Surgery FAQs

What is endoscopic sinus surgery?

Sometimes abbreviated ESS or FESS (Functional Endoscopic Sinus Surgery), this procedure opens the sinuses and allows them to drain. The surgeon uses an “endoscope” to see into the nose and sinuses, similar to the one we may have used in the office. Specialized instruments are used in conjunction with the endoscopes to perform the procedure.

Most people have four sinuses on each side of their face, for a total of eight sinuses. These are the maxillary, ethmoid, sphenoid and frontal sinuses. The maxillary sinuses are in you cheek, the ethmoids are between your eyes, the sphenoid is in almost the exact center of your head and the frontal sinuses are in your forehead. It is possible that you may not have all of these sinuses, or they have already been opened by previous procedures.

Sinusitis may affect some or all of these sinuses. Based on your symptoms, endoscopic exam and CT scan we will determine which sinuses need to be opened. Occasionally during surgery it may determined that additional sinuses may need to be opened.

What are the benefits of surgery?

The goal of sinus surgery is to improve the drainage pathway of the sinuses. By opening the natural drainage pathway of the diseased sinus, the frequency, duration and severity of infections should be reduced.

It should be emphasized that surgery is not a cure for sinusitis but is one of the steps in managing your disease. Although there are patients who have mechanical obstruction due to their particular anatomy, many patients have an intrinsic problem with the lining (mucous membrane) of their nose. While the first group of patients will receive the maximal benefit from surgery (i.e. fixing the plumbing problem), the benefit for patients with mucous membrane disease is also tangible. It is important to note, however, that if you are one of the patients who have diseased mucous membrane (i.e. form polyps) no amount of surgery can change this fact. So although surgery plays a role in managing the disease, it is rarely, if ever a cure.

However, one of the most important benefits of surgery is the ability to deliver medications (sprays/nebulized drugs) to lining of your sinuses after they have been opened. Therefore, surgery is an adjunct to, not a replacement for, proper medical management.

What are the alternatives?

Continuing medical therapy alone and avoiding surgery is always an alternative. Medical therapy is chiefly antibiotics and/or steroids along with other medications. These medications can be taken orally or can be applied topically. A full allergy evaluation and allergy desensitization (if appropriate) should also be considered. In some cases, balloon sinuplasty can be considered an intermediate stop between failed medical therapy and traditional endoscopic sinus surgery. As with any surgery, you should feel more than comfortable seeking a second opinion from another surgeon.

What are the risks of sinus surgery?

It must be emphasized, that the things listed below are rare, and that if surgery was discussed, your possible benefits from the surgery outweigh the risks.

Surgery, like everything in life, carries with it some risks. Your surgeon has spent years, including additional training in endoscopic nasal surgery, to minimize these risks. Many patients have had previous endoscopic sinus surgery, and the risks of this procedure are no different from before. Nevertheless, you should be aware of the risks so that you can make an informed decision.

All surgeries carry the risks of bleeding, infection and pain. The risk of bleeding increases with certain medications (see pre-operative instructions). Occasionally, there is a significant amount of bleeding that would warrant an early termination of the procedure. In these rare cases it is felt that since this is an elective procedure, the risks of a blood transfusion, and the risks of operating with the diminished visualization due to the bleeding necessitate stopping.

You will most likely be placed on antibiotics after the procedure to minimize the risk of infection. The length of treatment varies, but ranges from 2-4 weeks. However, in some cases an infection occurs despite antibiotic therapy.

Some scar tissue develops after any surgical procedure, and if this occurs it may obstruct the sinuses that have been opened. For this reason, you will have several post operative debridements where clot and scar tissue will be removed. Dr. Dubin routinely puts in very small packs (spacers and/or stents) that you will most likely not notice are there. These will be removed at your first debridement.

It is possible that you may get some swelling or bruising around your eye after surgery as well as some tearing for the first week. This is rare, however, and is exceptionally rare for the tearing to be permanent.

