Endoscopic surgery for sinusitis

Surgery Overview

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In endoscopic sinus surgery, an endoscope is inserted into the nose, providing the doctor with an inside view of the sinuses.

Surgical instruments are inserted alongside the endoscope. This allows the doctor to remove small amounts of bone or other material blocking the sinus openings and remove growths (polyps) of the mucous membrane. In some cases a laser is used to burn away tissue blocking the sinus opening. A small rotating burr that scrapes away tissue may also be used.

The surgery may be done in a hospital (inpatient) or in a doctor's office or clinic (outpatient). Either local or general anesthesia may be used. The procedure takes 30 to 90 minutes.

What To Expect After Surgery

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Minor discomfort and bleeding are common during the first 2 weeks after surgery. Weekly visits to the surgeon may be necessary for about 3 weeks after the surgery to have dried blood and mucus removed.

Recovery also may involve:

• Packing the nose with gauze to absorb bloody drainage.
• Taking antibiotics.
• Using a nasal spray containing a steroid for 6 months or longer to reduce inflammation.
• Using saltwater washes (saline nasal lavage or irrigation) to keep the nasal passages moist.
• Avoiding activities such as blowing the nose, exercising strenuously, and bending forward for a few days.
• Using a humidifier to keep room air moist, especially in the bedroom.

Why It Is Done

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Endoscopic surgery may be needed when medication treatment has failed to improve or cure chronic sinusitis. It is the preferred method of surgery for most cases of chronic sinusitis that require surgery.

How Well It Works

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Endoscopic surgery improves symptoms in about 90% of people.¹

However, surgery does not always completely eliminate sinusitis. Some people may need a second operation.

Surgery is most successful when used along with medication and home treatment to prevent future sinus infections. A second surgery and future sinus infections may be avoided if antibiotics are taken to prevent reinfection.

Risks

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As with any surgery, there are always some risks involved. However, endoscopic sinus surgery is very safe when performed by an experienced surgeon who has special training with endoscopic surgical techniques.

Minor complications (such as scar tissue attaching to nearby tissue, or bruising and swelling around the eyes) occur in a small number of people who have the surgery. Major complications (such as heavy bleeding, eye area injury, or brain injury) occur in fewer than 1% of cases.² Most complications of endoscopic sinus surgery can be managed or prevented.

What To Think About

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Sinus surgery may involve the use of scalpels, lasers, or small rotating burrs that scrape away tissue. No one method is necessarily any better or safer than another; techniques vary depending on the surgeon's experience and preferences. The rotating burr is becoming the preferred device for sinus surgery.

Endoscopic sinus surgery does not cause as much visible scarring as traditional sinus surgery. Also, it may not cost as much as traditional surgery because there is a shorter hospital stay, if any, and a shorter recovery.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Shah AR, et al. (2008). Acute and chronic sinusitis. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology—Head and Neck Surgery, section 4, pp. 273–281. New York: McGraw-Hill.

2. Joint Council of Allergy, Asthma, and Immunology (2005). The diagnosis and management of sinusitis: A practice parameter update. Journal of Allergy and Clinical Immunology, 116(6 Suppl): S13–S47.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Denele Ivins
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Donald R. Mintz, MD - Otolaryngology
Last Updated	August 15, 2008