Endoscopic Sinus Surgery in Delhi, India

Endoscopic sinus surgery is also referred to as Functional Endoscopic Sinus Surgery (FESS), as it helps restore the function of the sinus. This is a minimally invasive surgical procedure performed to eliminate blockages and other conditions in the sinus. This is carried out with the help of a nasal endoscope. This procedure helps to relieve sinus symptoms without making incisions in and around the area of the nose.

FESS is carried out when the patient has either a chronic sinus inflammation or chronic infection in the sinus region, which doesn't heal even after taking medications involving antibiotics. With this surgery's help, the passage between the nose and the sinus is widened, and the mucus trapped in the sinus can be removed accordingly. This surgery is carried out on an inpatient basis under general anaesthesia. The doctor thoroughly examines the patient and goes through the patient's entire medical history, followed by a physical examination.

Afterwards, certain tests are conducted by the doctor, which is as follows: 

Nasal endoscopy to access the nasal passages and sinuses with the help of an endoscope to determine any possible signs of inflammation and infection.

Non-contrast CT scan of sinuses to look for the extent of disease and to study the sinus anatomy of the patient before the surgery.

Who are the Best Candidates for Endoscopic Sinus Surgery Procedure?

• Chronic Sinusitis: Patients who have chronic sinusitis that persists for 12 weeks or longer despite medical treatment are considered good candidates for endoscopic sinus surgery.
• Severe or Persistent Symptoms: Patients who experience severe or persistent symptoms such as facial pain, pressure, congestion, headaches, or loss of smell and taste may benefit from the surgery.
• Sinus Blockage: Patients with sinus blockage or obstruction that impairs the drainage of mucus may also benefit from the surgery. This can be due to factors such as nasal polyps, deviated septum, or scarring from previous sinus surgery.
• Failed Non-Surgical Treatments: Patients who have tried medications, nasal sprays, or allergy shots without success may be good candidates for endoscopic sinus surgery.
• Good Overall Health: Patients who are in good overall health and do not have any underlying medical conditions that may complicate the surgery, such as uncontrolled diabetes or heart disease, may be considered for the surgery.

Who is Not a Good Candidate for Endoscopic Sinus Surgery Procedure?

• Blood Clotting Disorders: Endoscopic sinus surgery may not be a good option for those who have bleeding disorders or take blood-thinning medications because these conditions increase their risk of bleeding during the treatment.
• Uncontrolled Medical disorders: People who have uncontrolled medical disorders, such as diabetes or heart disease, may not be ideal candidates for surgery because they raise the risk of complications.
• Active Infections: Patients who have active sinus infections or sinus inflammation, such as a sinus abscess. Surgery cannot be considered until the infection has been treated and eliminated.
• Acute Sinusitis: Patients who suffer acute sinusitis, which is a temporary sinus irritation, are not suitable candidates for endoscopic sinus surgery. Antibiotics and other non-surgical treatments for this illness tend to work effectively.

Indications for Endoscopic Sinus Surgery

Patients require this procedure mainly because of the following:

• Nasal congestion
• Difficulty in breathing
• Pain in the nasal cavity
• Nasal polyps. Soft, benign growth is present on the lining of the nose.
• Sinusitis. Inflammation of nasal sinuses.

Contraindications for Endoscopic Sinus Surgery

• Lack of proper instrumentation.
• Lesions that tend to extend towards the palate.

Goals of Endoscopic Sinus Surgery

Various goals of endoscopic sinus surgery are as follows:

• To improve the drainage of sinus
• To improve the airflow through the nose
• To reduce the severity of the infections present in the sinus area
• To reduce the symptoms of sinusitis

Endoscopic Sinus Surgery Procedure

Before the Procedure

Before the procedure, the patient is expected to follow and share valuable information with the doctor. These are as follows:

• Inform the doctor about the routine medications for various ailments, if any, and a detailed medical history of those conditions.
• Avoid ibuprofen, aspirin, or any other blood thinners at least one week before undergoing the procedure as it will interfere with the blood clotting mechanism, causing excessive bleeding after the procedure and eventually resulting in delayed healing.
• It is advised not to consume anything after midnight before the day of surgery.
• Avoid smoking at least three weeks before this procedure, as it worsens the symptoms.

