A difference between functional endoscopic sinus surgery and conventional sinus surgery is that in the former an endoscope is used in the nose to view the nasal cavity and sinuses. This generally eliminates the need for an external incision. The endoscope allows for better visualization of diseased or problem areas. This endoscopic view, along with detailed x-ray studies, may reveal a problem that was not evident before.
Another difference is that functional endoscopic sinus surgery focuses on treating the underlying cause of the problem. The ethmoid areas are usually opened, which allows for visualization of the maxillary, frontal, and sphenoid sinuses. The sinuses can then be viewed directly, and diseased or obstructive tissue removed if necessary. There is often less removal of normal tissue, and the sinus surgery can frequently be performed on an outpatient basis.
Endoscopic sinus surgery is generally intended for people with chronic sinus problems who do not respond to medical therapy. The diagnosis of chronic sinusitis must be based on an assessment by your doctor, as other problems can cause symptoms similar to those found with sinus disease. The majority of people with sinusitis do not require surgery. Their sinus symptoms can usually be successfully treated medically, including antibiotic therapy and other medications, treatment of allergy, and environmental control. The type of medical therapy used is based on your doctor’s assessment of the cause.
However, in some people surgical intervention is required as a sinus treatment. This may be because an infected or inflamed area does not clear with antibiotic therapy or other medications, the symptoms keep returning when antibiotics are stopped, or for other reasons. You should discuss the need for sinus surgery with your doctor.
Prior to sinus surgery, you will need to have some blood work and possibly some other studies performed. To be current, blood work should be done within one month of surgery. Other studies include an EKG and chest x-ray, which are ordered if your age or medical history indicates a need. Typically, you will have a visit to be re-examined prior to surgery. If you have a CT scan from outside this institution, bring it with you. Surgery will not be performed without the CT scan.
In some cases, starting oral steroids (or increasing the dose if you are already on them) and/or antibiotic therapy is done in the pre-surgical period. Take these medications as directed by your doctor. If you have a significant increase in your sinus infection in the week(s) prior to surgery, notify your doctor. Your sinus surgery may need to be postponed.
. Do not take aspirin or salicylate containing analgesics for at least 10 days prior to surgery. Aspirin, even in small quantities, can significantly increase bleeding during surgery and post-operatively.
. Do not take non-steroidal anti-inflammatory drugs (Ibuprofen, Advil, Motrin, Aleve) for at least five days prior to sinus surgery. These drugs will also increase bleeding, although the effects on the blood are shorter.
. Do not smoke for at least three weeks prior to surgery. Not only does smoking worsen sinus symptoms, smoking in the weeks before or after surgery will result in excessive scarring, and may result in failure of the operation.
. Do not eat or drink anything beginning at midnight the night before sinus surgery. If you are taking medications, ask during your pre-surgical evaluation if these can be taken on the morning of surgery.
. You should obtain some Afrin nasal spray from your pharmacy, and spray into the nose one to two hours prior to the operation.
The surgery is typically not uncomfortable and should not be an unpleasant experience. The operation can be performed under general or local anesthesia, with an anesthesiologist providing monitored sedation. Your physician will discuss the advantages/disadvantages of each type, and together you will decide which is right for you. Although there are potentially serious risks from surgery in this area, the incidence of these risks is very low (see Risks of Endoscopic Sinus Surgery).
If you choose local anesthesia, you will be given medication to make you sleepy and relaxed. You will usually hear some crunching sounds as bone is removed which may sound loud to you. You may also feel some mucus or blood in the back of your throat that you should swallow. You will be able to talk to us during the surgery, so let us know if anything bothers you. Should you experience significant discomfort during the procedure, we will provide monitored sedation.
In some cases, it may be necessary to repair the nasal septum at the time of sinus surgery. If this is required, additional risks associated with septal repair are possible (see Risks of Endoscopic Sinus Surgery).
