Endoscopic Sinus Surgery

Endoscopic sinus surgery is an operation performed through the nostrils using highly specialised instruments.

What are the reasons that endoscopic sinus surgery may be undertaken?

Chronic sinus infection with or without nasal polyps

When people experience chronic sinus infection symptoms, they are first managed with medical therapy and if these do not control sinusitis symptoms, then sinus surgery may be beneficial. In these cases, the passageways of the nasal sinuses and nose are widened to return them to their prior functional state. Hence, this type of sinus surgery is termed Functional Endoscopic Sinus Surgery (F.E.S.S.) and is the commonest reason that endoscopic sinus surgery is undertaken.

Removal of cysts and tumours

Cysts and tumours may need to be removed either because they are blocking the sinuses or affecting surrounding structures or in order for a sample to taken to ascertain their nature.

Individuals with Graves’ disease who have eye issues

Graves’ disease can cause an increase in the contents of within the eye socket. This may cause the eyes to bulge and affect vision. Surgery is undertaken to ‘decompress’ the walls of the eye socket. Dr. Michael performs this procedure in conjunction with an ophthalmologist. He is also conducting a research study at the Royal Victorian Eye and Ear Hospital, Melbourne looking into ascertaining which is the best surgical technique to achieve improvement.

Nosebleeds (epistaxis)

Nosebleeds that occur from blood vessels towards the back of the nose previously required major invasive surgery to access these blood vessels. However, with the use of endoscopic sinus surgery techniques, these blood vessels can be approached with less difficulty.

Blocked tear ducts  

Our tears drain into the nose via a tube that passes from the middle corner of the eye into the nose. When this tube is blocked, surgery may be helpful. This surgery is traditionally performed by making a cut on the outside of the nose. However, newer endoscopic techniques mean that this operation can now be undertaken through the nose without any external scars.

Facial pain (sinus headaches) on flying or SCUBA diving

In some individuals, narrow sinus passageways may become blocked by swelling due to changes in air pressure such as during flying and SCUBA diving. These individuals can experience significant pain in their face during either ascent or descent. We term this sinus barotrauma. In select patients, Dr. Michael uses an innovative technique called balloon sinuplasty to help ‘dilate’ the sinus passageways and prevent them from blocking.

CSF (the fluid that bathes the brain) leakage

The roof of the nasal cavity is formed by very thin bone. As a complication of operations, injuries or certain medical conditions, breaks in this bone can cause fluid to leak. Previously, repair of these leaks required extensive surgery involving removal of the skull cap. However, endoscopes allow us to now close many of these leaks through the nose.

What happens before the operation?

In your consultation with Dr. Michael, he will ask questions in relation to issues that you may be having with your nose. You will also have an endoscopy. This is a specialised examination where a fine camera (endoscope) is used to inspect the inside of the nasal passageways. Other tests such as investigating for allergies may also be arranged. Dependent upon what is found, Dr. Michael may consider medical treatments and other tests before advising upon surgery.

What does an endoscopic sinus surgery operation involve?

An endoscopic operation is undertaken with general anaesthesia and performed through the nasal passageways without any external cuts.

Dr. Michael has significant expertise in these techniques and typically uses an endoscope together with other highly specialized instruments.  Dr. Michael undertakes more complex sinus operations in Melbourne and employs technology termed image-guidance which provides an extra-level of anatomical information which aims to reduce complications. 

The exact details of the procedure will vary depending upon the reason that is undertaken and these will be discussed with you prior to your operation.

You may require temporary nasal packs. These are required in approximately 1 in 20 of the operations that Dr. Michael performs. Dependent upon the degree of surgery, the time of day of your operation and any co-existing medical issues will determine whether you are able to go home on the day of surgery or require an overnight stay.

Are there any risks to having a endoscopic sinus surgery?

There are general risks associated with having an operation. These include nausea and vomiting, bleeding, infection and allergies to medicines or dressings used. When having an operation under general anaesthesia, other risks include blood clots in the legs or lungs, a stroke or a heart attack. However, the risk of these serious complications is extremely low. Your anaesthetist will discuss these with you prior to the operation. 

With regards to endoscopic sinus surgery, there are a number of specific risks. These are listed below:

The nasal lining has a very rich blood supply. Rarely, there can be excessive bleeding following the operations. This is usually managed by placing packs in the nose. If bleeding is not controlled, a short procedure under general anaesthesia may be required to seal blood vessels.

Scarring (adhesions) may occur between adjacent opposing surfaces in the nose. These adhesions do not usually cause any problems but Dr. Michael may divide them when you are seen at your follow up appointments.

If your symptoms recur, a revision operation may be required. This is more common in those who have sinus disease without polyps and much more of an issue in those that smoke. However, Dr. Michael may recommend continued medical treatments to reduce the chance of requiring revision surgery.

We do not fully understand the mechanism for why people get nasal polyps and hence removing them with surgery can help symptoms but does not cure the reason that they occur. Hence, they may grow back and require another operation.

The nasal cavity and sinuses are situated adjacent to the eye and its nerve, the tear duct, blood vessels and a fluid containing sac that covers the brain. Damage to these structures is extremely rare. To minimise these risks, surgeons use their experience, knowledge of the surrounding anatomy and CT scans of the area which provide a map of regions that are safe and unsafe to operate upon.

What happens after the operation?

There is usually no pain or external bruising involved and people typically go home the same day. If you required nasal packing, Dr. Michael may arrange for an overnight stay for observation. The nasal packs are then removed the day following the operation. You are likely to feel congested (similar to a heavy cold) for a period of 4-6 weeks. To aid with healing, you will be asked to regularly irrigate your nose with a salt water solution. Dependent upon your sinus issues, you may also be given additional medicines.

You will be seen at regular intervals to assess for complications and assess your progress.

Are there any precautions that I should undertake?

If you are undertaking desk-duties, 1 week of leave from work may be sufficient. However, if you are in a more active profession, 2 weeks leave should be considered owing to the risk of bleeding. You should refrain from exercise for 4-6 weeks.