Endoscopic sinus surgery

About endoscopic sinus surgery

Endoscopic sinus surgery is a procedure to help stop sinusitis.

For more information, see 'About the procedure' below.

About sinuses

Your sinuses are air-filled spaces between your eyes, and behind your forehead and cheeks.  These spaces are connected to the inside of your nose.

A mucous membrane lines your sinuses and produces mucus which helps to keep the air you breathe clean, warm and moist. If the opening between a sinus and the inside of your nose gets blocked, the mucus gets trapped and can become infected.

This can cause the mucous membrane to become inflamed, causing it to swell and form extra folds in your nose and sinuses. These are called polyps (small growths) and usually make the symptoms worse.

About sinusitis

Sinusitis is an infection in the lining of your sinuses. 

Sinusitis is not usually serious, but it can cause unpleasant symptoms. These include pain, a blocked nose, discharge, less sense of smell and the feeling of having mucus at the back of your throat or nose.

Symptoms of sinusitis can be worse at some times, particularly if you also have hay fever or other allergies.

Sinusitis can be temporary, for example, after a cold. It can also continue, for example, if you have nasal allergies or develop polyps.

If you decide against the endoscopic procedure

You will continue to have sinusitis. 

Sometimes infection can spread, causing an infection of the tissues surrounding your eye, or between your sinuses and your brain, causing a brain abscess.

Alternatives to the procedure

Antibiotics can help to clear any infection.

If your sinusitis is caused by an allergy, you may be able to prevent it by avoiding allergy ‘triggers’ or by taking medicines such as antihistamines, nasal steroid spray or a nasal wash.

If you smoke, quitting smoking can help clear your sinuses.

About the procedure

We will not perform the procedure unless we have your written consent.

• We usually perform the endoscopic sinus procedure while you are under a general anaesthetic (asleep), but sometimes we use a local anaesthetic. Your anaesthetist will discuss options with you. We may also give you injections of local anaesthetic to help with pain after the procedure.
• We perform endoscopic sinus surgery through your nostrils. It does not cause facial scars or change the outside shape of your nose.
• We use a small telescope (endoscope) to examine your nasal passages. We use surgical instruments to remove any polyps and widen the passages from your sinuses into your nose.
• We may limit our surgery to just your sinuses at the front of your nose or we may involve all your sinuses. Your surgeon will discuss this with you.
• To prevent bleeding after the procedure, we may place some temporary packing in your nose. This disappears within 1 or 2 weeks.

The procedure usually takes 1 to 2 hours.

Most people make a good recovery. If your sinusitis is caused by an allergic reaction or polyps, you may need to continue using a nasal spray.

If you had polyps, they may come back again even if you use a nasal spray (this affects 4 in 10 patients) and you may need another procedure.

Preparing for the procedure

To prepare for the procedure, do the following.

• Try to quit smoking. This may reduce your risk of developing complications after the procedure. 
• Maintain a healthy weight. If you are overweight, you have a higher risk of developing complications.
• Take regular exercise. This will help to prepare, recover and improve your health long-term. Ask your GP or healthcare team for advice on a suitable exercise plan.

• At your pre-op assessment, tell your healthcare team about any medicines you take. This includes blood-thinning, herbal and complementary, dietary supplements and over the counter medicines.

After the procedure

After the procedure we will transfer you to the recovery area and then to the ward. Most patients can go home the same day.  If you had non-dissolvable packing in your nose, you will need to stay overnight and we will remove the packing the next morning.

To reduce the risk of blood clot, follow your healthcare team's instructions on medicine or wearing special stockings.

Recovery after discharge from hospital

After the procedure, follow this advice.

If we have not given you sedation during your procedure, for the first 24 hours you must not:

• operate heavy machinery
• drive any vehicle
• undertake potentially dangerous activities (including cooking)
• consume alcohol
• sign legal documents.

When you shower or bath, try to keep your ear dry because soapy water can cause an ear discharge. Do this for 2 weeks.

Do not blow your nose for at least 1 week.  After a week you will blow out thick bloody mucus and your nose will feel blocked for a few weeks.

Your surgeon will give you a nasal spray or drops to use. You may also need a nasal cleansing kit (douche) to keep your nose clean.

We may give you a course of antibiotics to reduce the risk of infection.

For 6 weeks, do not swim and then do not dive deeper than 2 metres. 

Benefits and risks

Benefits

The aim is to widen the passage between the sinus and your nose so that mucus no longer becomes trapped and we can give you medicine to treat inflammation. This should prevent the sinusitis from returning, but your sense of smell may not improve.

Risks

During or shortly after procedure

Pain (common: more than 1 in 20). You can expect some pain or discomfort. We will discuss pain relief with you.

Significant bleeding (less common: fewer than 1 in 20). Some bleeding is expected during most procedures, however significant bleeding may require further treatment. Usually we can deal with this during the procedure, but you may need a blood transfusion or further emergency treatment.

Cerebrospinal fluid leak (rare: fewer than 1 in 100). This is leakage of the fluid that usually surrounds and cushions the brain and spinal cord. All sinus operations carry a small risk of damage to the thin bone at the base of the brain, with leakage of fluid from around the brain into the nose, or other related injuries.

If this rare complication happens you will have to stay in hospital longer and may require another operation to stop the leak. Infection can spread from the sinuses into the spinal fluid causing meningitis (this is very rare).

Damage to the eye (rare: fewer than 1 in 100). Damage to the eye can lead to worsening or loss of vision (loss of vision is very rare).

The sinuses are close to the wall of the eye socket. Sometimes minor bleeding can occur into the eye socket, causing bruising around the eye. This usually gets better without any special treatment, although it is important that you do not blow your nose.

More serious bleeding into the eye socket can happen (this is very rare). This can cause severe swelling of the eye and lead to altered or double vision, or loss of sight (loss of sight is very rare). If a serious eye complication happens, an eye specialist may recommend additional operations.

In the days after the procedure

Ongoing symptoms (common: more than 1 in 20). Despite the procedure, symptoms may continue and we may recommend further tests or treatments.

Further treatment needed (common: more than 1 in 20). This can be caused by our findings from the procedure, or from complications. The patient often needs medicine to control and prevent sinus disease returning.

Bloodstained nasal discharge (common: more than 1 in 20). This often happens after surgery and usually resolves within days.

Sinusitis (rare: fewer than 1 in 100). Sinusitis is swelling of the sinuses, usually caused by an infection. This is rare, but if it happens it can be serious.

Loss or change in sense of smell (rare: fewer than 1 in 100). This can be unpleasant and affect how things taste. This usually improves over the weeks following surgery, but some loss of sense of smell can be permanent (this is very rare).

In the months or years after surgery

Return of symptoms (common: more than 1 in 20). If this happens we may give you nasal sprays to use after your surgery. You may need a further sinus operation (this applies to 1 in 8 patients).