Is Empyema Surgery Really Necessary? Recurrence and Post-Operative Care | Incheon Empyema

Hello, this is Baekrokdam Korean Medicine Clinic.

My nose is blocked, and my head feels foggy all day. Medication only helps temporarily, and the hospital is telling me to have surgery... Do I really have to?

Many patients ask this question in the consultation room. Sinusitis, in particular, is a chronic problem that goes beyond the simple discomfort of a blocked nose and significantly lowers the quality of life. It can lead to a heavy head, loss of smell, lack of concentration, and in severe cases, fatigue or emotional mood swings.

However, compared to that discomfort, the direction of treatment for sinusitis is often divided too dichotomously. Is the suggestion that surgery is the immediate next step if medication doesn't work truly the right answer? Or is there a middle option? Today, we intend to calmly examine various options, including the principles of sinusitis surgery, its necessity and limitations, and non-surgical approaches including Korean medicine.

2. What is Sinusitis? – Different from Simple Nasal Congestion

Sinusitis is a disease that cannot be ignored just because it appears like a cold. It may start like a cold but persist for several weeks or even months. Patients usually describe it like this:

Runny nose flows down the back of my throat. I constantly feel like something is stuck in my throat.

I can't smell well. I also feel the taste of food less.

My head feels heavy, and my eyelids ache every morning.

These symptoms occur as secretions fill the spaces called the paranasal sinuses. These spaces are located deep inside the nose, and normally, air flows in and out while the mucous membrane maintains moisture and blocks bacteria. However, when inflammation occurs and the exit is blocked, secretions cannot escape and accumulate.

The important point here is that it cannot be explained solely by a structural problem of being 'blocked.' Some people have a deviated septum but no sinusitis, while others have a normal nasal structure but suffer from recurring chronic sinusitis. In other words, complex factors such as the state of the mucous membrane, immune response, and internal circulation can be the cause.

3. Principles and Reality of Surgery – What Kind of Surgery is it, and is it Necessary?

When recommended for surgery by a doctor, patients react like this:

They're shaving bone? That's a bit scary.

If I do it once, will it never happen again?

Usually, surgery uses an endoscope to widen the exit of the paranasal sinuses where inflammation has accumulated and, if necessary, removes part of the mucous membrane or very fine bone structures. This is the so-called ESS (Endoscopic Sinus Surgery). The surgery itself is performed precisely and relatively safely under anesthesia. The problem is that this surgery only removes the 'result of inflammation.' In other words, it cleans up the surface while leaving the causes that made secretions accumulate—such as decreased mucous membrane function, paralysis of cilia, or stagnation of lymph flow—untouched. Therefore, there are not a few cases where it recurs within several months after surgery. In fact, many patients consider re-operation within 1-2 years. In this regard, surgery needs to be a 'last resort.' Surgery may give the feeling that something has been resolved, but surgery without functional recovery can be a repeating cycle.

4. Why is Recurrence Frequent – From the Perspective of Mucous Membrane Function and Lymphatic Circulation

People whose symptoms recur even after surgery say:

I think it's getting blocked again. It's not much different from before.

My nose seems a bit clearer, but my head still feels heavy and tired.

The reason is simple. The space we breathe in is not just a tunnel, but a space that must have a 'functioning mucous membrane.' In this membrane, very fine cilia move constantly to push secretions outward. However, if these cilia are paralyzed or if the mucous membrane becomes swollen and hardened due to chronic inflammation, it will not flow no matter how much the structure is widened. Furthermore, lymphatic flow operates very importantly around the nose and paranasal sinuses. If lymphatic circulation in the face and skull area is blocked, inflammation does not drain and remains. Recently, methods to help this flow, such as physical circulation methods like lymph drainage or techniques to regulate facial pressure, are being attempted. Ultimately, mucous membrane health, lymphatic flow, and immune response—all of these matter. Surgery may be nothing more than touching one part of that.

5. Non-surgical Approach – Korean Medicine Attempts and Complex

Strategy

In Korean medicine, sinusitis is not viewed simply as a bacterial infection. It is diagnosed as follows:

• Damp-heat has accumulated in the lungs, blocking the body fluids
• Phlegm-fluid has gathered and clumped in the upper body
• The lung qi's dispersing energy (seontong) is blocked

Herbal medicine treatment proceeds in a way that resolves these pathological states. It cools heat-toxins, dries dampness, and allows qi to flow. Acupuncture treatment helps lymphatic circulation and local immune regulation by stimulating acupoints related to the nasal mucosa.

Above all, in Korean medicine, rather than just managing symptoms, the treatment is designed around the question, 'Why did this person develop this specific symptom pattern?' Therefore, constitutional tendencies, accumulated fatigue, sleep status, and eating habits are all considered together. While this approach may take some time, there are cases that improve without surgery, and it is particularly meaningful as a complementary treatment to prevent recurrence after surgery.

6. What Is the Right Choice for Me?

"In the end, it kept coming back if the cause wasn't properly resolved."

These are words spoken by one of our patients. Sinusitis surgery may be absolutely necessary. However, before considering surgery, or even after surgery, what must be considered is 'Has the flow of my body been restored?' Breathing comfortably is not simply because space was secured, but because that space is alive. Therefore, before the choice of surgery, or even after it, a strategy centered on the recovery of mucosal function and internal circulation is necessary. That can be the path to true recovery.

#Sinusitis #SinusitisSurgery #IncheonSinusitis