Endoscopic Sinus Surgery

What are sinuses and sinusitis?

Sinuses are air-filled spaces in the bones of the face and head around the nose. They are connected to the nose through small openings. The sinuses are important in the way we breathe through the nose and in the flow of mucous in the nose and throat.

When the sinuses are working properly we are not aware of them. But they often are involved in infection and inflammation that cause symptoms. These infections and inflammations are called sinusitis.

Sinusitis is caused by blocked, inflammed or infected sinuses. Patients will often complain of a blocked nose, facial pressure and pain, runny nose or mucus problem. Other symptoms include headaches and partial or total loss of smell. Sinusitis can be difficult to diagnose and the specialist will need to examine your nose carefully with a telescope in order to establish what is wrong.

Most patients with sinusitis get better without any treatment. Others need treatment with antibiotics, nasal drops, sprays or tablets. In a small number of patients with severe sinusitis an operation is needed.

In rare cases if sinusitis is left untreated can lead to complications with infection spreading into the nearby eye or into the fluid around the brain. These very serious complications are some of the reasons that a sinus operation may become necessary.


What is Functional Endoscopic Sinus Surgery or FESS?

FESS is the operation necessary when sinusitis is difficult to treat with medicine. In the past sinus surgery was done through incisions (cuts) on the face and mouth. Today the use of endoscopes allows the operation to be done through the nose without those incisions.

Before the operation patients will be treated with nasal drops, sprays or tablets for a few weeks if not months. There is also a need for a CT scan to diagnose sinusitis and help with the operation if done.


How is the operation done?

The operation is usually done with the patient asleep (general anaesthetic). The surgeon uses special endoscopes and instruments to unblock your nose and sinuses. Everything is done through your nose without any external cuts.


What happens after the operation?

Immediately after the operation your nose may feel blocked. This may happen if the surgeon needs to place dressings or spints in your nose to stop the bleeding. This is not always necessary and even if they need to be placed they are usually removed the next day after the operation. It is common to have some stuffy nose even after removing the dressing or spints until the swelling and mucus in the nose get better.

It is important that you do not blow your nose for 48hrs after the operation to avoid bleeding. The use of nasal drops, sprays and salty water for a few days is recommended. Some mucus and blood stained fluid might drain from your nose for a few days after the operation and this is normal. It is important to stay away from dusty and smoky environments while you are recovering.


How long will I be off work?

You can expect to go home the day after your operation. Following that, you will need to rest at home for at least one week. If you do heavy lifting and carrying at work you should be off work for at least 2 weeks.


What are the possible complications?

Any operation involves risks. However, these potential risks are very uncommon.

Bleeding: It is common to have a small amount of blood from the nose for a few days after the operation. Major bleeding is extremely uncommon and it is very rare for a transfusion to be required.

Eye problems: The sinuses are very close to the wall of the eye socket. Sometimes, minor bleeding can occur into the eye socket and this is noticed as some bruising around the eye. This is usually minor and gets better without any special treatment, although it is important that you do not blow your nose. More serious bleeding into the eye is very rare. If that happens it can cause severe swelling of the eye, double vision or even rarer loss of sight.

Spinal fluid lead: The sinuses are very close to the bone at the base of the brain. The brain and spine are surrounded by fluid. In extremely rare cases there is leak of this fluid into the nose. If this happens and is not noticed and repaired by the surgeon during the operation a second operation might be necessary to fix it.


How often do complications happen?

In general, complications are very rare. In a survey of all ENT surgeons that do this type of surgery in England, eye complications happened only in 1 of 500 patients and spinal fluid lead in 1 in 1000 patients and there was no loss of sight at all. Minor complications such as minor nasal bleeding were the commonest observed.