What is endoscopic sinus surgery?
Endoscopic sinus surgery can improve symptoms in patients with chronic sinus problems. The goal of endoscopic sinus surgery is to help the sinuses become healthier. During surgery, the surgeon uses an endoscope to look at the natural openings of the sinuses. Using small instruments, the surgeon then works to make these openings bigger. This type of surgery avoids any incisions or scars on the outside of the face or head. The procedure is done by placing the endoscope and instruments inside the nostrils.
The pictures above show the view just before and after surgery on the 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 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.
Enlarging the natural sinus openings can allow the sinuses to drain more effectively. Surgery also helps with the cleanliness and hygiene of the sinuses. After the sinuses have been opened, using something like a sinus rinse can help clear the sinuses much more effectively. Medications such as nasal sprays may be more helpful after surgery because the medication can reach into the sinuses much more effectively.
Patients are most commonly under general anesthesia for this type of surgery. This means that they are completely asleep. The procedure is most commonly performed at a surgery center (commonly known as outpatient surgery centers or ambulatory surgery centers). Patients will generally come to the surgery center the morning of surgery. After a short recovery period after surgery, patients go home the same day. In our practice, Dr. Goyal does not place nasal packing inside the nose or sinuses.
After surgery, the goal is to make sure that the sinuses continue to drain well. Patients are seen for a series of office visits to ensure that things are healing well after surgery. During these visits, the surgeon will again use an endoscope to look inside the nose. The surgeon can then see the openings that were created at the time of surgery and make sure that they are healing properly. Sometimes, mucus and debris need to be removed to help the nose and sinuses heal properly.
What are the risks of sinus surgery?
As with any surgical procedure, endoscopic sinus surgery has associated risks. Although the chance of a complication occurring are very small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.
--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 usually gives patients significant improvement in their symptoms, but surgery is not a cure for sinusitis. Most patients have to continue using some medicines to keep their nasal problems under control. Most patients do not need to have surgery again, but revision surgery is sometimes needed if there is scarring or if problems like polyps return.
--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: 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.
What can patients expect after sinus surgery?
Endoscopic sinus surgery is very effective for the treatment of chronic sinus problems. Most patients feel dramatically better after surgery. Patients typically 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.
The recovery after sinus surgery generally lasts a week. Most patients have pain, fatigue, nasal stuffiness, and nasal drainage after surgery. Pain is generally very mild with this type of surgery. Most patients tell us that they have to take only a few doses of their pain medicine during the entire postoperative period.
Most patients find that they are very stuffy right after surgery from the swelling after the procedure. This typically starts to improve about a week after surgery. Patients typically have drainage of some mucus and blood from the nose after surgery. This is a normal part of the healing process. For the first week or so, patients find that their overall energy level can be low.
After surgery, we recommend that you use saline sprays and nasal rinses. You can find sprays and rinse kits 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. For visit our page about sinus surgery recovery for more information about what to expect during the recovery period.
For more information about sinus surgery…
Dr. Goyal has written several articles and book chapters on sinus problems and sinus surgery. Please see these links for more information:
- Information on our website about the diagnosis of chronic sinusitis.
- Information on our website about recovery after sinus surgery.
- Information on the American Rhinologic Society website about sinus surgery.
- Dr. Goyal's published papers related to sinus surgery are listed below:
- Goyal P, Hwang PH. In-Office Surgical Management of Sinus Disease: Office-Based Surgical Procedures in Rhinology. Operative Technique Otolaryngol Head Neck Surg. 17(1):58-65, March 2006.
- Goyal P, Leung M, Hwang PH. Endoscopic approach to the infratemporal fossa for the management of invasive fungal sinusitis. Am J Rhinol. 23(1):100-104, January 2009.
- Isaacs SJ* & Goyal P. The role of three dimensional computed tomography in defining frontal recess and frontal sinus anatomy. Am J Rhinol. 23(5):502-505, September/October 2009.
- Nelson JJ* & Goyal P. Temperature variations of nasal endoscopes. Laryngoscope. 121(2):273-278, February 2011.
- French C* & Goyal P. Submucosal Resection of the Middle Turbinate. Laryngoscope. 123(8):1845-1848, August 2013.
- Dr. Goyal has written a book chapter about sinus surgery: