Endoscopic Sinus Surgery

The paranasal sinuses are a collection of air cells that open into the nasal cavity. There are generally four pairs of sinuses including the frontal, ethmoid, maxillary, and sphenoid sinuses. Sinusitis occurs when there is inflammation and/or infection of the paranasal sinuses. Sinusitis is caused by obstruction of the drainage sites, abnormal sinus lining, or both. Problems with sinus lining include environmental allergies, inability to adequately fight infection, production of abnormally thick mucus, and the tendency to form polyps. Causes of obstruction of sinus drainage include narrowed openings, abnormal anatomy, and polyps.

Selected cases of chronic sinusitis that have failed medical therapy can be treated with endoscopic sinus surgery. Endoscopic sinus surgery is a technique in which small endoscopes and specialized surgical instruments are used to allow a surgeon to surgically treat the paranasal sinuses through the nasal cavity. In select cases, a computer guided imaging system is used to assist the surgeon during endoscopic sinus surgery. Endoscopic sinus surgery is performed to open obstructed sinuses by enlarging natural openings or by correcting abnormal anatomy. Endoscopic sinus surgery is also performed to remove nasal polyps and small nasal and sinus tumors. Endoscopic sinus surgery cannot cure all chronic sinusitis because it cannot directly change the nature of the sinus lining.

Other procedures including septoplasty or treatment of the turbinate bones may be performed with endoscopic sinus surgery to improve the nasal airway, or to allow access to the paranasal sinuses.

Possible complications of endoscopic sinus surgery include:

1. Bleeding
2. Infection
3. Eye complications including bleeding around the eye, double vision, visual loss, chronic tearing
4. Brain complications including spinal fluid leak and meningitis.
5. Scarring of the sinus cavities or nasal cavity.
6. Changes in sensation of smell and/or taste.
7. Change in voice quality.
8. Anesthetic complications including arrhythmias. Breathing difficulties, and death.

PRE-OPERATIVE SINUS SURGERY INSTRUCTIONS

1. Nothing by mouth after midnight the evening before surgery except medications as instructed by the anesthesiologist at the preoperative evaluation.
2. Notify your doctor if cough, fever, or other symptoms of respiratory tract infection develop prior to surgery.
3. Aspirin, aspirin products, ibuprofen, or other nonsteroidal anti-inflammatory medications should not be taken for two weeks prior to surgery. Vitamin E should not be taken for two weeks prior to surgery.
4. Plan to remain in town for two weeks after the surgery.

POST-OPERATIVE SINUS SURGERY INSTRUCTIONS

1. Take antibiotic and pain medication as directed.
2. Saline nasal irrigation: Initially, 2 - 3 puffs of saline nasal mist (Ocean, Ayr, etc.) every 2 - 4 hours while awake and as needed. If instructed by your surgeon, start nasal saline irrigation using a bulb syringe 4 - 5 times per day.
   Recipe for Saline Irrigation: 1 tsp. non-iodized salt (sea salt, canning salt, etc.)
   1 tsp. baking soda
   1 pint of water

Boil ingredients in water for 2 minutes. Keep at room temperature for up to 1 week.

1. Limit physical activity for two weeks. No heavy lifting or straining.
2. No nose blowing for 2 weeks.
3. Sneeze with mouth open.
4. A small amount of nasal or postnasal drainage is common after surgery. Although not mandatory, a drip pad may be taped under the nose until the drainage subsides.
5. Avoid aspirin, aspirin containing products, ibuprofen (Motrin, Advil), or similar anti-inflammatory medications for two weeks after the surgery. Tylenol is permitted.
6. Call for any heavy bleeding, problems with vision, swelling, bruising around the eye, or a temperature of greater than 101.5 degrees.
7. Avoid undue exposure or fatigue as these may predispose to an upper respiratory tract infection.
8. Please call the office to confirm your follow-up appointment.

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