When an Allergist Should Refer Endoscopic Sinus Surgery for Chronic Rhinosinusitis, with Kent Lam, MD

At the 2025 Academy of Allergy, Asthma, & Immunology (AAAAI) in San Diego, Kent Lam, MD, from Eastern Virginia Medical School at Old Dominion University presented on when an allergist should consider a referral for endoscopic sinus surgery for patients with chronic rhinosinusitis.

At the meeting, HCPLive sat down with Lam who discussed what factors indicate a patient with chronic rhinosinusitis may need endoscopic sinus surgery. The surgery should be considered if a patient has already tried other treatment options, such as topical steroids or antibiotics, and still experiences symptoms of nasal congestion, facial pain and pressure, nasal drainage, and decreased sense of smell.

“As an otolaryngologist, or an ear, nose, and throat surgeon, I would really recommend that an allergist refer a patient with chronic rhinosinusitis to an ENT if the patients are still having symptoms in spite of the regular use of topical steroid sprays or topical steroid medications delivered through a nasal saline irrigation method or through the exhalation delivery system,” Lam said. “Sinus surgery has been found to be very helpful for patients with chronic rhinosinusitis as the goals of surgery are really to help reduce the inflammatory burden within the nose and in the sinuses.”

The goal of the surgery is not to remove the tissue entirely—the epithelium is still important to the sinuses— but rather, to improve the drainage pathways and the ventilation of the sinuses.

To balance patient symptom burden and quality of life with the potential risks and benefits of surgical intervention, Lam said that he always establishes the surgery expectations for patients. Hence, they know what to expect post-operation.

“I always tell patients that there are risks involved with surgery, but the mode of surgery now is minimally invasive, so we're able to do these surgeries using special telescopes that go in through the nostrils,” Lam said. “So, following surgery, patients don't have any scars, don't have any incisions on their faces.”

However, patients could have a risk of bleeding, scarring, or persistence of symptoms following the surgery, so patients should be aware of these risks ahead of the surgery, so they can make an informed decision about whether to have the operation.

“I tell patients that following surgery, they have to come back to see me in the office so that we can perform routine [debriefing],” Lam said. “We can perform routine nasal examinations to ensure that scar tissue hasn't reformed [or] formed in the sinuses.”

References

Lam, K and Han, J. When Should the Allergist Consider Referral for Endoscopic Sinus Surgery for Chronic Rhinosinusitis (CRS) Patients? Presented at AAAAI 2025 in San Diego on March 1.