Specialities

[ What are sinuses? ] [ What is sinusitis? ] [ How is sinusitis diiagnosed? ] [ How is sinusitis treated? ] [ Functional Endoscopic Sinus Surgery ]

What is Endoscopic Sinus Surgery?   

 Sometimes abbreviated as ESS or FESS (for Functional Endoscopic Sinus Surgery), this procedure opens the sinuses and allows them to drain. To see into the sinuses, the surgeon uses an "endoscope," which utilizes fiberoptic glass rods to provide superb visualization during the surgery. This allows the surgeon to precisely open the sinus drainage pathways wider while leaving the remaining tissue undisturbed. The surgeon passes specialized instruments alongside the narrow scope into the nose to perform the necessary procedures.

 A nasal endoscope:

The majority of individuals have four sets of sinuses on each side: maxillary (under the eyes), ethmoid (between the eyes), frontal (above the eyes), and sphenoid (behind the nose). (See "What are sinuses?"). Sinusitis may affect some or all of these sinuses. Based on your symptoms, examination, and CT scan, your surgeon will determine which sinuses will need to be opened. Occasionally during the surgery, additional inflammation or infection is discovered and may necessitate opening more sinuses. Your surgeon will discuss this with you prior to the procedure.

What are the benefits of surgery?   

The goal of endoscopic sinus surgery is to improve the drainage of the sinuses and prevent mucus from building up in these chambers. When secretions accumulate in a blocked off sinus, they may become infected with bacteria and result in a flare up of sinus symptoms. By widening the natural drainage pathways of the sinuses, surgery helps to decrease the frequency, severity, and duration of infections. The diagram below shows the effect of better drainage after a FESS

In many cases, surgery does not entirely prevent flare-ups of sinusitis. In other words, surgery is not a cure for sinusitis. In most patients with sinusitis, the lining of the nose and sinuses (the "mucosa") over-reacts to irritants, swells, and causes accumulation of mucus. Sinus surgery does not directly treat this over-reactive lining, but instead drains the sinuses and allows the mucosa to improve on its own. Sometimes the lining does not recover completely and still requires medications like nasal sprays and antihistamines. Opening the sinus cavities more widely allows the spray medications to get into the sinuses and directly act on all of the mucosa. Surgery, therefore, acts with medications to improve the lining and keep the sinuses healthy. It is an adjunct to, not a replacement for, proper medical management.

What are the risks of surgery?    

All surgeries carry with them the risk of bleeding, infection, and pain. The risk of bleeding is increased by certain medications so you should review all medications (prescription, over-the-counter, and herbal) with your physician prior to surgery. Aspirin must be stopped 10 days prior to surgery and other anti-inflammatory medications such as ibuprofen (Motrin, Advil, etc.) must be stopped 4 days prior to surgery. You may have small nasal sponges placed at the conclusion of the procedure if your nose is oozing excessively. Due to the size of the sponges, most patients do have difficulty breathing through their noses while they are in place. The sponges are usually removed within 1-2 days and do not cause too much discomfort.

The risk of infection will be minimized by taking antibiotics after the procedure. The length of antibiotic treatment is individualized based on endoscopic findings but usually lasts 2-4 weeks. Most patients' pain is relieved by mild pain killers. You will receive a prescription for sufficient pain medicine after your surgery.

You should expect to visit your surgeon multiple times during the initial post-operative period. This post-operative care is critical to the success of the surgery and usually entails visits every week or every other week for four to six weeks. During these visits, your nose will be thoroughly examined to be sure it is healing properly and that excessive scarring is not developing. Sometimes it is necessary to remove a small amount of scar tissue under local anesthesia.

In some cases it is necessary to straighten the nasal septum in order to gain access to the sinuses or to improve breathing through the nose. This procedure, called a septoplasty, carries with it the additional risks of a permanent hole in the septum (septal perforation) or numbness of the top front teeth. Rarely, septoplasty can change the appearance of the nose.

Lack of improvement or even worsening of the underlying condition and the need for re-operation are other risks inherent with any surgery. Surgery also carries with it risks of anesthesia. Endoscopic sinus surgery can usually be performed under either local or general anesthesia although some cases, due to medical reasons, require general anesthesia. You should discuss your anesthesia preferences with your surgeon in order to determine what is best for you. You will also have an opportunity to discuss the risks and benefits of each form of anesthesia with an anesthesiologist.

What should I expect after surgery?    You should expect an uneventful recovery. You will want to take it easy for the first few days and then return to normal activities over the next week. Most patients take a week off of work/school following the surgery. Depending on the individual and the how extensive the surgery was, additional time off may be necessary. You can expect some nasal stuffiness for the first 3-4 days after surgery as well as occasional bloody mucus discharge from your nose. You can travel by air two days after the surgery but cannot swim for 4-6 weeks following the procedure. You will receive a complete list of instructions following surgery.