Endoscopic Sinus Surgery

What Is Endoscopic Sinus Surgery?

Endoscopic sinus surgery - also called endoscopy or sinoscopy - is a procedure used to remove blockages in the sinuses (the spaces filled with air in some of the bones of the skull). These blockages cause sinusitis, a condition in which the sinuses swell and become clogged, causing pain and impaired breathing.

A thin, lighted instrument called an endoscope is inserted into the nose, and the doctor looks inside through an eyepiece. Much like a telescope with a wide-angle camera lens, the endoscope beams light into different parts of the nose and sinuses, allowing the doctor to see what is causing blockages. Surgical instruments can then be used along with the endoscope to remove the blockages and improve breathing.

This surgery does not involve cutting through the skin, as it is performed entirely through the nostrils. Therefore, most people can go home the same day.

Endoscopic sinus surgery is a relatively new procedure designed to increase the amount of air flowing through the sinuses and allow mucus to drain properly out of the nose. The procedure can:

• Relieve nasal blockages
• Relieve facial pain
• Improve breathing
• Improve the sense of smell and taste

Endoscopic sinus surgery is an effective procedure to correct:

• Sinusitis
• Deviated septum, in which the partition separating the left and right sides of the nose is crooked
• Polyps, a noncancerous water-filled swelling
• Tumors, a swelling caused by an uncontrolled growth of cells.

What Conditions Are Treated With This Surgery?

Endoscopic sinus surgery is used to treat:

Sinusitis

Sinusitis is a common condition that usually is easy to treat with medication. It feels much like a head cold, with a blocked, stuffy, or runny nose.

Sinusitis is actually a swelling of the inner lining of the sinuses. This swelling causes the openings of the nose to be blocked so that the mucus inside can no longer drain out. When the mucus cannot drain, the pressure of the blocked fluid creates pain in the face and impairs breathing.

For most people, sinusitis is a temporary condition that goes away with simple treatment. If the symptoms continue for a significant period of time without responding to medication, or if the symptoms are especially severe, surgery may bring about permanent relief.

However, surgery for sinusitis is considered a last resort and will not be recommended unless all other courses of treatment have been exhausted over a period of time with little or no results.

Sinusitis can be the result of:

• A cold that lingers
• A bacterial or viral infection
• Swelling due to allergies
• Having small sinus openings

Deviated Septum

The partition separating the left and right sides of the nose, called the septum, is sometimes crooked. This crooked condition is called a deviated septum. Some people are born with this abnormality, but sometimes it is the result of an injury.

Very few people have a perfectly straight septum, but endoscopic sinus surgery is only recommended for those whose septum is crooked enough to cause significant sinus blockage. The surgery can then straighten the septum and improve breathing.

Polyps

A polyp, also called a cyst, is a benign (noncancerous) water-filled swelling about the size of a grape, which develops in the sinuses and causes blockage. They most frequently occur in people who have asthma.

Polyps can sometimes be reduced in size with medication. However, endoscopic sinus surgery has proven to be an excellent method with which to remove polyps and restore normal breathing.

Tumors

A tumor is a swelling caused by an uncontrolled growth of cells that creates new tissue. It is not water-filled like a polyp.

A tumor can be noncancerous or cancerous. Tumors in the sinuses are quite uncommon but can sometimes be removed with endoscopic sinus surgery. However, more extensive surgery is often necessary.

About The Sinuses

The sinuses are spaces filled with air in some of the bones of the skull. Air passes in and out of these spaces, and mucus drains through them and out of the nose. They also reduce the weight of the skull and give our voices a nicer sound.

There are four main pairs of sinus openings, sometimes called sinus cavities, in the face:

• Maxillary - in the cheekbones
• Ethmoid - between the eye sockets
• Frontal - in the forehead and above the eyebrows
• Sphenoid - deep in the head at the back of the nose

Each of these pairs of sinus openings has a channel that leads to the nose. These channels are quite narrow, and when the lining of the channels becomes swollen, blockage results. This lining is called the mucous membrane. This same mucous membrane forms the inner lining of the nose.

The mucous membrane in the nose and sinuses is our personal air conditioner. It warms, moistens, and cleans the air. The mucous membrane creates a clear, wet, slightly sticky mucus that gathers any dust, smoke, bacteria, or virus particles that may have been in the air. Tiny hairs along the membrane called cilia act as tiny oars, moving the mucus along much like a conveyor belt through the sinuses and out the nose.

When the mucus containing the unwanted particles reaches the nose and throat, the body prompts us to swallow, spit, sneeze, or cough it out of the body. When a cold or allergy prevents the cilia from moving the mucus through, the nose becomes blocked.

The mucous membrane is also one of the body's front-line defense systems. It releases chemicals that help to destroy bacteria and viruses before they can attack.

If a virus, bacteria, allergen or other irritant is strong enough to prevent the mucous membrane and cilia from doing their job, blockages can occur in any of the pairs of sinus openings.

