Are There Any Alternatives To Sinus Surgery?

What you’ll learn

What you’ll learn:

• Understand the importance of optimizing medical management before considering sinus surgery.
• Explore minimally invasive procedures like balloon sinuplasty and their role in breaking the cycle of inflammation.
• Learn how office-based procedures can offer viable alternatives to traditional sinus surgery, with reduced downtime and cost.

Listen to the audio version below.

If you’ve been living with chronic sinus issues or you’ve already been told by another ENT that you need sinus surgery then it’s natural to wonder whether that’s really your only option. Our doctors, Dr. Undavia, Dr. Reddy, and Dr. Smith, get this question often, especially from patients seeking a second opinion. The short answer: yes, there are alternatives, and for many patients, they’re worth exploring first.

Do I Have to Get Sinus Surgery if it Was Recommended?

Before considering any procedure, the first step is making sure every non-surgical option has been fully explored. Your sinuses are air-filled cavities around the eyes and beneath the brain, and most sinus disease comes down to obstruction caused by inflammation. Reducing that inflammation is the goal of medical management, which can include:

• Nasal steroids
• Oral and topical antibiotics
• Allergy and environmental irritant management
• Specially compounded rinses and irrigations (antifungal, antibacterial, and steroid combinations) for patients who aren’t responding well to standard oral medications

For many patients, optimizing these options resolves symptoms without ever needing a procedure.

What Are the Alternatives to Sinus Surgery?

Balloon sinuplasty is one alternative to traditional sinus surgery and takes a different approach. Rather than removing the “door” to a sinus, it uses a small balloon catheter to gently push the door open — widening the natural opening without removing any tissue. The technology was originally developed for cardiac procedures, where balloon catheters replaced more invasive open-heart techniques, and has since been adapted for use in the sinuses.

Balloon sinuplasty can be performed on every group of sinuses that would otherwise require surgery, and unlike traditional sinus surgery, it’s often done in the office under local anesthesia, without the need for a hospital or surgery center visit.

What’s the Difference Between Balloon Sinuplasty and Traditional Sinus Surgery?

To understand the alternatives, it helps to understand what traditional sinus surgery actually does. Functional endoscopic sinus surgery (FESS) opens the natural passageways of the sinuses. Think of each sinus as a room, and the surgery as removing the door entirely so the room stays permanently open. It’s performed through the nose, without external incisions, and is itself a far less invasive approach than the surgical techniques used decades ago.

Why Do Patients Look for Alternatives?

There are several common reasons patients seek an alternative to traditional sinus surgery:

• Time off work. Traditional surgery often requires up to a week of recovery; many patients want to avoid that.
• Anesthesia concerns. Some patients are apprehensive about general anesthesia, or are higher-risk candidates due to cardiac or pulmonary conditions, or because they’re on blood thinners that increase bleeding risk.
• Comfort. An operating room can feel intimidating, while a familiar doctor’s office is far less stressful.
• Cost. Hospital and surgery center procedures typically cost significantly more than in-office alternatives.

Are In-Office Procedure as Effective as Surgery?

It depends on the patient. For some, a minimally invasive procedure is a complete replacement for traditional surgery; for others, it’s a helpful step that may or may not be enough on its own. Chronic sinus inflammation tends to feed on itself, and breaking that cycle is sometimes all that’s needed — a minimally invasive procedure can accomplish that without the downtime of a full surgery.

Increasingly, many practices — including ours — also offer hybrid procedures that combine balloon techniques with more traditional approaches where needed, still performed in-office under local anesthesia.

The right approach depends on several factors specific to each patient: their anatomy, what they’ve already tried, the underlying cause of their sinus disease, and their day-to-day quality of life. It’s not just about how the sinuses look on a CT scan — chronic inflammation can also have downstream effects on conditions like asthma or bronchitis, which our doctors take into account when recommending a treatment plan.

Am I a Good Candidate for Balloon Sinuplasty?

Sinus treatment is best approached step-by-step. If your very first ENT visit resulted in a recommendation for sinus surgery — without first trying nasal sprays, rinses, or allergy management — that’s worth a second opinion. Similarly, if medication hasn’t worked and surgery is presented as the only next step with nothing in between, that’s also worth questioning.

The vast majority of patients who are candidates for sinus surgery are also candidates for balloon sinuplasty or a hybrid procedure. Exceptions include patients with especially challenging anatomy, fungal sinus disease, or extensive nasal polyps, where traditional surgery may be more effective. Even so, every patient should at least have the option presented to them.

