Sinus surgery, also called endoscopic sinus surgery, is a procedure to remove blockages in the sinuses. It is typically performed when medical treatments have not improved sinusitis symptoms. Sinus surgery is considered a safe and effective treatment option for chronic sinusitis. However, like any surgery, it does carry some risks and requires recovery time. Understanding the details of sinus surgery can help you decide if it may be right for you.
What are the sinuses?
The sinuses are hollow cavities in the bones around the nose. There are four pairs of sinuses:
– Maxillary sinuses – in the cheeks
– Frontal sinuses – in the forehead
– Ethmoid sinuses – between the eyes
– Sphenoid sinuses – behind the eyes
The sinus cavities are lined with a mucus-producing membrane. Tiny hair-like projections called cilia sweep mucus out of the sinuses and into the nose. This mucus then either drains down the back of the throat or is blown out through the nose.
What is sinusitis?
Sinusitis refers to inflammation of the sinus cavities. It can be caused by an infection, allergies, air pollution, structural problems in the nose, or other factors that prevent proper sinus drainage.
The main symptoms of sinusitis include:
– Facial pain, pressure, congestion
– Headache
– Runny nose, postnasal drip
– Loss of smell
– Cough, sore throat
– Fatigue
Acute sinusitis lasts less than four weeks. Chronic sinusitis is when symptoms persist for more than 12 weeks. Recurrent sinusitis means you have several acute sinusitis episodes per year.
What causes chronic sinusitis?
In many cases, chronic sinusitis is caused by blockages that prevent mucus from draining properly. Potential causes of blockages include:
– Nasal polyps – noncancerous growths in the lining of the sinuses
– Deviated septum – crooked partition between the nostrils
– Bone spurs – bony overgrowths in the sinus cavities
– Swollen or inflamed sinus lining due to allergies or infection
– Abnormal narrowing of the sinus drainage paths
Even small structural issues or inflammation in the sinuses can obstruct mucus drainage and cause repeated sinus infections.
When is sinus surgery recommended?
Sinus surgery is generally recommended when you have:
– Chronic sinusitis that has not improved with medication
– Repeated acute sinus infections
– Nasal obstruction due to structural problems like a deviated septum
– Sinusitis with nasal polyps
The goal of surgery is to open up the sinus drainage pathways and restore ventilation and mucus drainage. This can often help resolve chronic sinus inflammation.
Sinus surgery may also be performed to biopsy or remove sinus tumors, repair facial injuries, or as part of skull base surgery.
What are the types of sinus surgery?
The most common type of sinus surgery today is called functional endoscopic sinus surgery (FESS). FESS involves inserting a small fiber-optic tube called an endoscope into the nose. The surgeon views the sinuses on a video monitor and uses special surgical instruments to open up blocked sinus pathways.
Other types of sinus surgery include:
– Balloon sinuplasty – Inserting a small balloon catheter to dilate the sinus openings.
– Septoplasty – Straightening a deviated septum. This is often combined with FESS.
– Turbinate reduction – Trimming enlarged turbinates (nasal concha) to open airway.
– Polypectomy – Removing sinus polyps.
– Caldwell-Luc – Making an incision in the roof of the mouth to access maxillary sinuses. This more invasive technique is rarely used today.
The endoscopic approach allows precise, minimally invasive sinus surgery through the nostrils, without any external incisions.
What are the risks of sinus surgery?
As with any operation, sinus surgery does carry some risks, such as:
– Bleeding
– Infection
– Scar tissue formation
– Damage to surrounding anatomical structures like the eyes or brain (very rare)
– Need for revision surgery if the original surgery was not successful
– Anesthesia-related risks
Your otolaryngologist will discuss the potential risks and complications specific to your case. The overall major complication rate is estimated to be 1-2%.
How is endoscopic sinus surgery performed?
FESS surgery is typically performed under general anesthesia as an outpatient procedure. The steps include:
1. Anesthesia administered through an IV.
2. Insertion of an endoscope into the nostril. The endoscope has a tiny camera to visualize the sinuses.
3. Special surgical instruments are used to remove tissue and open blocked areas.
4. Saline irrigation helps remove debris and mucus.
5. Nasal packing and splints may be placed at the surgery site.
6. The nostrils are not “packed” like in the past, so the recovery is less painful.
The surgery typically takes one to three hours depending on how many sinuses need treatment. Most patients can go home the same day.
How long is the recovery from sinus surgery?
Most people can return to normal activities within one to two weeks after sinus surgery. General recovery guidelines include:
– Days 1-3: Rest at home with medications to manage pain and nasal dripping. Use saline spray to keep nasal passages moist.
– Days 4-7: Return to light activities. Congestion and discomfort improve.
– Days 8-14: Steadily resume normal work and social routines.
– Weeks 3-4: Feel completely back to normal. Resume exercise and air travel.
– Up to 2 months for full healing internally.
Patients typically see improvements in their sinusitis symptoms within the first few weeks after surgery. However, maximum results may take several months as the sinus lining fully heals.
It’s important to follow all post-op instructions from your surgeon, including irrigating the sinuses and attending follow-up appointments.
What is the recovery like after sinus surgery?
Recovering from sinus surgery involves allow the nose and sinuses to heal, controlling pain and discomfort, and preventing complications like infection or bleeding.
Typical recovery recommendations include:
– Saline nasal rinses – Use saline spray or irrigation 2-6 times per day starting 24 hours after surgery. This keeps nose moisturized and clears mucus/debris.
