Considering Sinus Surgery ?

When antibiotics and nasal steroids fail to control sinus symptoms, surgery may offer prompt and lasting relief.

The majority of patients can either be treated through a simple balloon dilation in the office or through Functional endoscopic sinus surgery usually performed at the attached Medarva Stony Point Surgery Center .

Consideration of your symptoms, physical examination, and sinus CT results will all help your surgeon determine if surgery is needed and if so, what surgical approach is best.

If you answer “yes” to one or more of the following questions, you may wish to see an ENT specialist (otolaryngologist) for a thorough evaluation of your sinuses and to determine if surgery might be right for you:

  • Do you have frequent facial pain or pressure?
  • Do you have chronic nasal discharge?
  • Do you have difficulty breathing through your nose?
  • Is your sense of smell or taste impaired?
  • Do you get three or more sinus infections per year?
  • Do you require more than one antibiotic to treat a sinus infection?
  • Have had polyps in your nose or sinuses?
  • Have you had swelling or fluid in your sinuses on CT scan?

Functional Endoscopic Sinus Surgery

If your sinuses become frequently or permanently blocked, a surgeon can enlarge the drainage pathways by surgically cutting out the crowded or diseased bone fragments and tissue. Modern sinus surgery is performed using endoscopes: small telescopes that are designed to fit easily inside the nose.  These provide the surgeon with a magnified, “endoscopic” view of your nasal and sinus cavity. The term “functional” refers to the concept of removing only enough tissue to create effective drainage, while preserving as much of the normal anatomy and mucous membrane as practical.

With chronic sinusitis, mucous becomes trapped in the compartments of the sinuses (left side). Functional endoscopic sinus surgery removes the small bony partitions creating larger drainage pathways (right side).

Balloon Dilation Sinus Surgery

Over time, surgeons found that they could remove less and less tissue as long as the larger sinuses were drained.  With selected patients, such minimally invasive sinus surgery could even be performed in the office under local anesthesia.[1] The introduction of Balloon Sinuplasty has created a new way of thinking about endoscopic sinus surgery – a recent study conducted partly at Richmond ENT demonstrated that balloon dilation of the maxillary sinus alone can improve disease in the ethmoid sinus as well.

Expectations following Sinus Surgery

After any general anesthetic, you should go home and rest for the day.  Do not make any important decisions or drive a car for at least 24 hours after taking prescription pain relievers.  Keep your head elevated to reduce swelling.  Warm, moist air will be soothing. Use cold compresses only if you have had a rhinoplasty.

Sinus surgery is not as painful as you may think. For most patients, we recommend 2 tablets of Aleve (naproxen sodium 220mg) twice daily for about 5 days after nasal and sinus surgery. This may be supplemented by Tylenol (acetaminophen) for breakthrough pain. Prescription pain relievers are rarely necessary. Call your surgeon directly if pain is not controlled as expected.

Nasal packing is dependent upon the severity of bleeding in surgery.  With limited surgery, we try to avoid nasal packing altogether. Patients with nasal polyps almost always require some packing, but usually the soft foam sponge is smaller than the polyps removed.  Despite our best efforts, you should be prepared for the possibility that breathing through the nose may be worse for the first week after surgery.

After sinus surgery, crusts will usually accumulate in the sinus that can cause residual infections and scarring. Irrigating with sterile salt water (saline) will help you to keep your nose clean and free of crusts. You should not blow your nose for at least two weeks, as forceful blowing or sneezing can force air or infected mucous into the eye socket or brain cavity. Remember to continue all allergy and sinus medications that you were taking before surgery, including nasal steroid sprays. The surgery is not a cure for allergy.

Your surgeon will want you to return for a follow up appointment usually within 1 week following sinus surgery. It is important for your doctor examine your nose and to remove crusts as they accumulate. Several such visits may be required, depending on the health of your nose at follow-up.  Unlike most types of surgery, the professional fees for sinus surgery do not include postoperative endoscopy and cleaning.  Depending on your insurance, you may need referrals for these visits, and you should expect that they will be billed separately from the main surgery.

Risks of Sinus Surgery

Major complications from sinus surgery are exceedingly rare.  However, sinus surgery involves the removal of bone and tissue very close to brain and in between the eyes.  Injuries to the brain, spinal fluid leakage, meningitis, blindness, double vision, and loss of smell have all been described after endoscopic sinus surgery. General anesthesia alone can cause serious complications, including stroke, heart attack, tooth injury, voice injury and death. Again, these risks are serious but rare – as are the risks of driving an automobile. More common, but less serious complications include nasal obstruction, bleeding, soreness, persistent infection, and need for re-operation. Select a surgeon who is certified by the American Board of Otolaryngology – Head and Neck Surgery and who has good training and experience with endoscopic sinus surgery, as well as balloon sinus dilation.

[1] Armstrong, M:  Office Endoscopic Sinus Surgery.  Presented at the American Rhinologic Society, Palm Desert, CA, April 26, 1999.  Armstrong, M. Office-based Procedures in Rhinosinusitis.  Otolaryngol Clin N Am 38:1327-1338, 2005.