Endoscopic Sinus Surgery

Sinus surgery has evolved over the years from its introduction in the 19th century.  What previously required external cuts on the face is almost exclusively performed with small instruments introduced through the nostrils and used to open the sinus while visualizing through an endoscope.  An endoscope is a small camera that allows enough room in the nose for the surgeon to work and remove diseased tissue with microinstruments.  The surgery is typically performed asleep, however recently less invasive sinus treatments can be performed in the office.  Typically after surgery there is minimal packing, mild pain and shorter recovery times.

Why is sinus surgery needed?

stock_endoscopicSinus surgery evolved in the treatment of sinusitis and is typically performed for “chronic” sinusitis.  Chronic sinusitis is a general term for chronic inflammation often accompanied by intermittent or chronic infection.  This is the most common reason for surgery and is indicated when symptoms have lasted longer than 3 months after failing maximal medical therapy.  Medical therapy typically includes a combination of antibiotics, steroids, saline irrigations and occasionally allergy therapies.  The patient is typically suffering despite our best medical efforts and the surgery helps to remove diseased tissue and open the sinuses in order to deliver topical medical therapy and test for recurrences of infection.  This allows improved breathing and medical treatment.  At this time, we understand many of the reasons for chronic sinusitis, but we do not have a consistent cure.  Surgery is also indicated for recurrent infections that resolve, nasal polyps, nasal and sinus tumors, CSF leak, and to treat disorders of the eye that involve the sinuses.

What is needed prior to surgery?

Before having sinus surgery, patients have typically been seen and managed by their primary care provider who will often try antibiotics, steroids and nasal irrigations.  Often this is accompanied by allergy treatments.  After referral to Dr. Timothy Kelsch, we will review your past treatments as well as consider further medical therapy prior to surgery.  This may include broad spectrum antibiotic therapy, steroid therapy, review of aspirin associated sensitivities, immune system evaluation, and allergy testing.  Additionally, prior to surgery every sinus surgeon needs a “road map” which is provided by a CT scan of the sinuses.  This allows the surgeon to review needed anatomic detail as well as possible areas of anatomic blockage to be targeted.  As well, we can review the anatomy for areas that may be potential “pitfalls” during surgery.  Lastly, you will often review the scan and anatomy with the surgeon during which Dr. Timothy Kelsch can point out valuable information about the exact nature of the surgery and areas for concern.

What are the benefits of sinus surgery?

Surgery allows the sinus drainage pathways to be opened and allowing better drainage, aeration, surveillance and culture sampling of the sinuses.  It also allows for further treatment of the sinuses with topical therapies which may include, antibiotics, steroids, or antifungal therapy.  To put it plainly, after oral medical therapy has not worked, sinus surgery removes disease and allows us to treat the sinuses topically  in a targeted method to treat the infection and inflammation.  This leads to long term reduced symptoms typically and more aggressive management of the acute “flare ups” that can occur with a chronic condition.  You don’t have to live with the symptoms that antibiotics don’t fix.

Is anything needed in preparation for surgery?

Yes.  We will need to alleviate factors that make surgery more difficult.  You will need to discontinue all aspirin products and non-steroidal anti-inflammatory drugs.  Additionally, several vitamins and herbs increase the risk of bleeding  and will need to be stopped 1 week prior to surgery.  You may also be on a blood thinning medication by your physician or cardiologist.  You will need permission prior to surgery to discontinue this medication.  As well, all preoperative testing including EKG, chest x-ray, heart evaluation, kidney evaluation, lung evaluation and laboratory work will need to be completed prior to surgery.  We want you to be as safe as possible to prevent any unforeseen complications.

What is Balloon Sinuplasty?

Balloon Sinuplasty is a minimally invasive dilation of the sinus drainage openings also known as “ostia”.  These can become blocked with severely inflamed and diseased tissue requiring dilation to improve drainage. They may also be narrow congenitally leading to a predisposition for recurrent infections.  By dilating the opening we can alleviate the recurrent blockage that easily occurs with each infection.  Please refer to the section on Balloon Sinuplasty for a video showing the surgery method.

What is the recovery like?

The recovery depends on the degree and extent of the sinus disease.  For recurrent acute sinusitis treated with Balloon Sinuplasty in the office recovery is often 24-48 hours. However more extensive disease may require a week off of work and 6-8 weeks of healing time after surgery.  Occasionally absorbable packing may be used and this can require debridement in the office performed as a separate procedure at your follow up appointments.  Debridement and cleaning are vital for the recovery and allow for improved healing and outcomes.  This will also allow for better delivery of topical medications to the diseased areas.  Debridement in the office can occasionally be painful, but typically is described as “tickling” or making the patient want to sneeze.

What are the possible complications of surgery?

Sinus surgery is performed near the eyes and the lining of the brain.  There can be injury to these structures, but this occurs very rarely.  Much less than 1% of sinus surgery leads to these complications, and typically a surgeon may be unfortunate enough to have seen even 1 such complication in his entire career.  These concerns should be discussed with the surgeon.  Other possible risks include loss of smell, tearing of the eyes, areas of chronic facial discomfort or numbness and continued nasal obstruction.