What is endoscopic sinus surgery?

Endoscopic sinus surgery is a procedure to help stop sinusitis. Sinusitis is an infection in the lining of your sinuses (air-filled spaces behind your forehead, between your eyes and behind your cheeks, that are connected to the inside of your nose).

Sinusitis causes symptoms of pain, a blocked nose, discharge, reduced sense of smell and the feeling of mucus at the back of your nose or throat.

What are the benefits?

The aim is to widen the passage between the sinus and your nose so that mucus no longer becomes trapped and your healthcare team can give you medication to treat inflammation.

This should prevent the sinusitis from coming back but your sense of smell may not improve.

Are there any alternatives?

Antibiotics may help to clear the infection.

If your sinusitis is caused by an allergy, you may be able to prevent sinusitis by avoiding the 'triggers' of your allergy or by taking medication such as antihistamines, nasal steroid spray or a nasal wash. If you smoke, stopping smoking may help clear your sinuses.

If you use a nasal steroid spray for a long time, you can reduce the size of polyps, which may mean that you do not need surgery.

What will happen if I decide not to have the procedure?

You will continue to have sinusitis.

Sometimes infection can spread either through the thin bone between your sinuses and eye socket, causing infection of the tissues surrounding your eye, or between your sinuses and your brain, causing a brain abscess.

What does the procedure involve?

The procedure is usually performed under a general anaesthetic but a local anaesthetic can be used. The procedure usually takes 1 to 2 hours.

Endoscopic sinus surgery is performed through your nostrils and does not result in any facial scars or change to the outside shape of your nose.

Your surgeon will use a small telescope (endoscope) to examine your nasal passages. They will use instruments to remove any polyps and to widen the passages from your sinuses into your nose.

How can I prepare myself for the procedure?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Smoking stops your nose clearing mucus properly and this can increase the feeling of a blocked nose. People who continue to smoke after sinus surgery are more likely to need another procedure.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help you prepare for the procedure, help you recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you may need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team are trained to reduce the risk of complications.

Any risk rates given are taken from studies of people who have had this procedure. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, have other health problems or you smoke. Health problems include diabetes, heart disease or lung disease.

Possible complications of this procedure are shown below. Some can be serious and may even cause death.

General complications of any procedure

• Bleeding during or after the procedure.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Venous thromboembolism (VTE) — this is a blood clot in your leg (deep-vein thrombosis - DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the procedure.

Specific complications of this procedure

• Adhesions, where scar tissue forms deep inside your nose.
• Leak of fluid from your brain. Your surgeon can usually repair any damage during the procedure. If the damage is not repaired, you may get inflammation of the membrane that surrounds your brain and spinal cord (meningitis).
• Damage to the orbit (the bone around your eye) (risk: 1 in 500).
• Double vision.
• Blindness.
• Toxic shock syndrome, which is an infection of your bloodstream.
• Damage to your tear duct causing your eye to become watery.
• Reduced sense of smell.
• The problem coming back. You may need another procedure to fix it.

Consequences of this procedure

• Pain.

What happens after the procedure?

You should be able to go home the same day.

If you had non-dissolvable packing in your nose, you will need to stay overnight and the packing will be removed the next morning.

Do not blow your nose for at least a week. Your nose will continue to feel blocked for a few weeks.

Your surgeon will give you a nasal spray or drops for you to use. You may be given a course of antibiotics to reduce the risk of infection.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery.

Summary

Sinusitis is not usually serious but it can cause unpleasant symptoms. If medication does not help, endoscopic sinus surgery should help prevent the sinusitis from coming back.

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