Nasal Disease Handbook
Endoscopic Sinus Surgery
Endoscopic sinus surgery is an operation in which the surgeon examines the interior of the nose and the openings to the paranasal sinuses. Using state of the art microtelescopes and instruments, abnormal and obstructive tissues are then removed. In most cases the surgery is performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort.
Whereas, in the past, attention has often been directed towards the removal of all sinus mucosa from the major sinuses, the endoscopic approach relies on the principle that sinus disease is reversible if the underlying obstruction can be identified and corrected. A careful diagnostic workup is therefore important and consists of examination, CT scans of the sinuses, nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected blood tests. Surgery is usually recommended only after medical therapy has failed.
Potential surgical complications include bleeding, bruising around the eyes, swelling, scarring inside the nose, and infection. Rare complications include the possibility for intracranial entry and spinal fluid leak. The ethmoid sinus is located under and adjacent to the brain, and the fluid that surrounds the brain can leak through into the nose. If this happens, there is the potential for infection which can result in meningitis. Because the endoscopes used in surgery allow visualization of the ethmoid sinuses, this complication is uncommon. Double vision and loss of vision have been reported after ethmoid surgery. Fortunately, this is a rare complication. No surgery is always successful. This is the best sinus procedure available today.
The advantage of endoscopic sinus surgery is the philosophical recognition that the surgical goal is to open the natural drainage channels, thereby restoring normal physiologic function. This differs greatly from past procedures, which were ablative and destructive. Other advantages over past sinus surgeries are: diminished post operative discomfort, minimal nasal packing, decreased bleeding, shorter recover time, and most importantly, a 90% success rate.