What is endoscopic sinus surgery?
Endoscopic sinus surgery is a type of surgical procedure to help patients with chronic sinus problems. Surgery helps open the windows into the sinuses so that the sinuses can drain better.
The sinuses are little air pockets in the bones of the face. The lining inside the sinuses has glands that make mucus. There are also little “hair” called cilia that help to actively move the mucus. After the mucus is produced, these cilia propel the mucus out of the sinuses through the sinus openings. When the mucus is pushed out of the sinuses, it goes into the nasal passages. From there, it can then be pushed towards the back of the nose to be processed.
For many patients with sinus problems, the sinuses can become infected, swollen, irritated, or blocked. A lot of different types of terms are used to describe these types of issues. You may hear terms like chronic sinusitis, sinus obstruction, sinus inflammation, or sinus polyps.
Sinus issues can become chronic when they last for many months or years. In the past, the thought that chronic sinus issues were caused by infections. That is certainly possible, but many people with chronic sinus issues have more of a problem with inflammation than they do infection. There is often no easy “cure” for chronic sinus problems. But, with different treatments, most patients can get a lot of relief for this sinus issues. Sometimes, the treatments include different medicines. Sometimes, allergy treatments can be helpful. In other cases, sinus surgery can be helpful.
The goal of sinus surgery is to help open the sinus windows and allow the sinuses to drain more effectively. Now, sinus surgery is performed by using tools and endoscopes placed inside the nostrils. That is why we refer to this type of surgery as “endoscopic sinus surgery.” Sometimes, people also call it “functional endoscopic sinus surgery” or “FESS” because the goal is to improve the function of the sinuses.
Endoscopic sinus surgery can be used to treat any of the sinuses that are supposed to drain into the nose. There are four sinuses on each side of the face. The names of these sinuses are the maxillary, ethmoid, sphenoid, and frontal sinuses.
Sometimes, other types of names are used for sinus surgery. You may hear these types of terms used to describe sinus surgery: maxillary antrostomy for maxillary sinus surgery, ethmoidectomy for ethmoid sinus surgery, sphenoidotomy for sphenoid sinus surgery, and frontal sinusotomy for frontal sinus surgery. These terms just refer to surgery on each individual sinus separately. As a group, they are all called endoscopic sinus surgery.
The goal of endoscopic sinus surgery is to help the sinuses become healthier. During surgery, the surgeon uses the endoscope to look inside the nose. The doctor then enlarges the sinus windows. This is done using small surgical instruments to make the sinus openings bigger.
The entire procedure can be performed through the inside of the nostrils. That means that there won’t be any incisions, scars, or stitches on the outside of the face or nose.
How does sinus surgery help make the sinuses healthier?
When the sinus openings are enlarged, the mucus from the sinuses can drain better into the nose. With better sinus openings, the cilia can do a better job at clearing material from within the sinuses. This improves what we call “mucociliary clearance.”
Better openings after sinus surgery also make it easier for patients to maintain the hygiene of the nose and sinuses. After the sinuses have been opened with sinus surgery, using something like a sinus rinse will allow the rinse fluid to “wash” the inside of the sinuses. Many patients use things like the Neilmed sinus rinse bottle or neti pot to help rinse their nose and sinuses after surgery.
The larger openings also allow medications to be delivered to the insides of the sinuses after surgery. Nasal sprays and medications mixed into the sinus rinse can penetrate into the sinuses themselves. This helps control things like swelling, inflammation, and infection on a long term basis. By using medicines that enter the sinuses directly, this can also cut down on the need for things like antibiotic pills and steroid pills. Of course, decreasing the need for those types of medications help avoid side effects on the rest of the body.
What does surgery involve if I choose to have surgery?
Sinus surgery is most commonly a procedure under general anesthesia at an outpatient surgery center.
General anesthesia means that the patient is completely asleep for the surgery. The anesthesia is provided by an anesthesia doctor, while Dr. Goyal would focus on the surgery itself.
An outpatient surgery center is also known as an ambulatory surgery center. This is a facility separate from a hospital where these types of procedures are performed. The team at the surgery center includes nurses and surgical technicians. The entire team focuses on providing a comfortable experience with a smooth and rapid recovery.
On the day of surgery, patients arrive at the surgery center 1-2 hours before their scheduled procedure. The receptionists and nursing team will get the patient ready to undergo surgery. The anesthesiologist will then speak to the patient before the procedure. The anesthesia doctor will then put the patient to sleep at the start of the procedure. Dr. Goyal will perform the surgery. When the procedure is complete, the anesthesia doctor will wake the patient up and take them to the recovery room. After a recovery period in the recovery room, patients go home the same day. In our practice, Dr. Goyal does not place nasal packing inside the nose or sinuses at the time of surgery.
What is the recovery like after sinus surgery?
After surgery, most patients can expect a stuff nose and lots of nasal drainage. We don’t use nasal packing, so most patients do not have much pain after surgery. In fact most of our patients use a little Tylenol as needed for whatever pain they do have. In the past, many patients who had sinus surgery described a miserable recovery. Thankfully, things are usually much more comfortable these days!
For the first few days, there will be lots of nasal drainage as the body heals. The drainage can be a combination of things like clots and mucus from the healing process. It is helpful to take some time to rest the first few days after surgery. Patients should avoid straining, lifting, exercise, or any excessive activity.