During the Procedure

FESS is the standard procedure performed by doctors to treat various conditions of the sinus. The doctors continue to modify their approach depending on the patient's condition. The basic steps involved in this procedure are as follows:

• Anaesthesia: The operation is performed under general anaesthesia, which means that the patient will be asleep during the procedure.
• Endoscope Insertion: The surgeon will place the endoscope through the nostril to reach the sinuses. Using the endoscope, the surgeon can observe and remove any damaged or inflammatory tissue inside the sinuses while getting a clear picture of the inside of the sinus cavity.
• Removal of Obstructive Tissue: The sinuses' obstruction-causing tissue, such as polyps, scar tissue, or irritated mucous membranes, will be removed by the surgeon using specialised surgical tools like microdebrider.
• Sinus Drainage: The surgeon may use a specialised tool to enlarge the sinus passages and enhance drainage, which will improve sinus function.
• Finalisation: To stop any bleeding and encourage healing, the surgeon will pack the sinuses with gauze or special packs when the procedure is finished. Dissolvable packing may be used in specific circumstances.

Post-operative care

The doctor provides the patients with a particular set of instructions for relieving discomfort and keeping the sinuses clear after FESS. These comprise the following :

• Nasal saline spray: This can be applied every two to three hours after surgery, and it helps to make the nose more comfortable and relaxed. Saline sprays are available as over-the-counter medications and can be purchased in any pharmacy outlet.
• Sinus irrigation: Patients will begin sinus irrigation with the help of sinus rinse kits after the pack removal. It is recommended to irrigate at least twice a day for the best possible results by following the instructions provided by the doctor. Initially, this will feel awkward, but after a few uses, it will become soothing for the patient as it helps to remove the debris which is left behind in the sinuses after surgery.
• Bleeding: The patient experiences occasional discharge of blood during the initial three to five days after sinus surgery. Most commonly witnessed after sinus irrigation. In such cases, it is advised to tilt the head back slightly and breathe gently through the nose. If the bleeding still persists, patients may use the oxymetazoline nasal spray recommended by the doctor. If nothing works at all, then doctor consultation becomes mandatory.
• Pain: Pain is to be expected, apart from the usual nasal and sinus pressure, for the initial few days after surgery. The patient may feel a sinus infection or a dull pain in the sinuses. Certain medications like Acetaminophen help to relieve mild discomfort. If Acetaminophen isn't effective enough to control the pain, it is advised to use the medication prescribed by the doctor.
• Fatigue: Patients can expect to feel tired and lethargic for the first week after surgery which is to be expected, and the majority of the patients rest at home and take a break from the workplace for a few days in order to heal quickly. Since every patient is different, some return to work sooner as compared to others.
• Nasal congestion and discharge: Patients will experience certain issues like nasal congestion and discharge for the first few weeks after surgery. The nasal passage and breathing should return to normal two to three weeks after the completion of surgery.

Precautions After Endoscopic Sinus Surgery

• Avoid blowing of nose for around two weeks after surgery, as it can lead to bleeding.
• Avoid aspirin and anti-inflammatory medications two weeks before and after the surgery.

Complications After Endoscopic Sinus Surgery

Although FESS is a minimally invasive procedure and a relatively safe one, there are still a few complications that can be experienced by patients at certain times. These are as follows:

• Sinus inflammation results in the tearing of the eyes. This occurs as a result of injury to the tear ducts. However, this is a very rare complication.
• Patients can experience loss of the sense of smell.
• Minor blood loss is associated with this surgery. In very rare cases, there is excessive bleeding among the patients, and it requires nasal packing to be done by the doctor.
• In some patients, there is leakage of cerebrospinal fluid resulting in the development of meningitis.
• FESS may lead to a possible eye injury leading to double vision or even loss of vision in one eye.

When to call the doctor

• Swelling around eyes
• High-grade fever above 101 degrees Fahrenheit
• Watery discharge from the nose after one week of the procedure
• Constant bleeding from the nose, even after the application of decongestant spray
• A severe headache followed by neck stiffness after one week of the procedure

Outlook

Patients require a few months at least to recover fully from FESS in order to feel completely normal like before. The majority of the patients resume their work activities after a period of two weeks.

Review

Reviewed by Dr. Sumit Mrig, Associate Director and Head, ENT(Ear Nose Throat) on 08-Aug-2023.