This article is on Endoscopic Sinus Surgery (ESS), a common surgical procedure in Otolaryngology. It is intended to help inform patients, relatives of patients and health professionals. The information in the grey boxes is more technical and intended more for Health professionals that are reading this article.

 

What are sinuses?

Sinuses are hollow spaces in the skull and there are four pairs of them. They are found within the skull behind the forehead, nose and cheeks. (Figure). Functions of the sinus include humidification, voice resonance and protection.

 

What is Endoscopic Sinus Surgery?

Endoscopic sinus surgery is an operation of the sinuses using a telescope connected to a camera called an Endoscope.

The surgery is completed under a General Anaesthetic (an Anaesthetist will explain to you how this process will happen). The surgeon will place the Endoscope and other instrument through your nostrils to work on the sinuses. There are usually no cuts required to the skin

Other names of the surgery you may see include: Functional endoscopic sinus surgery, FESS and ESS.

 

What is an Endoscope?

An Endoscope is a long thin telescope with a camera and light connected to it. It allows easy access into spaces within the sinus or other body parts without making cuts to the skin.

 

What are the indications?

On most occasions, the surgery aims to improve symptoms of sinus disease for patients where medication treatment has not been effective. The surgery can also be used to remove some cancers within the sinuses.

 

What happens before surgery?

Endoscopic Sinus Surgery

  • You cannot eat or drink anything from 6 hours before your surgery.
  • The anaesthetist will see you either in clinic days before the operation or on the day of surgery.
  • You may be asked to have routine blood tests taken prior to your surgery.
  • A scan of your sinus is required before the operation. This may already be completed before you see your ENT Surgeon.

Your surgeon may sometimes ask you to take a short course of antibiotics or steroids before the operation. Other medications such as blood thinning medicine will need to be stopped before your operation.

 

How long is the surgery?

The duration of the operation will vary depending on how extensive the disease is. Generally it could take between 1-3 hours of operating time. But the entire process which includes pre-operation checks, anaesthesia and recovery can take several hours.

 

Complications:

  1. Haemorrhage – Intra-operative & Secondary
  2. CSF Leak
  3. Orbit Injury
  4. Hyposmia

 

What are the risks?

Mild bleeding from the nose and bruising to the eye are common after the operation. Your ENT Surgeon will explain all the risks of surgery and answer any questions during your consultation.

 

Are there alternative options?

Recommendations will depend on the indication for surgery. Your Surgeon will discuss all alternative options with you. For Chronic Rhinosinusitis treatment with medication is a valid alternative if symptoms are controlled. Surgery is usually offered when medical treatment has not been effective.

The final decision to proceed with surgery is made by the patient and the option of not undergoing surgery is always available.

 

How long is the recovery?

Most patients either go home on the same day of their operation or stay overnight in hospital for observations. Expect to take 1-2 weeks off work or school after the operation. There is some flexibility depending on how extensive the operation is and the work you do.

After the operation, you will be given instructions to rinse your nose with salt water and a prescription for any other medication you require. Small amounts of blood and/or blood clots for 1 to 2 weeks after the operation is normal. Your nose will initially feel blocked, regular use of the salt water rinse will help, try not to blow your nose.

There may be some pain and discomfort for a few days after the operation. Simple pain relief including paracetamol and ibuprofen should be taken. Your ENT Surgeon will schedule a clinic follow up with you, usually 1-2 weeks after the operation.

 

Further reading:

1. Cleveland Clinic

 

References:
1. Hamilos D, Holbrook E. Chronic Rhinosinusitis: Management. 2019. UpToDate

 

Author + Affiliation:
Dr Johnny Wu, Department of Otolaryngology, Waikato Hospital.
Reviewed by Dr Andrew Wood, Otolaryngologist, Waikato Hospital

 

Date of Publication +/- Review:
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