Endoscopic Sinus Surgery : Procedure, Recovery, and Effectiveness

About 31 million people in America get affected by sinus infections.⁽¹⁾ Individuals suffering from frequent sinus problems are unable to breathe easily or enjoy the different scents. Medications can give temporary relief; however, if there are recurrent infections of the sinus or if there are growths blocking the sinus passages, then sinus surgery is needed.

In this article, we will discuss about endoscopic sinus surgery, the procedure and the recovery process.

Endoscopic sinus surgery also known as functional endoscopic sinus surgery is a procedure done for removing the blockages present in the sinuses.⁽²⁾ In this procedure, an endoscope is used, which is a thin camera on a rod with a light attached at the end for better visualization of the sinuses. In this procedure there is also insertion of specialized surgical tool via the nostrils for widening the natural drainage pathways and removal of any blockage.⁽³⁾

An endoscopic sinus surgery is done for the following:⁽³⁾

• If the patient has nasal polyps.
• If the patient has chronic and recurrent sinus infections or inflammation.
• If there are nasal tumors present.
• If there is any nasal obstruction and congestion.

Endoscopic sinus surgery is done to:

• Increase airflow through the nose.
• Reduce the severity and frequency of sinus infections.
• Improve the sense of smell.
• To deliver nasal rinses and medication to the sinus cavities.

This surgery is recommended when the patient has significant physical problems making his daily life activities difficult. In cases where the patient needs a procedure to facilitate drainage, then a balloon sinuplasty is done to clear a blocked sinus passage.

Balloon sinuplasty is recommended, as it is an office procedure whereas endoscopic sinus surgery is often an outpatient surgery. Balloon sinuplasty also has a lesser recovery time than endoscopic sinus surgery.

Balloon sinuplasty is not always advised as many experts do not think that this is an adequate surgical option. This procedure is also not right in cases where the doctor needs to remove tissue.

This is a minimally invasive procedure and is done completely through the nostrils. Majority of the patients can return home the same day. There is very small risk with endoscopic sinus surgery.⁽⁴⁾ The risk of complications is very less and these are linked with the base of the skull and to the eyes, such as cerebrospinal fluid leakage. Some of the other risks which can occur with this procedure are: excessive bleeding, infection, development of a nasal septum hole; vision loss and the need for surgeries in the future.

General anesthesia is often used in this procedure, which has some risks, which will be discussed by the healthcare team with the patient before the surgery.

An article from 2012 says that endoscopic sinus surgery has a success rate of 80% to 90% in treating chronic sinusitis.⁽⁵⁾ Point to note is that follow-up surgeries may be needed as time goes and some patients can continue to experience sinus infections even after this procedure. A vital factor for patient satisfaction after endoscopic sinus surgery is the expectations which the patient has.⁽⁷⁾ So, it is important for a good discussion with the doctor regarding the results which are to be expected.

With time, there has been much advancement in endoscopic sinus surgery, which increases its effectiveness. Experts have found that this surgery seems to have better results when done along with treatments such as nasal spray triamcinolone.

After this procedure the following can be expected to develop:

Patient feels as if they have a bad head cold. There is also swelling surrounding the nose, upper lips, eyes and cheeks. A drip pad is placed under the nose to collect blood and mucus. It is important to avoid putting anything inside the nose after this procedure and avoid blowing the nose for about couple of weeks. Swelling and congestion improves significantly in a week or two. Patient should be ready to return to school or work about a week after the procedure.⁽⁸⁾

The patient is recommended by the doctor to use large quantities of saline wash for irrigation of sinuses. Medication is prescribed to deal with any pain and potential infections and this can consist of oral and topical steroids.

Other than this, a stent can be placed to slowly release steroids into the sinuses or the nose or both when the surgery is done and they are removed after the postoperative period. Always consult your doctor before taking any over-the-counter medications. The sense of smell is usually not good after the surgery and gradually returns over the period of a month or two.

It is recommended to avoid lifting anything which is heavier than 10 pounds in the initial week after surgery. Other than this, patient should also avoid flying for a minimum of 2 weeks and avoid swimming for at least 6 weeks. Many of the patients feel like their old selves after a month or two of endoscopic sinus surgery, however, follow-up visits with the doctor for about 3 to 4 months is important to ensure that proper healing is occurring in the sinuses.

Endoscopic sinus surgery is recommended for patients having blockage in their sinuses or if they are suffering from recurrent sinus infections, as this affects the ability to breathe and smell. This surgery is done on an outpatient basis and a camera scope is inserted through nostril along with any surgical tools needed for clearing the sinus pathways.

As with any surgical procedure, this also has some risks. Always discuss with your doctor about any concerns before undergoing this surgery and always follow your doctor’s instructions with regards to post operative care.

References: