Chronic Sinus Problems and Sinus Surgery

Sinusitis refers to inflammation of the sinuses — the air-filled spaces within the bones of the face and skull. When this inflammation persists for more than 12 weeks, it is termed chronic sinusitis. At its core, chronic sinusitis reflects a breakdown in the barrier function of the nasal lining, allowing microscopic irritants such as allergens or microbes to penetrate and trigger a long-lasting immune response.

Depending on the nature of that immune trigger, patients develop different symptoms and forms of inflammation — a concept known as sinusitis endotyping. These include:

• Type 1 (bacterial-dominant) — associated with congestion, discharge, and pressure
• Type 2 (allergic/inflammatory) — associated with nasal polyps, sneezing, or smell loss
• Mixed endotypes — displaying overlapping features

Understanding your specific endotype is key to choosing the most effective treatment.

• Persistent nasal congestion or blockage
• Nasal discharge (clear or discoloured)
• Post-nasal drip
• Facial pain or pressure
• Reduced or lost sense of smell
• Headache or fatigue
• Recurrent flare-ups (acute sinusitis episodes)

Mr Patel uses a comprehensive, physiology-based approach to diagnosis that includes:

• Nasal endoscopy — a detailed in-clinic examination of the nasal passages and sinus openings
• CT scan of the sinuses — to assess inflammation and anatomical factors
• SNOT-22 scoring — a validated questionnaire to assess symptom severity before and after treatment
• Clinical correlation — combining history, imaging, and lab results to identify the likely sinusitis endotype

This structured approach allows for a precise, personalised treatment plan.

Medical Therapy

All patients begin with evidence-based medical management, which may include:

• Nasal corticosteroid sprays
• Saline or xylitol-based nasal rinses
• Short courses of antibiotics (when bacterial infection is suspected)
• Anti-allergy medications
• Oral steroids (in selected cases)

Sinus Surgery (ESS)

For patients who do not improve with medical therapy, Mr Patel offers Endoscopic Sinus Surgery (ESS). This is a minimally invasive procedure that opens the sinus passages to restore drainage, improve airflow, and enhance medication delivery.

Mr Patel does not perform balloon sinuplasty, as he believes in definitive surgery that addresses all affected areas thoroughly.

Mr Patel regularly performs revision and complex sinus surgery, including frontal sinus procedures — a domain typically managed by highly specialised surgeons. His expertise in these challenging cases ensures that even patients with a history of previous operations, scarring, or difficult anatomy can receive safe, effective treatment. By tailoring the extent of surgery to each patient’s symptoms, anatomy, and inflammatory profile, Mr Patel aims to restore long-term sinus function while reducing the risk of recurrence.

Mr Patel uses an endotype-based approach to tailor both the extent of surgery and post-operative care. His decision-making is guided by:

• Symptom duration and severity
• Failure to respond to optimal medical therapy
• CT findings and endoscopic results
• Patient preferences and lifestyle factors

All patients receive:

• Pre- and post-operative SNOT-22 assessments to measure real impact
• Close early follow-up to prevent adhesions or scarring
• Tailored post-op care, e.g.: 
  • Macrolides or xylitol irrigations for Type 1 inflammation
  • Allergy management for Type 2 disease

Mr Patel aims to deliver a single, definitive surgery where appropriate — with thoughtful, science-led follow-up to maximise long-term benefit.

• A physiology-first approach to sinus disease
• Endotype-based treatment — understanding why inflammation persists
• Objective outcomes tracking with SNOT-22 scoring
• Close, attentive aftercare to optimise healing
• No major complications to date, including CSF leaks, haemorrhages or orbital injury

Symptom Improvement

Patients experience an average 79% reduction in symptoms (SNOT-22 scores) at 3 months following surgery.

Safety Data

There have been no major complications to date (e.g. CSF leak, haemorrhage or visual disturbance), though the general risk of these remains between 0.1% and 1% in sinus surgery.