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Endoscopic sinus surgery

Published by Bupa's health information team, May 2009.

This factsheet is for people who are planning to have endoscopic sinus surgery, or who would like information about it.

Endoscopic sinus surgery is a non-invasive way for surgeons to treat recurring sinusitis. This means that the surgeon doesn't need to make any cuts in your face. Instead, he or she uses an endoscope which is a flexible tube with a camera on the end to access your sinuses. The endoscope allows your surgeon to examine and treat your sinuses.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

Animation - Where the sinuses are found
About endoscopic sinus surgery
What are the alternatives?
Preparing for your operation
About the operation
What to expect afterwards
Recovering from endoscopic sinus surgery
What are the risks?
Questions and answers
Related topics
Further information
Sources

Where the sinuses are found

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About endoscopic sinus surgery

Sinuses are hollow air-filled spaces in the skull bones behind your face. Your sinuses are connected to your nose and have a similar lining called the mucous membrane. This membrane produces a secretion called mucus to keep the lining moist. Excess mucus normally drains out of the sinuses and down the back of your throat. If the sinus lining becomes inflamed (sinusitis) or overgrows and blocks the sinuses (polyp), the mucus can't drain in the normal way. You may develop symptoms like a headache and blocked nose.

Endoscopic sinus surgery is generally done to improve drainage from a sinus if no other treatments have worked. It's done using an endoscope, which is inserted through the nostril. The endoscope has a light and camera lens at its tip so that the surgeon can see inside the nose and sinuses. Instruments are passed down the endoscope to remove any tissue that is blocking the sinus or causing problems like chronic sinusitis.

Illustration showing the location of the frontal and maxillary sinuses
The location of the frontal and maxillary sinuses

Illustration showing the location of the frontal, ethmoid and sphenoid sinuses
The location of the frontal, ethmoid and sphenoid sinuses

What are the alternatives?

Endoscopy is the preferred way for surgeons to do sinus surgery, but there are alternatives.

Surgery

Other methods of sinus surgery involve making cuts in the face to access the sinuses. One of these is called the Caldwell-Luc method, which involves making a 'window' between the maxillary sinus and the nose to allow the mucus to drain. The maxillary sinuses are the air-filled spaces either side of your nose, beneath your cheekbones. The surgeon makes a hole in your jaw above your teeth, through which he or she can access your sinuses. However, this type of surgery is usually only carried out if your sinuses are permanently blocked. Talk to your surgeon about what type of procedure is best suited to you.

Medicines

It may be possible to use antibiotics and steroids to treat your chronic sinusitis instead of surgery. Speak to your surgeon to see which is the best method for you.

Preparing for your operation

Your surgeon will explain how to prepare for your endoscopic sinus surgery. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

If you have a cold in the week before the operation, please phone the hospital. The operation may need to be postponed until you have fully recovered.

Endoscopic sinus surgery can usually be performed as a day case, with no overnight stay in hospital. However, you may need to stay overnight if your operation is a lengthy or complicated one.

The operation is usually done under general anaesthesia, which means you will be asleep during the procedure. You may be able to have the operation under local anaesthesia, which means that you will still be awake but the sinus tissues will be numb.

If you are having the operation under local anaesthesia, you may be offered a sedative to help you relax during the operation. At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon, or another trained healthcare professional, will usually ask you to sign a consent form. Your anaesthetist may also ask you to sign a second consent form. These confirm that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the operation

Each operation is individual and will be adapted to meet your needs. Your surgeon will explain what type of operation is needed, based on a detailed examination of your nose. To help plan the operation, he or she may send you for a CT scan. A CT scan uses X-rays to make a three-dimensional image of your sinuses.

Once the anaesthetic has taken effect, the endoscope is carefully inserted through one of the nostrils. Pictures from the endoscope's camera may be displayed on a screen. Instruments are inserted alongside the camera. Your surgeon may widen the openings between your sinuses and your nose to help the sinuses to drain. He or she may also remove any blockages, inflamed tissue or polyps in your sinuses.

At the end of the operation, packs (sticks of absorbent dressings) may be put in your nose to stop any bleeding. Your surgeon may also insert splints (thin plastic sheets) inside your nose to help support it.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

If you have packs in your nose, these will be taken out within 24 hours. If your surgeon used splints, they may be left in for longer and removed at a later date.

When you feel ready, you can begin to drink and eat, starting with clear fluids. Your nurse will show you how to use nasal drops if they are needed.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

Recovering from endoscopic sinus surgery

It's normal for your nose to feel blocked after endoscopic sinus surgery. This may last for a few weeks after the procedure.

You should try not to blow your nose for the first 48 hours after the operation. Your nose may drip, but you should only wipe or blow it very gently, and try to sneeze through your mouth rather than through your nose. Try to avoid crowded or smoky places and people who you know to be suffering from coughs and colds.

You may have some watery, blood-stained fluid from your nose after you return home. Don't pack the nostrils to try and stop this as it is normal.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

A cold compress (such as an ice pack or packet of frozen peas) placed across the bridge of your nose may also help with any pain. You shouldn't apply ice directly to your skin as it can damage your skin.

Your surgeon may recommend irrigation of your sinuses. Irrigation involves washing out the sinuses to remove any excess mucus.

Follow your surgeon's advice about returning to work and leisure activities. Most people are able to return to work one to two weeks after the operation. You shouldn't play any sports in which your nose may get bumped for at least a month.

What are the risks?

Endoscopic sinus surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure, for example, feeling sick as a result of the general anaesthetic.

It's normal to have some blood-stained discharge or crusting round your nostrils after the operation. Your surgeon may also prescribe you antibiotics to reduce your risk of infection.

Complications

Complications are when problems occur during or after an operation. Most people aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

After the operation, a small amount of bleeding from the nose is common and not serious.

It's also possible for the sinuses or surrounding tissue to be damaged. The sinuses are separated from the eye sockets, tear ducts and the brain by thin layers of bone. If the bone near the brain is affected, there is a risk of developing meningitis, but this is extremely rare. If any of these bony structures are damaged, you may need a second operation to repair them.

You may have a small amount of bleeding in the eye socket. This is usually not serious and doesn't need any treatment. However, it's important you don't blow your nose if you have bruising around the eye. More serious bleeding involving the eye can cause swelling and permanently affect your vision.

The eye and surrounding area can be injured during endoscopic sinus surgery. However, this complication is rare and will depend on your surgery. Your surgeon will explain whether or not this risk applies to you.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.