Endoscopic Sinus Surgery
About 40 million Americans suffer from at least one sinus infection every year. Millions suffer multiple episodes a year causing them to take numerous courses of antibiotics, sometimes for 3-4 weeks continuously, several times a year. In addition, with allergies making a sinus infection even worse, many unhappy people miss work or school due to recurrent sinus infections during the fall and spring, when allergic symptoms tend to be worse. Today, there are newer and more effective medical and surgical treatments for recurrent sinus infections.
- Patients who suffer from chronic sinus infections
- Patients who have difficulty breathing since their sinuses are blocked due to anatomic situations, such a deviated nasal septum, a broken nose, nasal polyps, or enlarged turbinates mucous production causing blocked breathing and nasal congestion
Sinus Surgery FAQs
What are the sinuses and what is sinusitis?
The sinuses are air pockets within the bones of the skull and face that are connected and drain into the nose. There are 8 sinus cavities in the skull of varying sizes. The walls of the sinus cavities are lined with a layer of tissue that constantly maintains a flow of fluid and mucous to moisten the air that we breathe and clean the nose. This flow of mucous is ongoing, cleansing the nose and throat of bacteria, viruses, and inhaled pollutants.
These 8 sinus cavities drain through tiny holes into the nose. When these drainage passages become blocked, the sinuses do not drain properly, and the mucous gets blocked in the cavity. The cleansing effect is stopped and the fluid trapped in the sinus cavities fosters growth of bacteria and viruses, causing a sinus infection.
Sinus infections typically require a 1-3 week course of antibiotics. In chronic (recurrent) sinusitis, this can happen 4-10 times a year, or more.
What causes blocked sinuses?
Blocked sinus passages occur from a number of causes of obstruction. Most commonly, the sinus passages temporarily block up due to swelling from a common cold or allergies such as hay fever. Certain anatomic situations cause distinct blockage, such as a deviated nasal septum, a broken nose, nasal polyps, or enlarged turbinates (tissues in the nose that filter the air). The nasal septum is a partition made of cartilage and bone that separates the right and left sides of the nose. It is commonly deviated or bent due to heredity or a broken nose, causing blocked breathing and sinusitis.
What are the signs and symptoms of sinusitis?
- Thick drainage from the nose – The infected mucous is thicker, secreted in large amounts, is often yellow, and can be foul smelling.
- Headache and sinus pain – Blockage of the sinuses during an infection causes pus and mucous to become trapped in the cavities, pressure cannot be equalized, and this can cause severe facial pain, headache, toothache, and general malaise. This becomes much worse during a descent in a plane or sudden change in barometric pressure from climate changes. It is also worse when lying down, which can disrupt sleep.
- Loss of sense of smell and taste – The nerve for smell and taste is high in the nose. Due to swelling during an infection, air cannot reach the nerve endings making it difficult to smell and taste. This is almost always temporary.
- Recurrent infections – As sinusitis worsens, there is less and less of a response from antibiotic therapy. Patients may find they are on antibiotics every several weeks through out the year. This is when the condition becomes chronic. The pain, congestion, stuffiness, and drainage seem to never go away.
- Chronic fatigue – Facial pain and nasal congestion interferes with sleep and patients with recurrent sinusitis feel “out of it”, unmotivated to exercise, and tired all the time. This improves when the sinus condition is corrected.
Does sinusitis make my asthma worse?
Sinusitis and asthma are closely related. A sinus infection can bring on an asthma attack and chronic cough due to a persistent “post nasal drip”, which is drainage from the sinus and nasal cavities down the back of the throat. Often patients have a decrease in the number of asthma attacks if sinusitis is properly treated.
Why is sinusitis so difficult to diagnose and treat?
Even though the condition is relatively common, it is under diagnosed or incorrectly diagnosed, probably due to lack of adequate knowledge of the disease and its treatment. Many people feel sinus infections are just “another head cold” and self-medicate with over the counter sprays and tablets, which are ineffective long term. Many people live with this condition until the symptoms are so bad, they finally seek medical help from a specialist.
What is new in medical management of sinusitis?