Endoscopic sinus surgery can correct chronic or severe blockages in one or more of the maxillary, ethmoid, frontal, or sphenoid sinuses.

What Causes Sinusitis?

The potential causes of sinusitis include:

• Virus
• Bacteria
• Fungus
• Allergies
• Asthma
• Poor air quality
• Extremes of temperature and humidity
• Dehydration
• Excessive nose blowing
• Foreign objects placed in the nose
• Stress
• Diseased teeth
• Hormonal imbalances
• Medication side effects
• Low immune system
• Deviated septum
• Small sinus openings
• Polyps
• Tumors

Most cases of sinusitis can be easily treated by a family doctor. However, in those cases where the sufferer has chronic sinusitis or repeated attacks of acute sinusitis that have not responded to medication, endoscopic sinus surgery may be the answer. This is especially true in the case of nasal obstructions such as polyps.

There are two types of sinusitis:

Acute sinusitis means that the symptoms of the condition are temporary, usually lasting no more than 30 days. However, the symptoms of acute sinusitis are more severe and painful than the symptoms of chronic sinusitis.

Chronic sinusitis means that the symptoms of sinusitis occur frequently or for long periods of time. The symptoms are usually more annoying than painful. However, those with chronic sinusitis are more likely to have recurring attacks of acute sinusitis, which can be quite painful.

What Are The Symptoms Of Sinusitis?

Symptoms of sinusitis vary from person to person. The most common symptoms are:

• Stuffy or runny nose
• Clear, thin discharge from the nose (as in chronic sinusitis), or thick yellow or green discharge from the nose, sometimes tinged with blood (as in acute sinusitis)
• Sneezing and/or coughing
• Pain over the bridge of the nose
• Headache that is worse in the morning, when bending forward, or when riding an elevator
• Post-nasal drip from the nose into the throat
• Frequent throat clearing
• Itchy eyes and/or nose
• Impaired sense of smell and/or taste
• Bad breath
• Fever and chills
• Pain in the roof of the mouth or teeth
• Face and eye pain

Less common symptoms, which may or may not be accompanied by a stuffy nose, are:

• Earache, feeling of fullness in the ear, swelling, and tenderness behind the ear, and/or ear popping due to mucus in the Eustachian tube of the ear
• Sore throat and hoarse voice caused by infected post-nasal drip
• Swelling of the eye area due to spread of infection from the sinuses to the eye
• Severe headache with vomiting, a very rare symptom, indicates the possibility of meningitis or the spread of infection into the brain.

Sinus Surgery Differ From Traditional Surgeries?

There are other types of surgeries that can correct blockages in the nose and sinuses, but endoscopic sinus surgery is becoming the procedure of choice for more and more doctors.

Compared to other more traditional methods, endoscopic sinus surgery:

• Is less painful
• Leaves no visible scars
• Causes less bleeding
• Creates less discomfort after surgery
• Requires less packing in the nose after surgery
• Has a faster recovery period
• Has a higher success rate

When sinus surgery was first performed, surgeons would have to reach the sinuses by entering through the cheek area. This often caused scarring and possible disfigurement. In another traditional procedure, surgeons enter the sinus through the upper jaw.

In the past, it was thought that the damaged sinus tissues could never function normally again and had to be removed. Now, it is believed that as long as enough room is created for air to properly pass through the nose, the sinuses can once again do their job. Therefore, the objective of endoscopic sinus surgery is to do as little as necessary to restore the normal function of the sinuses.

Putting It All Together

Here is a summary of the important facts and information related to endoscopic sinus surgery.

• Endoscopic sinus surgery is an outpatient procedure used to remove sinus blockages that cause sinusitis.
• An endoscope is a thin, lighted instrument, much like a telescope with a wide-angle camera lens, which is inserted into the nostrils. The doctor can examine the sinuses by looking through an eyepiece at the opposite end of the endoscope. Surgical instruments can then be used next to the endoscope to remove blockages or growths, such as polyps.
• Endoscopic sinus surgery is an effective procedure for correcting sinusitis, deviated septum, polyps, and sometimes tumors.
• To determine if surgery is recommended, a doctor will take a detailed medical history and list of symptoms, noting how long the symptoms have been present. A CT scan is usually taken next to obtain an overview of the sinuses prior to the use of the endoscope.
• Surgery will be performed only if all other courses of treatment have failed or if symptoms are especially severe.
• Endoscopic sinus surgery lasts 60 to 90 minutes, after which the patient spends an hour or two in a recovery room. As long as the patient has someone else available to drive, he or she can usually go home the same day.
• Full recovery from endoscopic sinus surgery generally takes 30 to 60 days. It is recommended that the person not return to work or school for about a week after surgery.
• Endoscopic sinus surgery has become popular among doctors because it leaves no scars and causes less pain and discomfort for the patient than traditional sinus surgeries.