– Medications – Painkillers, decongestants, nasal steroid spray as prescribed by your doctor.
– Rest – Take it easy for several days after surgery. Sleep with head elevated on 2-3 pillows to minimize swelling.
– Ice packs – Apply to nose and cheeks to reduce swelling.
– Humidifier – Use a humidifier to prevent nasal passages from drying out.
– No blowing nose – Do not blow your nose for at least a week after surgery to avoid disrupting the surgical site. Gently wipe instead.
– No strenuous activity – Avoid exercise, heavy lifting, air travel for 2 weeks or as advised by your surgeon.
– Nasal care – Use saltwater nasal spray and irrigate nostrils with saline rinse if directed by your doctor.
– Follow-up appointment – See your ENT within 7-10 days after surgery to ensure proper healing.
Call your doctor right away if you have heavy nasal bleeding, fever over 101°F, severe pain, or vision changes after sinus surgery.
What are the risks and complications of sinus surgery?
While sinus surgery is generally safe when performed by an experienced surgeon, potential risks and complications include:
– Bleeding – Heavy nasal bleeding after surgery may require medical attention to control.
– Infection – Sinus infections are possible after surgery. Symptoms include fever, facial pain/pressure, pus drainage. Oral antibiotics are used to treat sinus infections.
– Adhesions – Scarring or adhesions may form in the sinus cavities, blocking mucus drainage. Further surgery may be needed to correct this.
– Recurrence – Polyps, scar tissue, or fungal infections can cause sinus obstruction to recur after surgery. Some patients need revision surgery.
– Anosmia – Damage to the olfactory nerves may permanently reduce sense of smell. This occurs in about 5% of surgeries.
– CSF leak – Rarely, a tear in the thin bone between the sinus and brain can cause cerebrospinal fluid leakage. This requires immediate repair.
– Eye injury – Also very rare. Endoscopic techniques protect the eyes from surgical instruments.
Your doctor will explain your specific risks based on your sinus anatomy and medical history. Following all post-op instructions can help prevent complications.
What is the success rate of sinus surgery?
The success rate of endoscopic sinus surgery is estimated to be about 80-90% based on various studies. Most patients experience significant improvement in symptoms like congestion, headaches, and infections after surgery.
However, some factors reduce surgical success:
– Severe nasal polyps have a recurrence rate of 20-50% after surgery.
– Up to 18% of patients need revision surgery within 2 years due to scarring or adhesions.
– Patients with nasal polyps, asthma, or aspirin sensitivity have lower surgical success rates.
– Completely resolving a deviated septum or enlarged turbinates is difficult, which may limit symptom relief.
Regular follow-up and medical management is often needed after surgery, especially in complicated cases. Patients may still need oral steroids, nasal spray, and other medications to optimize results.
What are alternatives to sinus surgery?
Nonsurgical treatment options for chronic sinusitis include:
– Nasal steroid sprays – Reduce mucosal swelling and blockage. Examples include Flonase, Rhinocort, Nasacort.
– Nasal saline irrigation – Rinsing the sinuses helps thin mucus and clear debris using a Neti pot or nasal rinse bottle.
– Oral steroids – Used short-term for severe sinusitis or nasal polyps.
– Decongestants – Oral decongestants like pseudoephedrine (Sudafed) or nasal sprays may be used for temporary relief.
– Antihistamines – If allergies contribute to sinusitis, antihistamines like Zyrtec, Claritin, or Allegra can help.
– Antibiotics – Prescribed for bacterial sinus infections, but often ineffective for noninfectious sinusitis.
– Immunotherapy – Allergy shots may help if sinusitis is triggered by indoor or outdoor allergens.
– Acupuncture – Some chronic sinusitis sufferers report symptom relief with acupuncture.
Talk to your ENT doctor about the most appropriate nonsurgical options for your condition based on the cause of your sinusitis symptoms.
When should you see a doctor about sinusitis?
See your primary care doctor or an ear, nose, and throat (ENT) specialist if you have these warning signs of sinusitis:
– Sinus pain and pressure lasting longer than a week
– Thick nasal discharge, especially yellow or green
– Fever over 101°F
– Reduced sense of smell
– Severe headaches or facial pain
– Swelling around the eyes
Recurring sinus infections or chronic sinusitis symptoms lasting longer than 12 weeks also warrant medical evaluation. Your doctor will examine your nasal passages and sinuses for blockages. Testing may include:
– Nasal endoscopy – Inserting a scope camera into the nose
– CT scan – Detailed sinus images using X-ray technology
– MRI scan – Using magnets and radio waves to view sinus anatomy
– Allergy testing – Checking for allergies exacerbating sinusitis
If antibiotics and other medications do not effectively treat your sinusitis, discuss options like sinus surgery with your ENT specialist. Surgery may be appropriate if blockages, polyps, or other structural issues are causing persistent sinus infections and symptoms.
Conclusion
Sinus surgery is an effective treatment for chronic sinusitis caused by blockages, polyps, deviated septum, or other anatomical factors that impede normal sinus drainage. While serious complications are rare when performed by an experienced surgeon, risks include bleeding, infection, scarring, anosmia, and CSF leak.
Most patients see significant improvement in symptoms within the first weeks after surgery and can resume normal activities within two weeks. However, some cases have lower success rates and require revision surgery or continued medical management. Discuss the benefits and risks of sinus surgery carefully with your ENT to determine if it is the right treatment option for your chronic sinusitis.