The most serious, but fortunately rare, complications are due to the proximity of important structures to your sinuses. These are chiefly your brain or eyes. The risks include double vision, loss of vision, brain injury, leakage of spinal fluid and meningitis.

In some cases it is necessary to straighten the septum in the middle of your nose (septoplasty) to gain access to the sinuses and/or relieve nasal obstruction. This procedure carries with it the additional risk of a hole in the septum that would connect one side of the nose to the other. It is rare for this to occur and is even rarer for it to cause a problem. Very rarely, septoplasty can change the appearance of the nose or cause permanent numbess of the front two teeth. It is common, however, to have some temporary numbess in a small area behind the front two teeth.

If you still have sense of smell, it is possible in rare cases that this may decrease or be lost.

Lack of improvement or worsening of your underlying condition, as well as the need for an additional procedure are risks that are inherent with any surgery.

There are also the risks of anesthesia with should be addressed by the anesthesiologist. This procedure is almost uniformly performed under general anesthesia. Although this is exceptionally safe, it does carry with it the risk of cardiac event (heart attack), stroke, and even death.

It must be emphasized again, that the things listed above are rare, and that if we have recommended surgery, it is our opinion that your possible benefits from the surgery outweigh the risks.

What should I expect after surgery?

You will have some fatigue and will want to take it easy for about a week. Most people return to work that does not involve strenuous physical activity in about a week. However, some people return earlier and some require longer recuperating. You will have same nasal stuffiness and some bloody nasal drainage for several days. We will also have you irrigating with saline and will most likely have you on antibiotics and/or steroids. Our post operative instructions can be viewed above.

It is expected, however, that a full recover will take 4 to 6 weeks. The most common symptoms that linger after the first week or two are post nasal drainage, cough, fatigue and mild facial pressure. For people who are very active, the fatigue that accompanies any surgical recovery is often the most noticeable symptom.

Does Dr. Dubin routinely pack the nose after sinus surgery?

In general, Dr. Dubin does not routinely pack after sinus surgery. He places a small amount of absorbable material in the nose that do not affect breathing. This is significantly smaller than “historic” packing and is typically not uncomfortable. You will be able to breath through your nose with these in place and there will be no strings coming out the front of your nose. The absorbable material minimize the amount of cleaning that need be done at the first post-operative visit. This absorbable material is irrigated by you and is suctioned out by Dr. Dubin. Unlike formal packing it does not get “pulled” out of your nose. The decision about what to place in the nose is made during surgery.

What is Sinuplasty?

“Sinuplasty” refers to a procedure, or specifically a surgical device that was developed by Acclarent. This device is similar to balloon angioplasty, the technology that expands the vessels in someones heart. These balloons are advanced into the opening of a patients sinuses and are expanded to open the narrowed channels and are then removed from the nose. It can be performed in the office or in the operating room. It is occasionally used in conjuction with more traditional sinus techniques.

Am I a candidate for Sinuplasty?

Like all medical advances, the information in the popular press may not reflect reality. Although useful, this new technology is not for everyone, and in many cases is not a substitute for standard techniques. However, in some people it is a technique that may decrease recovery time. Only with a thorough examination, in conjunction with a CT scan, can this be determined. Dr. Dubin is trained in the most advanced techniques and offers Sinuplasty for appropriate candidates under local anesthetic in the office.

My sinusitis has come back even though I have had surgery. Why?

There are a number of reasons that your sinusitis may return after surgery. The most simple of these, is that sinus surgery does not prevent sinus infections, but makes them more manageable and less symptomatic. Another reason is that there are some people whose noses make polyps and these people are not cured by sinus surgery. Surgery is still the first step in managing the disease, but successfully controlling symptoms requires continuous medical management of the inflammation of the lining of the sinuses which ultimately results in polyps. The third common reason is scarring that can occur that can result in sinus drainage problems. Regardless, if your symptoms either did not improve after sinus surgery or rapidly return, it is appropriate to see someone who has advanced training in nasal and sinus disease and who has expertise in revision sinus surgery.