Endoscopic Sinus Surgery

What Is Endoscopic Sinus Surgery

Endoscopic sinus surgery is also known as:

• Nasal surgery
• FESS surgery
• Sinusitis surgery

Endoscopic sinus surgery is safe and effective treatment for patients with sinus conditions
Contemporary sinus surgery is performed using fibreoptic telescopes and other modern instruments
Sinus surgery relieves the symptoms of sinusitis

Sinus structure and function

• The sinuses normally act to filter and humidify the inhaled air and provide protection to the eyes and face in case of injury
• There are four sets of sinuses in the face and skull:
  • The maxillary sinuses are located beneath the eyes on either side of the nose
  • The ethmoid sinuses are located between the eyes
  • The frontal sinuses are located above the eyes in the forehead
  • The sphenoid sinuses are located deep behind the nose in the centre of the skull
• The nasal passages and sinuses are lined by mucosa that secretes mucus
• The protective mucus drains from the sinuses into the nasal passages through small openings
• The drainage of mucus helps to clean the sinuses
• The sinus openings can become blocked by thickening from allergy, infection, nasal polyps or trauma

Sinusitis – sinus infection

• If the nasal and sinus passages are blocked the sinuses become poorly ventilated, inflamed and vulnerable to infection
• A blocked nose, facial pain, headache, discoloured mucus, and a loss of smell are some of the usual symptoms of sinusitis, depending on the severity of the inflammation and infection
• Chronic sinusitis is present when infection is present over the long term
• With recurrent sinusitis there are intermittent attacks and worsening in symptoms between times of fairly minimal symptoms

Before nasal surgery

• Before sinus surgery you may need to take nasal steroid spray, antibiotics or other treatment depending on the extent of the sinus disease
• Do not take aspirin or non-steroidal anti-inflammatory medication such as Nurofen for 3 weeks before surgery as these tablets can increase the risk of bleeding
• If you are on aspirin, Plavix, warfarin or other medicines discuss alternatives with your surgeon before stopping the medication
• Tell your surgeon if you have an allergy or history of bad reaction to antibiotics, anaesthetics or other medications
• Bring your CT scans to hospital so they are available for your operation
• Smoking: stop smoking at least 3 weeks before sinus surgery

Anaesthesia for nasal surgery

• Endoscopic sinus surgery is usually performed under general anaesthesia
• The risk of surgery is low
• Give your anaesthetist a list of your medications and make known any health problems or previous reactions to anaesthesia
• Inform your anaesthetist about any heart problems, respiratory disease, diabetes or other medical condition before surgery
• If you have any questions about your anaesthetic you need to contact your anaesthetist or make an appointment to visit the pre-admission clinic

Nasal surgery

• Endoscopic sinus surgery may provide effective treatment to people with sinus problems that have not improved with medical management
• The aim of endoscopic sinus surgery is to open the passages from the sinuses into the nose and restore normal ventilation
• Endoscopic sinus surgery is performed through the nostrils and external incisions are not needed
• The extent of sinus surgery depends on the severity of the sinusitis and the specific type of sinus disease
• Endoscopic sinus surgery usually takes between one to three hours depending on the complexity of the operation needed

Sinus surgery recovery

Healing

• The nose usually heals after 4 to 6 weeks after sinus surgery
• In patients with nasal polyps and severe sinus disease the healing process can take much longer
• During this time you will want to avoid dusty or smoky environments

Medications

• Following sinus surgery you will receive prescriptions for a number of medications
• Typically these include pain medicine, an antibiotic, saline nasal irrigations and often a steroid spray
• For best results it is essential that the medications are taken as directed
• The medications promote rapid healing and are essential components of post-operative care – failure to take them can lead to post-operative infection and scarring
• The medications will be adjusted based on the progress of your healing as assessed on examination of the nose during appointments following surgery
• If you have a question please contact the office – we want to make sure the recovery from surgery and healing process progresses well

