Sinus surgery is an effective way to treat a number of problems with the sinuses. Techniques have improved dramatically in recent years leading to better results and a faster recovery.*
*Individual results may vary.
When is sinus surgery necessary?
The most common reasons for sinus surgery are to treat a sinus infection that will not resolve with medications or to treat patients with recurrent severe sinus infections. Sinus surgery may also be needed in patients with severe pain when flying or diving, to remove polyps or other growths or to provide keyhole access to other parts of the skull. In patients with polyps or severe chronic sinusitis, sinus surgery helps to create a cavity within the nose that is favourable to topical treatments.
Sinus surgery is usually a second line treatment that is suggested after a comprehensive trial of appropriate medical therapy has been completed. The aim of sinus surgery is usually to restore ventilation and improve drainage to one or more blocked sinuses.
How is sinus surgery performed?
Sinus surgery is now performed without any external incisions. The medical term for modern sinus surgery is “Functional Endoscopic Sinus Surgery” or a “FESS”. The term “endoscopic sinus surgery” means “keyhole sinus surgery”.
Small telescopes called “endoscopes” are place in the nose and the image is projected onto a large digital monitor. Sinus surgery performed in this way allows very delicate and precise changes to be made with minimal bleeding.
Angled telescopes can be used in sinus surgery to see around corners. This allows even the difficult to access frontal sinuses to be widely opened and treated via keyhole sinus surgery techniques.
Before sinus surgery
You may need a course of antibiotics or steroids before your sinus surgery. Your surgeon will also provide you with a list of medications that need to be avoided before surgery to minimise the risk of excessive bleeding. All patients having sinus surgery require a CT scan and you will need to bring this with you on the day of your sinus surgery.
Anaesthesia for sinus surgery
Sinus surgery is performed under general anaesthesia. There are different types of general anaesthesia and some are better than others for sinus surgery. Ensure your anaesthetist is using “TIVA” (total intravenous anaesthesia) for you sinus surgery.
Recovery and care after sinus surgery
Sinus surgery takes from one to three hours depending on the complexity of the case. After surgery you will be transferred to recovery. You may have some small “patties”, packs or splints in your nose to help control bleeding if this is a problem. You may be able to go home the same day but usually an overnight bed is booked as a precaution.
The lining of the nose swells after sinus surgery and it is normal to have a blocked nose for a few days. A saline nasal wash is started the day after sinus surgery and this well help to clean out any left over blood inside the nose.
After sinus surgery attendance at a follow-up visit at approximately one week is very important. There are usually a number of subsequent visits to ensure everything heals perfectly.
Complications of sinus surgery
Serious complications in modern sinus surgery are rare. If you have concerns about specific complications of sinus surgery, discuss them further with your surgeon. A few of the possible complications of sinus surgery are worth specifically mentioning.
- The sinus disease may not be instantly cured by the operation.
Chronically infected sinuses and nasal polyps occasionally take some time and often further topical treatments to settle things down.
- Delayed bleeding may occur at home up to two weeks after sinus surgery.
- An infection that may need antibiotics.
- Smell may be decreased
- There may be permanent damage to the eyes or a leak of fluid from around the brain. These are exceptionally rare complications in modern sinus surgery.
Untreated sinus infections can also spread to the brain and eye and this also needs to be considered when weighing up the risks of surgery.
Dr Jason Roth is a sinus surgery specialist.