Most often, acute single episodes of sinusitis are successfully treated with medication. Based on the symptoms and possible nasal culture, the appropriate antibiotic can be prescribed. This is enhanced with thoughtful selection of nasal decongestants, nasal steroid sprays, washes, and possible antihistamines.
When this fails and the condition progresses to chronic sinusitis, prolonged courses of antibiotics may be attempted. When this fails, a CT scan should be obtained and surgical management should be considered. A CT scan can reveal underlying causes of sinusitis such as a deviated nasal septum, nasal polyps, are enlarged turbinates that cannot be seen on physical exam by the doctor.
When is surgery necessary?
Sinus surgery is considered based on the longevity and repeated nature of a patient’s symptoms and how badly these are affecting the quality of life. The recurrent symptoms are debilitating, interfere with a normal living, and often require excessive use of antibiotic therapy. At this point, surgery should strongly be considered. A CT scan is necessary to properly diagnose the location and underlying cause of the recurrent problem.
What is new in surgical treatment of sinusitis?
Several revolutionary advances have occurred in recent years that have improved the results of sinus surgery dramatically. Endoscopes connected to a TV monitor provide accurate and magnified views of the inside of the nose and sinuses, making surgery accurate and safe. CT scans are computerized x-rays giving detailed pictures of the nose and sinus anatomy allowing for accurate diagnosis and a “road map” during surgery. Powered nasal endoscopy is another major advance in this surgery. Using the nasal endoscope, the powered device gently shaves or debrides away the diseased, obstructive tissue under direct vision, while leaving normal tissue intact.
Most significantly, new image-guided technology allows the CT scan to be used as a real time “road map” during the procedure, allowing for very specific accuracy during the operation. To watch a live sinus surgery of an actual patient view the video below (warning-content is medically graphic):
Improved anesthetic medications and techniques allow for a speedy recovery with less drowsiness or nausea. Most often, Dr. Guida do not “pack the nose” after surgery making the recovery is much more comfortable.
What should I expect after sinus surgery?
The operation is done under intravenous sedation or general anesthesia on an outpatient basis either in Dr. Guida’s AAAHC certified operating room or an out-patient ambulatory surgery facility that is focused and experienced with nasal surgery on an out-patient basis. Afterwards the nose is generally not packed allowing for a quick, speedier recovery.
The most common complaint after surgery is not pain or discomfort, but a stuffy nose. Dr. Guida prefers that patients do not blow their nose for several days after surgery until after the first postoperative visit. Generally, there is no bruising after the operation unless a simultaneous operation is done on the outside of the nose, changing its shape (fixing a broken nose or doing a cosmetic operation). The nose is congested for several weeks after surgery, gradually improving, but does require several weekly or biweekly visits to my office follow up the first 4-6 weeks.
The improvements to be expected are an end to the recurrent cycle of infections and dependency on antibiotic therapy. In addition, a significant improvement in the ability to breathe through the nose should be expected. One may still get a head cold or sinus infection once or even a few times a year after this operation, which is normal, but the vicious cycle of an almost permanent sinus infection should end. With proper treatment and surgery, there should be a dramatic decrease in the number of infections as well as a decrease in the severity of the symptoms. When a sinus infection does occur after surgery, it should drain properly and respond better to antibiotic therapy.
Can sinus surgery be done at the same time as fixing a broken nose, having a “nose job”, and fixing a breathing problem?
Yes, it is very common, completely safe, and often recommended, if needed, to perform these procedures at the same time. Often, a broken nose or a deviated nasal septum is the actual cause of nasal obstruction that then causes chronic sinusitis. It makes complete sense to fix these problems at the same time.
In addition, doing cosmetic surgery while performing sinus surgery is safe and common. The patient will need to wear a splint on the nose for 5-6 days afterwards and bruising around the eyes for 7 – 10 days is likely. Again, there is rarely a need for nasal packing after these operations and there is little discomfort, except for a stuffy nose for about a week.
In Dr. Guida’s experience from performing hundreds of these operations, he has found that combining functional nasal surgery and sinus surgery with cosmetic nasal surgery does not significantly change or prolong the discomfort, stuffiness, or swelling during the healing process
If you would like to know more about Endoscopic Sinus Surgery, please call us at 212.871.0900 or Click Here to request an appointment.