For some patients with chronic or recurrent sinus infections, sinus obstruction or nasal polyps, the doctor will recommend sinus surgery. Usually these patients have been treated with multiple antibiotics and other medications and have been evaluated for allergies, but have persistent symptoms.
The goal of sinus surgery is to eliminate physical obstructions of the sinus cavities and nasal passages and to enlarge the natural sinus openings. The surgeon removes diseased bone or mucosa (skin lining), polyps or cysts, rinses the open sinuses and sometimes takes cultures. A pathologist examines the diseased tissue. The surgeon takes measures to minimize scarring and support healing structures. Surgery reduces the frequency of sinus infections by restoring natural patterns of ventilation and drainage within the nose.
Modern sinus surgery, sometimes referred to as Functional Endoscopic Sinus Surgery (FESS) is performed through the nostrils using narrow cylindrical scopes, fiberoptic illumination, magnification, video displays, and a variety of specialized instruments for removing diseased tissue. It is usually performed under general anesthesia (patient asleep) as an outpatient surgery.
The patient should stop all topical decongestant sprays four to six weeks prior to surgery. Before any sinus surgery, the patient must avoid blood thinners like aspirin or aspirin containing products such as Aggrenox, Ecotrin and Excedrin for two weeks. Other blood thinners such as Plavix, Coumadin and Warfarin should be stopped ahead of time according to your surgeon’s instructions. Non-steroidal anti-inflammatory medications (like Ibuprofen, Advil, Alleve, Naprosyn, Mobic and Celebrex) should be stopped at least a week before surgery. Surgery may be delayed or rescheduled if a patient has a respiratory illness, flare up of asthma or had any food or drink the morning of the procedure.
Risks of surgery include bleeding, formation of scar bands, recurrent sinusitis in the opened sinuses or progression of sinusitis to involve other sinuses, and recurrent growth of polyps. Rare risks include reactions to anesthesia, spinal fluid leak, decreased sense of smell, or injury to the eye socket resulting in pain or decreased vision.
Recovery typically involves nasal packing that is removed a day or more after surgery. One can expect a few days of bloody nasal drainage and post-nasal drip. Salt water (saline) sprays and irrigations are used for two weeks or more. Follow-up in the office for endoscopic cleaning is important to ensure proper healing