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Jay M. Dutton, MD
Rush-Presbyterian-St. Luke's Medical Center
Chicago, IL
Sinus surgery has truly evolved in the last several years. This procedure was once performed through external incisions, required extensive packing, and caused significant patient discomfort and a lengthy recovery. With recent advances in technology including the nasal endoscope, this procedure is now incision less and can often be performed with minimal packing, pain and recovery.
The most common indication for endoscopic sinus surgery is a chronic sinus infection refractory to medical management. Less common indications include (but are not limited to): recurrent infections (rather than a single chronic infection), complications of sinus infections, nasal polyps or mucoceles, chronic sinus headaches, impaired sense of smell, tumors of the nasal and sinus cavities, cerebrospinal fluid leaks, nasolacrimal duct obstruction, choanal atresia, and the need to decompress the orbit. Prior to undergoing endoscopic sinus surgery, patients should talk with their physicians to make sure that all reasonable medical options have been exhausted. In addition, patients should avoid any medications that may exacerbate bleeding, such as aspirin and ibuprofen products, as well as certain vitamins and herbal remedies.
Endoscopic sinus surgery may be performed under local or general anesthesia. The procedure involves the use of a small telescope (nasal endoscope) placed into the nasal cavity to visualize the surgery. The goal of the surgery is to identify the narrow channels that connect the paranasal sinuses to the nasal cavity and to enlarge these areas thereby improving drainage from the sinuses to the nose. Sometimes sinus surgery may require simultaneous repair of the nasal septum, which divides the two sides of the nose, or the turbinates, which filter and humidify air inside of the nose. The use of nasal packing will depend on the extent of surgery and physician preference. The recovery period will also vary depending on the extent of surgery but postoperative discomfort, congestion, and drainage should significantly improve after the first few postoperative days, with mild symptoms sometimes lingering several weeks after the surgery.
Endoscopic sinus surgery generally yields excellent results, and significant symptomatic improvement is achieved in the vast majority of patients. Adverse events are rare but may include postoperative bleeding, orbital complications, complications from the general anesthetic, cerebrospinal fluid leaks and intracranial complications such as meningitis. However, it is important to realize that chronic sinus infections are located directly beneath the skull base and adjacent to the eye and the failure to treat this problem without surgery may lead to dire consequences such as intraorbital or intracranial spread of the infection.
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