You Don’t Have to Fix Everything at Once

It’s a common misconception that every abnormality visible on a CT scan needs to be corrected in a single procedure. Dr. Undavia, who has a deviated septum, a concha bullosa (an air cell in the middle turbinate), and enlarged inferior turbinates himself, chose to treat only one issue — a turbinate reduction, performed in-office rather than correcting everything at once. The result was enough symptom relief to maintain his quality of life without further intervention.

The goal of treatment is symptom relief and improved quality of life, not necessarily addressing every finding to the fullest extent possible. Starting with the least invasive option that meaningfully improves how you feel is often the right approach.

When Is Sinus Surgery Still the Right Choice?

While alternative treatments help many patients, there are cases where sinus surgery remains the most effective path to lasting relief particularly for extensive nasal polyps, fungal sinus disease, or anatomy that doesn’t respond well to less invasive techniques. A consultation is the best way to determine which approach fits your specific situation.

Schedule a Consultation

If you’ve been told sinus surgery is your only option, or you’re not sure whether a less invasive alternative might work for you, we’re happy to provide a second opinion and walk you through every option available.

Audio Transcript:

Dr. Reddy:

Hey guys, welcome back to another episode. Today we are going to be discussing a topic entitled, are there any alternatives to sinus surgery? So oftentimes we’ll see a patient come in with chronic sinus issues or nasal polyps and they’ve been recommended sinus surgery by another ENT and they’ve come see us for a second opinion and they ask us, you know, is there any other alternatives to sinus surgery? Do I have to get sinus surgery? And what are your responses to them?

Dr. Smith:

Sure, so I often tell them, yeah, there’s a lot of different alternatives. And some of that starts with medical management and making sure that someone’s really done everything possible out there medically to manage allergies, environmental things, and irritants that could be triggering and causing more sinus disease. We’ve talked about kind of sinus anatomy and things in the past, so we won’t beat that over again, but essentially the sinuses are just these air-filled trauma cushions around the eye and underneath the brain. And most of the disease pathology occurs due to obstruction of the sinuses due to inflammation. And so you just want to make sure that whatever you can do to try to decrease that inflammation, we do. So in full consent, we talk to them about optimizing medical management with things like nasal steroids and maybe antibiotics. And those can be both oral and topical, so we were just recently talking about compounding medications. Sometimes if patients are not responding well to, because a lot of the times they’re on oral medications frequently, we can get special compounded rinses and irrigations for the nose to try to get some of the inflammation down and get better health in the sinuses. And those include antifungal, antibacterial, steroids, a kind of a conglomerate of medications to try to decrease some of the inflammation up there.

And then we start talking about kind of more minimally invasive type things and procedures. You know, one thing I often talk about to patients is that, you know, when someone comes in with a recommendation before sinus surgery, it’s typically functional endoscopic sinus surgery is what most people, you know, are recommended. So endoscopic sinus surgery was at one point a more minimally invasive approach. So, I sometimes will remind patients that these air-filled trauma cushions before to get access to them, patients in the old days, like historically they were getting trepanation or drilling or even chiseling into the sinuses. So there’s reports back even a thousand years of people with a mastoid sinus or the facial sinuses doing like chiseling or screwing into the sinuses to relieve the pressure and to like let the bad humors out of the sinus.

So, then people were doing these types of procedures maybe underneath of the skin, so under the lip, through the mouth. And so procedures really have, even to get to the point where we talk about functional endoscopic sinus surgery, which is sinus surgery through the nose, but opening up those sinuses. And we talked before about those sinuses being these rooms and basically taking those doors off to make it one big open floor plan.

So functional endoscopic sinus surgery, in and of itself is still more of a minimally invasive approach, but you’re doing more opening of the sinuses, taking out some of the natural grooves and passageways into the sinuses to make it one large expanded groove.

Dr. Reddy:

You’re widening the pipes.

Dr. Smith:

Correct.

Dr. Reddy:

So the simplistic way, I always tell patients which sometimes I don’t like your… But there’s a pipe analogy. Your nose is a series of pipes and they get partially clogged when you have chronic sinus issues. So the medications, the allergy management, all that stuff is essentially like Draino for your pipes, trying to unclog it with Draino. If that’s not enough, then you consider, what do you do, you call the plumber and maybe he roto-rotors it out, which that’s kind of similar to balloon sinuplasty, which we’ll go over in a minute. If that’s not enough, then you get a wider pipe, right? And that’s what functional and this is how the science is produced. You get the wider pipe. That’s essentially making the pipe bigger. And then what you were alluding to before, the in the old days and sometimes still occasionally done now is like the trepanation techniques. That’s like putting a whole secondary pipe in a whole different area that wasn’t there before. Now I don’t usually go that far, but let’s go over the rotor-routering technique, which is balloon sinuplasty.