Although the risk of bleeding appears to be reduced with this type of sinus surgery, on occasion significant bleeding may require termination of the procedure and the placement of nasal packing. Bleeding following surgery could require placement of nasal packing and hospital admission. A blood transfusion is very rarely necessary.
In the rare instance that a blood transfusion is necessary, there is a risk of adverse reaction or the transfer of infection.
Cerebral Spinal Fluid (CSF) Leak
All operations on the ethmoid sinus carry a rare chance of creating a leak of CSF (the fluid that surrounds the brain). The risk of CSF leak is generally considered higher when ethmoid surgery is done through the nose instead of by external incision. However, because the endoscope used allows for improved visualization, the risk of this complication is potentially reduced. Should this rare complication occur, it creates a potential pathway for infection, which could result in meningitis (inflammation of the brain). A CSF leak would extend your hospitalization and may require further surgery for repair.
Although extremely rare, there are occasional reports of visual loss after sinus surgery. Usually, the loss of vision only involves one side and the chance for recovery is not good. Temporary or prolonged double vision has also been reported after sinus treatment.
Because endoscopic sinus surgery is typically performed under local anesthesia, adverse reactions are uncommon. If general anesthesia is required, you would be subject to the occasional, but possibly serious risks involved. Adverse reactions to general anesthesia may be further discussed with the anesthesiologist.
Nasal Septum Reconstruction Risks
If nasal septal reconstruction is done, you could experience numbness of the front teeth, bleeding and infection in the nasal septum, or the creation of a septal perforation. A septal perforation is a hole through the septum, which may cause difficulty breathing through the nose. Since the cartilage in the septum has a “memory,” it may shift post-operatively and result in a renewed deviation. There is also a small risk of a change in shape of the nose.
Decreased Sense of Smell
Permanent loss or decrease in the sense of smell can occur following surgery. However, in a number of patients, it is already decreased prior to surgery, and typically improves with surgical intervention.
Tearing of the eye can occasionally result from sinus surgery or sinus inflammation and may be persistent. You may experience numbness or discomfort in the upper front teeth for a period of time. Swelling, bruising, or temporary numbness of the lip may occur, as well as swelling or bruising around the eye. Subtle changes in the sound of your voice are common.
Functional Endoscopic Sinus Surgery / FESS Recovery?
You will have a drip pad under your nose to collect mucus and blood. Change it only when it bleeds through. You may have to do this every hour for 24 hours after surgery.
You may have some swelling of your nose, upper lip, or cheeks, or around your eyes. Your nose may be sore and will bleed. You may feel “stuffed up” like you have a bad head cold. This will last for several days after surgery.
The tip of your nose and your upper lip and gums may be numb. Feeling will return in a few weeks to a few months. Your sense of smell will not be as good after surgery. It will improve and probably return to normal in 1 to 2 months.
You will probably be able to return to work or school in about 1 week and to your normal routine in about 3 weeks. But this varies with your job and the extent of your surgery. Most people feel normal in 1 to 2 months.
You will have to visit your doctor regularly for 3 to 4 months after your surgery. Your doctor will check to see that your sinuses are healing well.
Will Endoscopic Sinus Surgery Cure My Sinus Problems?
As with all sinus surgery, it is possible that the disease may not be cured by the operation, or that disease may recur at a later time. If this should happen, subsequent surgical therapy may be required. It should be realized that some medical therapy is usually continued after surgery, especially if allergy or polyps play a role in the sinus disease. This is necessary to prevent recurrence of disease.
Overall, the majority of patients have had significant improvement with the combination of surgery and continued medical management.
About Iranian Surgery
Iranian surgery is an online medical tourism platform where you can find the best otolaryngologists in Iran. The price of Endoscopic Sinus Surgery can vary according to each individual’s case and will be determined by an in-person assessment with the doctor.
For more information about the cost of Endoscopic Sinus Surgery in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number 0098 901 929 0946. This service is completely free.