When is sinus surgery necessary?
When the complications of sinusitis develop, sinus surgery may be needed on an urgent basis. Less urgent sinus surgery may be necessary when chronic sinusitis fails to respond to extensive and thorough medical therapy. For chronic sinusitis this usually involves a prolonged antibiotic course, preferably culture-directed, a course of steroids, nasal saline irrigations, and if allergic, treatment for allergies.
CT scans are also needed to confirm that symptoms are related to the sinuses. As an example a patient with headache as a symptom may have other causes for such (eg. migraine or tension/stress) that would not respond to sinus surgery. Endoscopy will be used also to help determine the causative agents and potential treatment options for them.
Functional Endoscopic Sinus Surgery (FESS)
Who will or will not benefit from FESS? What are its advantages?
In the late 1980’s and early 1990’s, a minimally-invasive approach to surgery for sinusitis called functional endoscopic sinus surgery (FESS) evolved. FESS represents a significant advance compared to the open sinus procedures performed prior to the development of FESS. The goal of FESS is to reestablish physiologically normal sinus drainage pathways by removing or correcting diseased pieces of tissues in key areas of sinus obstruction. Small rigid telescopes, also called endoscopes, are inserted into the nose and the surgery is performed using fine instruments to open the sinuses.
There are several advantages to FESS over the open sinus procedures that preceded it. To begin with, the ability to see within the nose and sinuses is much improved. Open sinus procedures often required facial incisions with resulting visible scars and lots of nasal packing. With FESS, there are usually no visible signs that surgery has been performed since the surgery is almost always done completely through the nostrils. Recovery is usually faster and there is usually less postoperative pain and bleeding. Nasal packing is used infrequently in FESS.
When patients with sinusitis do not improve after repeated courses of antibiotics and reasonable trials of the other medications used to treat sinusitis, the otolaryngologist may recommend undergoing FESS. The recommendation will also be based upon the physical examination, nasal endoscopy and CT scan findings. The decision to perform surgery should be made only after carefully considering the risks and benefits.
Patient preferences also play a role in the decision. The decision to have sinus surgery is usually made by the patient when the impact of the sinusitis on their quality-of-life is so significant that a successful surgery can improve their ability to function in daily life.
Questions about Functional Endoscopic Sinus Surgery?
Although many sinus-related problems can be treated with medicines, surgery may be needed in some patients. Whenever possible, CSC surgeons use newer, less deforming, and less painful techniques. The most common type of sinus surgery is Functional Endoscopic Sinus Surgery (FESS).
In FESS, your CSC surgeon will use small cameras and instruments to work carefully in the nose. They will remove obstructing tissues, allowing the sinuses to drain more naturally. This should decrease the severity, frequency, and duration of infections.
In some cases your surgeon may suggest surgery that includes “surgical navigation” — usually with a special type of CT or MRI scanner — in order to diminish the chance of complications and improve results.