Chronic sinusitis. Will i need surgery?

Hi, I am Dr. Atul Kumar Nimawat MS ENT. Thank you for your detailed query and for sharing the CT scan images and report. Based on the findings from your CT Paranasal Sinus (PNS) report, the following points are relevant: Key Findings: Minimal left-sided nasal septal deviation. Atrophy of the superior and middle turbinates—this may contribute to dryness or crusting. Mucosal hypertrophy in the right maxillary sinus with dependent air-fluid level—suggestive of acute on chronic sinusitis. Bilateral ethmoid and sphenoid mucosal thickening and blockage of the osteomeatal complex, leading to poor sinus drainage. Possible adhesions (synechia) noted, though not explicitly stated in the report. Clinical Correlation: Your symptoms of nasal obstruction, chronic sinus pressure, and difficulty breathing through the nose are consistent with chronic rhinosinusitis, possibly with nasal synechiae contributing to localized obstruction. Regarding Your Current Treatment: Defza 6 (Deflazacort) is a steroid that helps reduce inflammation but is not a long-term solution. Metaspray (Mometasone) is appropriate for maintenance therapy but may not be sufficient if anatomical obstruction is severe.

Continue nasal steroid spray (Metaspray) regularly. Consider saline nasal irrigation to clear secretions. A trial of broad-spectrum antibiotics (if infection persists). If no significant improvement in 2–4 weeks, FESS may be strongly considered. Surgical Consideration: Given your history and CT findings, Functional Endoscopic Sinus Surgery (FESS) may be advised if: Symptoms persist despite 4–6 weeks of optimal medical therapy. There is persistent sinus blockage, recurrent infections, or anatomical obstructions (e.g., synechiae or infundibular blockage). Surgery aims to restore sinus ventilation, remove obstructions, and prevent recurrence. It is a safe and effective procedure when conservative measures fail.

Please consult your ENT specialist with these findings. Surgical intervention is often beneficial in such chronic cases, especially when imaging supports poor drainage and mucosal disease.