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
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
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:
- 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
Endoscopic sinus surgery
is used to treat:
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
- A cold that lingers
- A bacterial or viral infection
- Swelling due to allergies
- Having small sinus openings
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
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.
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.
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
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
- Poor air quality
- Extremes of temperature and humidity
- Excessive nose blowing
- Foreign objects placed in the nose
- Diseased teeth
- Hormonal imbalances
- Medication side effects
- Low immune system
- Deviated septum
- Small sinus openings
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:
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.
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
- 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
- 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
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
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
- 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
- Surgery will be performed only if all other courses
of treatment have failed or if symptoms are especially
- 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