Dr. Undavia:

Well, can I, maybe you’ll like my example.

My example is this room is a sinus and there’s a door to enter the sinus. Traditional endoscopic sinus surgery is removing the door so that the sinus stays open. Balloon sinuplasty is pushing open the door.

Dr. Smith:

Yeah, I’m leaving the door intact. That’s the exact analogy I used.

Dr. Reddy:

Yeah, yeah. Let’s do a poll from the audience. Let’s see which one. Let’s not. We all know it’s all an analogy.

All right, so let’s go over balloon sinuplasty. Can you go over an overview of what that is?

Dr. Undavia:

So yeah, so actually can we start off by saying, you know, like why would someone come to the office saying I want an alternative? Sure. Yeah. Do you want to go over that?

Dr. Reddy:

Yeah, so there’s a lot of reasons why people are looking for alternatives to sinus surgery. One is that people don’t want to take off time from work, right? They know somebody that’s had sinus surgery and typically maybe that person had to take a week or so from work and they want to get back to work immediately. The other thing is, a lot of people may not be afraid of the surgery itself, but they might be afraid of the anesthesia. That’s number one. Or they might be afraid of anesthesia complications. They might be too high risk for anesthesia. They might have other cardiac issues or pulmonary issues that makes them at a higher risk for anesthesia. The patient might be on blood thinners and it’s hard for them to get off of it and they’re at an increased risk of perioperative bleeding.

So there’s all sorts of reasons why people wanna avoid a trip to the hospital or to an operating room. That place, when you go to the hospital and the operating room, it’s a scary place. When you come to a doctor’s office where you’ve been too many times, it’s much more comfortable. And so those are some of the main reasons.

Dr. Undavia:

Yeah, it can be more expensive to go to the hospital too.

Dr. Reddy:

That’s true. Definitely can be more expensive. So, oftentimes this isn’t talked about as much, but the facility you know, whenever you get a surgery done in the operating room, in a hospital, you have three main fees. You have the anesthesia fee, you have the surgeon fee, and by far the most expensive part of it is the facility fee. And so if you have a high deductible plan, or if you’re paying for anything out of pocket, the facility fee, the hospital fee, the surgery center fee is going to be by far the biggest fee. And so if you were getting a procedure done in the office, you’re saving potentially not only for yourself, but the healthcare system a whole bunch of money.

Dr. Undavia:

Yeah, so now we can go over alternatives. So when we talk about alternatives to traditional science surgery, we’re talking about doing office-based procedures. And you can pretty much do all the same things that you do in the operating room, in the office. We just use different tools. So instead of using something to remove that door, we use something to push open that door. And we have a lot of videos talking about balloon signing plasticity or even balloon eustachian tube dilation. This is a similar thing where we’re taking a device that has a balloon at the end and we use it to push over that egg shell or that little bit of a sinus wall that’s obstructing that sinus. So we put the balloon catheter into that sinus opening and we push it open. And we can do that for every group of sinuses that we do in the operating room.

Dr. Reddy:

Yep. And the technology came from an interesting place. It came from the cardiac world. So a lot of people have heard of open heart surgery and how in the past, open heart surgery used to be very, very common.

So over time, cardiac procedures have become more minimally invasive by a lot of these interventional techniques where small catheters and balloons are introduced in a minimally invasive fashion, so you’re avoiding sternotomy and open heart surgery. What has happened is that some very smart people have taken that same technology and modified it for the ENT world to be introduced in a similar fashion through your nose and sinuses, so now you’re no longer opening up blockages in an invasive fashion, you’re addressing them in a more minimally invasive fashion.

And so this is kind of the new frontier in ENT, and a lot of research and the pendulum is kind of swinging in the direction of doing more and more of these procedures in the office in a more minimally invasive fashion. And we’re just starting to see that trend appear and the ENT world.

Dr. Smith:

Yeah, and a lot of patients, I kind of explain to them, like inflammation begets more inflammation. So, you know, a lot of times you just need to break that cycle. And if you can break that cycle, and we’ve tried all the medical management, we haven’t been able to break the cycle, sometimes just that minimally invasive procedure is all you really need to break that cycle. And so that’s where, you know, a good ENT can help you kind of come up with a plan and formulate, like, is this a reasonable option for me? You know, is this a problem that you think maybe something more minimally invasive might be able to break this cycle and improve my sinuses. Um, and then of course, like we offer, and a lot of people across the country are starting to do more hybrid type of procedures too. Whereas like if somebody has some issues that might be improved with like a balloon, but might need something more like a combination with some traditional, some balloon, we’re able to do a lot of those things now in the office just under local anesthesia. Again, without the significant downtime and recovery is significantly lighter and easier.

