Endoscopic sinus surgeries

Functional endoscopic sinus surgery is the primary approach used today for the surgical treatment of chronic sinusitis. It is the procedure used to remove blockages in the sinuses. These blockages may cause pain, drainage of mucus, recurrent infections, difficulty breathing or loss of smell.

Symptoms

Patients with recurrent or chronic symptoms of sinusitis often experience:

• Nasal congestion

• Postnasal drip

• Facial pressure and headache

• Nasal obstruction

• Purulent drainage

• Hyposmia

Signs indicating the requirement of sinus surgery

Endoscopic sinus surgery is most commonly used for treating inflammatory and infectious sinus diseases. Some symptoms and conditions that are indicative of the need for an endoscopic sinus surgery are:

• Recurrent sinusitis

• Nasal polyposis

• Chronic sinusitis refractory to medical treatment

• Antrochoanal polyps

• Sinus mucoceles

• Removal of tumours

• Cerebrospinal fluid leak closure

• Optic nerve decompression

• Orbital decompression

• Dacryocystorhinostomy (DCR)

• Choanal atresia repair

• Epistaxis control

• Foreign body removal

When endoscopic sinus surgery is needed?

Generally, endoscopic sinus surgery is reserved for patients with documented rhinosinusitis, based on a thorough history and a complete physical scan, including computed tomography (CT) scan if appropriate, and in whom appropriate medical treatment has failed to work. 

• For nasal polyposis, medical treatment alone is not potent enough to treat it.

• Antrochoanal polyps also require surgical removal.

• Cerebrospinal leaks associated with cerebrospinal rhinorrhea can be treated endoscopically, avoiding a more extensive neurosurgical external approach via craniotomy. 

• Endoscopic approaches may also be used for ophthalmic procedures such as orbital decompression, endoscopic DCR, and optic nerve decompression for traumatic indirect optic neuropathy. 

Diagnosis

Our well-experienced doctors at CARE hospitals may make a diagnosis based on asking questions on general symptoms, doing a thorough physical examination as well as an examination of a patient's nose.

Nasal polyps may be visible using a simple lighted instrument. Nasal endoscopy can also help in the diagnosis which involves using a lighted magnifying lens or tiny camera (nasal endoscope) for examining the nose and sinuses. A CT scan may also help locate the position of a nasal polyp rooted deep inside the sinuses.

Chronic sinusitis can be diagnosed using a CT scan or MRI or by using a thin, flexible tube with fibre optic light attached to it that allows the nasal septum, polyps or tumours to be seen. An allergy test may also be recommended to find out if any particular substance or allergen is causing nasal flare-ups.

For diagnosing an antrochoanal polyp, the gold standard is to perform a CT scan showing a hypodense mass arising from an enlarged maxillary sinus.

For diagnosing the route of cerebrospinal fluid rhinorrhea, three imaging tests can be performed: 

• Isotope stereogram

• CT cisternography

• MRI 

Goals of an endoscopic surgery

The specific goals of performing an endoscopic surgery are:

• To reduce the number and potentiality of sinus infections,

• To improve symptoms related to sinusitis,

• To improve the passage of airflow through the nose,

• To make access for nasal rinses to reach the sinus cavities for cleaning and medicine delivery purposes.

What happens in an endoscopy?

Endoscopic sinus surgery is performed on an outpatient basis and does not include invasive surgery. Endoscopic sinus surgery is performed entirely through the nostrils and a patient can be discharged the same day of the operation.

An endoscope, which consists of a thin camera rod with a light attached to it, is used by a surgeon to magnify and better see the sinus tissues. Specialized instruments remove blocks in sinuses such as mucus, membrane swelling, nasal polyps, and scar tissue, safely and effectively.

What to expect after surgery?

There may be some bloody discharge along with nasal congestion for approximately two weeks post-surgery. Follow-up visits at the hospital may be arranged until the area is healed which can be up to four weeks or more. During this time, any remaining inflammation or scar tissue may be removed under local anaesthesia.

Postoperative comprehensive care is taken at the hospital to ensure successful completion of the surgery, to promote faster healing as well as to decrease the chances of complications.

Recovery after endoscopic surgery

Following endoscopic surgery, a doctor may advise a patient to use large volumes of saline washes to irrigate the sinuses and adhere to prescribed medicines for preventing infections and discomfort. Nasal irrigation following an endoscopic sinus surgery is important as it helps prevent infections as well as remove mucus and debris from the sinuses. Some specific medications may also be recommended to be used along with nasal irrigation. 

For proper nasal irrigation, several types of systems are available such as bulbs, squeeze bottles, and syringes. For irrigating the sinuses, a lot of saline water solution is rinsed through the nose repeatedly to flush out debris.

Nasal congestion may occur following an endoscopic surgery which may subside over time- generally, in two weeks time.

What are the chances of curing sinusitis?

As with all types of sinus surgery, it may be possible that the problem is not entirely cured by endoscopic surgery alone, or that the problem reoccurs at a later time. In this case, subsequent surgical therapy may be required to address the problem. Medication therapy is usually continued even after the surgery, especially in the case of polyps and allergies causing sinus problems. Overall, patients can benefit from the combination of surgical and medical therapy and achieve the desired goal.