We ask patients to start rinsing their nose with a sinus rinse bottle the day after surgery. The rinse may not flow all the way through the first week because the inside of the nose can be swollen. But it does help keep things moist and helps to loosen up clots and mucus. Ultimately, the rinse can help clear all of this material from the inside of the nose and sinuses in a gentle way. With the rinse, we typically recommend that patients do it at least 3-4 times a day. More frequent rinsing is better during this time period.
We will typically have a postoperative visit about a week after surgery. At that time, Dr. Goyal examines the sinuses using the little scope. This allows him to look inside the nose and at the sinus openings themselves. Sometimes, clots, mucus, and crusts need to be suctioned from these areas using a tool similar to a tiny vacuum cleaner.
Most patients start to feel better after that first week. After a few weeks, most of our patients feel a fair bit better than where they started in terms of their nasal and sinus symptoms.
Long term, the goal is that the sinus openings stay nice and open so that the sinuses can continue to drain and function well. That means that we will continue to see patients after surgery on a long term basis to check the healing and to help manage sinus issues. Most patients do feel dramatically better with their sinus symptoms after their nose and sinuses heal from surgery. A lot of times, our patients will continue to use things like nasal rinses and sprays to keep their sinus issues under good control. So, surgery does not “cure” sinus problems, but can make a big difference in making the sinus issues more manageable.
Saline sprays and rinse kits can be found at most pharmacies. Our patients find the NeilMed Sinus Rinse kit easy to use. You can find out more information about the kit at www.neilmed.com. Visit our page about sinus surgery recovery for more information about what to expect during the recovery period. You can also visit our page listing Frequently Asked Questions about Nasal and Sinus Surgery.
What are the risks of sinus surgery?
Any surgical procedure can have risks, and there are certainly risks with sinus surgery. The good thing his that the risk of a complication occurring after surgery is very small. But it is important that you understand the potential risks and ask us about any other concerns you may have. Not all risks or issues after surgery can be covered here, so please remember to discuss your particular concerns with your doctor. Some of the risks of sinus surgery include:
Bleeding
Most patients have some bleeding after sinus surgery. The bleeding is typically not heavy. Blood transfusion is rarely necessary and is given only in an emergency. In very rare situations, patients can have heavy bleeding after surgery. Some patients who have heavy bleeding may need to have packing placed to stop the bleeding. In extremely rare situations, patients may need to return to the operating room so that the bleeding can be stopped.
Recurrence of disease
Endoscopic sinus surgery does not “cure” sinus problems. Surgery typically helps most patients feel much better with their sinus issues. But, even after surgery, most patients will continue to use some maintenance medications for their nasal and sinus issues. Most patients do not need to have sinus surgery more than once. In some cases, though revision surgery is sometimes needed.
Cerebrospinal Fluid Leak
Your brain and spinal cord are surrounded by a fluid called cerebrospinal fluid (also known as CSF). The sinuses are located near the skull and brain. Any surgery close to the skull can lead to a leakage of CSF. A CSF leak can cause problems with an infection called meningitis. If a CSF leak happens, patients typically have to have another procedure to fix the hole.
Visual Problems
The sinuses are located next to the eye socket. Any surgery close to the eye socket can lead to injury of the eye, muscles around the eye, and nerves in the eye socket. Fortunately, injuries to the eye socket and structures inside the eye socket are extremely rare. However, if there is an injury, it can lead to problems with vision. The potential for recovery in such cases is not good. Injury to the eye muscles may result in double vision. Persistent tearing of the eye is another possible complication. Tearing problems usually resolve on their own but occasionally require additional surgery.
Other risks of sinus surgery
Other uncommon risks of sinus surgery include alteration of sense of smell or taste; persistence and/or worsening of sinus symptoms and facial pain; change in the resonance or quality of the voice; and swelling or bruising of the area around the eye.
Revision Surgery
Some patients may benefit from sinus surgery more than once. If someone needs surgery again, we call this revision sinus surgery. Revision sinus surgery can help even when the original surgical procedure may not have been very helpful. Read more about revision sinus surgery.
Other questions? Want to schedule an evaluation?
If you have other questions about chronic sinus issues or endoscopic sinus surgery, we would be happy to evaluate you at our office. In addition to evaluating your symptoms, we can help diagnose your issues by examining your nose with an endoscope.
If you are interested in having an evaluation at our office for your nasal and sinus issues, please contact us. You may request an appointment by calling, sending us a text message, or by requesting an appointment online. Our office staff is available Monday – Friday, from 8:30 AM to 4:30 PM.
Pictures of the maxillary sinus before and after surgery
The pictures below show the view just before and after surgery on the left maxillary sinus.
The maxillary sinus is the sinus located in the bone of the cheek. The image on the left shows the type of view we have before the sinus is opened. On the right, you can see how it looks just after the sinus has been opened. You can see into the maxillary sinus through the opening that has been created.
As this area heals, the goal is that the sinus will be able to drain much better than before surgery. This can help improve sinus hygiene, sinus swelling, and sinus infections. By making the sinus opening bigger in this way, we are trying to make the opening permanently larger than before surgery. Having the opening enlarged in this way also allows us to look at the sinus using the endoscope when you come back to the office after surgery.