Saline nasal irrigations

• Nasal crusting after sinus surgery can slow the healing process
• In order to keep your nose moist and prevent crusting you should use saline (salt water) to rinse your nose and sinuses
• There are two alternatives
  • Sinus irrigations – which are more thorough rinses using a bottle system
  • A fine mist-type salt water nose spray
• The bottle system, such as “Sinus Rinse or Neti Pot”, is preferred as it allows for a more thorough cleaning of the nose after surgery – it is best to do this at least twice a day after surgery and as your nose heals continue once a day
  • The “Sinus Rinse” system by NeilMed is available at many pharmacies with  prepared packets of salt-baking soda mixture
  • Alternately, you can make up the mixture using this recipe: mix ¼ teaspoon of non-iodised salt with ¼ teaspoon of baking soda in 250mL of tap water – mix the solution before you use it
• If you cannot tolerate sinus irrigations then you can use saline sprays that are available over-the-counter at most pharmacies
  • These sprays deliver a “mist” of salt water and keep the nose moist
  • For the first seven days following surgery you should use the spray at least once an hour while you are awake – as the nose heals you can reduce to four or five times a day
• You cannot over-do it with the salt water so use it more frequently if you wish

After sinus surgery – sinus surgery recovery

• You should be aware that it might take many weeks for your nose to work well after surgery – even longer if you have had chronic infections
• During that period of time the fine hair cells in the nose and sinuses do not work well, and mucus will tend to collect in the nose and sinuses rather than be cleared out by the hair cells
• The mucus may become thick, form crusts and become infected if you do not rinse your nose

What you should expect following endoscopic sinus surgery

Fatigue is normal

• Fatigue for a few days is not uncommon due to both the anaesthesia and procedure
• You will want to take it easy and avoid strenuous physical activity for around seven days
• Moderate activity like walking is usually well tolerated

Nausea

• Nausea following general anaesthesia is not uncommon but usually passes after around 12 hours
• Continue to sip fluids to avoid dehydration

Travel

• Many of our patients come from some distance – we prefer you stay in the local area overnight
• If necessary you may travel by air 48 hours after the surgery

A few things to be aware of:

Bleeding

• Oozing from the nose may occur for the first 24 to 48 hours following surgery
• By using saline flushes you will clear the nose and prevent crusts forming
• Occasionally persistent bleeding from the nose can develop and if this occurs sit upright and breath through your nose for 5 to 10 minutes – this should relieve most bleeding

Pain should be mild

• Some discomfort following the procedure is to be expected by is usually not severe
• Use the prescribed pain medicine as needed
• As soon as you feel ready switch to an over the counter pain medication like Panadeine or Panadol
• For the first two to three weeks after sinus surgery do not use medications that contain aspirin, ibuprofen, or other non-steroidal anti-inflammatory compounds as these promote bleeding

Nose blowing

• You may sniff as needed to clear the nose
• Realise that the interior of the nose will be swollen initially after sinus surgery
• Blowing your nose too early can promote bleeding – you may begin to blow your nose lightly 5 days after surgery

Go for a walk

• Walking and light exercise are good for you
• Some activities may increase bleeding – you should avoid bending, lifting or straining for one week after sinus surgery as they will all increase the risk of bleeding

Return to work when you feel ready

• Most people will return to work within a week following sinus surgery
• Some return earlier, some later so plan to have one week off and return as soon as you feel ready

Post-operative visits

• The care of your nose and sinuses does not end when the surgery is completed
• Generally your follow-up will consist of:
  • Weekly post-operative visits over the course of 4 to 6 weeks
  • During these visits your nose will be examined to ensure healing is progressing
  • in some cases debridement and small adjustments  may be necessary to ensure scar tissue does not form

Sinus surgery recovery

• The recovery period after sinus surgery is generally smooth and uncomplicated
• If you have any problems, following your sinus surgery, you should speak to your local doctor, who will arrange to contact your surgeon – this includes:
  • Fever greater than 38.5 degrees for more than 24 hours
  • Headache, light sensitivity or change in vision
  • An increase in swelling or redness around the nose
  • Increased pain and tenderness not controlled by pain medication
  • Persistent nasal discharge