• 3800 Reservoir Road, 1st Floor Gorman Washington, DC 20007
  • (202) 444-0757

Endoscopic Sinus Surgery

Endoscopic Sinus Surgery

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    Background:

    Sinusitis is a common health problem that can affect as many as 35 million people a year. The sinuses are empty, air-filled cavities within the face that open into the nasal cavities. Normally, the sinuses work together with the nose to filter, warm, and moisten the air we breathe for its journey to the lungs, and to drain away the unwanted fluid or germs that collect. Anything that blocks the flow of mucous through the narrow sinus openings can allow germs to collect and cause infection. Infection of the sinuses can be of an acute or chronic nature. Acute sinusitis often comes on suddenly, usually along with a cold, awhile chronic sinus disease develops when there is a continued blockage or obstruction of one or more areas of the sinuses. The key to treating acute or chronic sinusitis is to open the blocked sinuses through medication, allergy control, and when necessary, a procedural intervention. The sinuses generally become obstructed by swollen tissue (allergies or viral infections), polyps, or even a deviated septum.

    Viral Illness/Allergies: When someone has an upper respiratory infection or has an allergic reaction, the mucous membrane becomes swollen. The swelling can then block off the sinus and because of the inflammation and pressure difference between the sinus and nasal cavity, patients will often experience pain. Mucous continues to be produced inside the sinus, but it cannot ventilate or drain, which often results in bacterial growth.

    Nasal Polyps: are usually the result of allergies and inflammation. These waterlogged formations usually block off one or more of the sinuses.

    Deviated Septum: can cause direct physical obstruction of the sinus drainage/ventilation.

    What is endoscopic sinus surgery?

    Endoscopic sinus surgery is performed to open the sinuses and restore function by removing blockages, diseased tissue, polyps, or growth in order to promote proper sinus ventilation. An endoscope allows Dr. Reilly to clearly see and operate inside the small cavities and passageways of your sinuses. Endoscopic sinus surgery can treat chronic sinusitis (recurrent inflammation and infection of the lining of the sinuses) or frequent sinus headaches. Your paranasal sinuses (ethmoid, maxillary, sphenoid, and frontal) are essentially eight air-filled spaces that surround your nose, four on each side. If the passages to these spaces are narrowed or blocked, you may experience frequent sinus pain, frequent or chronic sinus infections, or congestion and drainage.  A CT scan, often called a “CAT scan,” can help determine which of the sinus openings are narrowed or obstructed.

    How is sinus surgery performed? Will I have scars from this type of nasal surgery?

    Endoscopic sinus surgery is performed with a small, lighted tube that can be inserted directly into your sinuses through your nostrils. Since the endoscope allows Dr. Reilly to correct sinus problems from the inside, no visible scarring is created when sinus surgery is performed alone. It is common for Dr. Reilly to perform your sinus surgery in conjunction with other procedures, such as septoplasty to correct a deviated septum, rhinoplasty, or removal of nasal polyps.

    When can I expect to get back to work?

    We recommend taking a full week off of work or school to adequately rest and recuperate from your sinus procedure. We will see you in the clinic one week after your surgery to ensure everything is healing properly and to perform a debridement, or “cleaning out,” of your sinuses. Depending on your occupation, you may be feeling up to returning to work after that first week. You should expect to be taking it easy for the first two weeks after surgery; we recommend no heavy lifting or strenuous exercise for a full two weeks. Avoid any rigorous exercise or contact sports for six full weeks after this nose operation.

    How much does sinus surgery cost?

    The sinus surgery cost is typically submitted to your insurance company and covered under your medical insurance benefits. We have a team who will help navigate you through the scheduling and authorization process.

    Endoscopic Sinus Surgery Pre-operative Considerations

    A complete history is needed to evaluate sinus concerns. It is important to review the symptoms and effectiveness of any medical treatment that has been previously received. A complete exam is done to evaluate the anatomy of the nose and sinuses. An endoscopic exam is usually performed after anesthetizing the lining of the nose to assess the sinuses. The doctor then forms an impression of the problem by reviewing the information from this exam.