So the nice thing is where the options are kind of plentiful as to what we can offer and combinations of what we can do to try to get those sinuses healthy again.

Dr. Undavia:

Sure. Is this a shortcut or is this like, you think of sinus surgeries, blooms on your plastics like a shortcut or do you? Are you basically doing the same thing?

Dr. Smith:

Yeah, so sometimes it’s an alternative and maybe a shortcut. Sometimes it’s a complete replacement. It really just depends on, you know, not everybody’s underlying problem or etiology to their science disease is the same. And so it is like a very patient independent kind of decision to make. And so we all kind of, it’s not just, oh, everybody who has sinus disease is a candidate for this. It really is dependent upon, you know, the patient, what they’ve tried in the past. And so it’s a little bit of a patient specific game plan as to who would be a good candidate for these. But most people would benefit from these types of procedures with sinus disease. And sometimes we talk about this too. You may not be able to improve everything 100%, but you might get things to look and again looking and feeling are two separate things. So sometimes patients have zero symptoms, but there might look like there’s still some mild inflammation in there. And so symptom-based and downstream effects of sinus disease are two things that we think about. So I of course care a lot about what the patient’s experiencing. So what’s their quality of life from their sinus disease? So what is it today? What is it every day? What is it monthly? How does that fluctuate over the course of the year?

But also do I see that disease or that sinus inflammation causing downstream consequences with asthma control or lung control bronchitis infections in the lungs? Is that chronic inflammation affecting their immune system overall? So I take a lot of those things into account when we decide what type of procedure and to offer a patient.

Dr. Reddy:

So one thing I wanna add is, the way that I look at this is that balloon sinuplasty and office procedures allows another step in your approach to a step-wise fashion of treating your problem.

Dr. Smith:

Correct.

Dr. Reddy:

So for example, if you were a patient and you went to an ENT doctor and you’ve never had your sinuses treated before and his recommendation was sinus surgery right off the bat, right? That would be a red flag, correct?

Especially if you haven’t tried like nasal sprays or rinses or allergy management first. Similarly, you know, if you’ve tried those medications and the only thing that you’re offered a sinus surgery and not an in-between option, that’s potentially a problem as well. The vast majority of people with sinus disease who are a candidate for sinus surgery is also a candidate for balloon sinuplasty or a hybrid procedure. With the exceptions of a few things like challenging anatomy or fungus disease or extensive nasal polyps or something like that, with the exceptions of those, almost everyone is a candidate for balloon sinuplasty. Now I think all of those patients should at least be afforded the opportunity to maybe consider it as an option.

It may not be the best option and it may not get the best results compared to traditional function on the scopic sinus surgery, but at least it should be put out there. That’s my two cents on the topic.

Dr. Undavia:

My two cents are that I have a deviated septum myself, I have a contravalosa, and I have two inferior turbinates that are very large. Both of you know about them.

Dr. Smith:

Patients don’t know what a contravalosa is. So I have an air cell in the middle turbinate that’s somewhat obstructing, or can cause obstruction of some of the sinuses.

Dr. Undavia:

I have three reasons to have difficulty breathing through my nose and I have a nasal belt. So I have four reasons to have difficulty breathing through my nose. I chose to have something done in the office by both of these guys. And so we did just a turbo reduction. So that was it. So I chose one of the things. It was something that was done in the office. It was easy. I was able to see patients later on that day and the next day. And I didn’t have to address everything. I think back in the back when we were training, we were taught you must fix everything to make the patient feel better. Yeah. Um, and now we’ve changed a little bit. Maybe you could do it so long as it’s easy and it doesn’t have any downside or any, if you don’t burn any bridges, you can start with one thing and see if you feel better. Now, if I had my septum fixed or my contrabellosa repaired, would I breathe even better? Probably. But the truth is I’m very happy right now. Yeah. I choose quality of life is a big, is a big way. Yeah. I’m very happy, I don’t need to do that.

Dr. Reddy:

Yeah, that’s a great point. You don’t need to, just because you have a laundry list of things that are wrong on your CAT scan, yeah, doesn’t mean you need every single one of those fixed right away to the maximal amount of aggressiveness.

Dr. Smith:

Yeah, to get the symptom improvement, quality of life improvement that you need. I agree. Dr. Undavia:

Yeah, very good. And then I was able to keep working out. I was able to do all the things I wanted to do.

Dr. Reddy:

Anything else to add?

Dr Smith:

No, I think that’s fantastic.

Dr. Reddy:

Great. Well, that’s all we have for today. We’ll join you guys next time. Take care.

While alternative treatments can help many patients, there are cases where sinus surgery is ultimately the most effective way to achieve lasting relief from chronic sinus issues.