    A CT scan (aka “CAT” scan”) is an advanced x-ray system that produces detailed cross-sectional images of the sinuses. Regular sinus x-rays show the sinuses, but the facial structures are superimposed on one another. The CT scanner performs one scan, or slice, at a time and then the CT scan produces a detailed study bey stacking individual image slices. The CT scan reveals a detailed “picture” of the inside of your sinuses.

    Chronic vs. Acute Sinusitis

    Acute: Infection that follows a cold or an allergic reaction commonly associated with discolored secretion, bad odor or taste, and pressure/pain in the face and forehead. This usually clears on its own and/or with medical treatment.

    Chronic: Sinusitis that occurs when the blockage persists for an extended period, often improves somewhat with medications, but either never totally clears up or the symptoms recur in frequent intervals. The CT scan will show chronic sinus inflammation, which remains despite proper medical treatment.

    Details of Endoscopic Sinus Surgery:

    Endoscopic sinus surgery is performed to open up the sinuses and restore function by removing blockages, diseased tissue, polyps, or growth in order to promote proper sinus ventilation. An endoscope allows the surgeon to clearly see and operate inside the sinuses.

    Endoscopic sinus surgery causes little tissue damage, swelling, bleeding, or discomfort. The surgery is performed within the nasal chambers and sinuses and therefore does not cause any visible scarring. Generally, this type of surgery is very effective. It is usually done as an outpatient procedure with general anesthesia. The extent of the sinus problems will determine what specific sinuses will be addressed.

    Endoscopic Sinus Surgery Post-operative Recovery

    Arrange for someone to stay with you for the first 24 hours.
    Go to bed and rest, lying on your back, with your head elevated with 2-3 pillows. You should be lying at a 45 degree angle.
    You may be up and around and able to go to the bathroom. You will be able to eat a light meal with assistance.
    Take medication only as directed.
    Moderate pain after surgery is a normal occurrence, which should be relieved by the pain medication prescription you have been given. Most patients require pain medication for less than 7 days after surgery.
    Bloody drainage is expected from your nose after surgery and will gradually progress to blood-tinged mucous. You will have a drip pad placed under your nose that may be changed every 1-3 hours when saturated completely. This is often necessary for 2-3 days after surgery. If you have an active nosebleed with copious flow of blood, please call immediately and/or come to the ED for evaluation.
    Gently place ice packs or a bag of frozen vegetables on and around the nose for the first 24 hours after surgery (on for 20 minutes, then off for 20 minutes).

    You may be up and around as tolerated but expect to tire more quickly than usual.
    Keep activity and meals light.
    On post-op day after surgery, start using nasal saline spray at least 3 sprays in each nostril at least 3 times per day (available over the counter from the drug store). This will help keep the nasal lining moist so as to avoid excessive crusting in your nose
    For the first 48 hours, be sure to keep the incisions clean and dry; apply petroleum ointment as needed. After 48 hours, you may shower; avoid scrubbing the surgical are and do not submerge your face in water. Any external bandages may be changed daily or as needed, if they become saturated.

    You will come into the office for a post-operative check-up and to have your nose cleaned and any nasal packing and/or splints removed.
    No alcohol for the first 7 days after surgery, which can increase bruising and swelling.

    Your swelling and congestion will gradually fade over this time period, but it may persist for up to 3 weeks.
    No strenuous activity or heavy lifting for 2 full weeks after surgery.

    1. Rest and good nutrition are important healing factors, especially during the first 6 weeks.
    2. Numbness and tingling of the upper lip, roof of mouth, and /or upper teeth may occur, which resolves with time.
    3. Sense of smell may worsen or improve depending on the extent of the sinus disease and the extent of surgery. Full sense of smell will often not return post-operative until 3-6 months after surgery.
    4. Rarely, changes in voice can occur (hyper-resonance), which tends to revert back to baseline within 3-6 months after surgery.