Otolaryngology, Head and Neck Surgery (Ear, Nose, and Throat)
When Surgery is Appropriate
Sinus disease causes a multitude of symptoms, including stuffiness, post-nasal drainage, headache, and fullness in the face, eyes, and ears. Patients are initially treated medically in order to clear the problem while, avoiding surgery. This may include antibiotics, decongestants, antihistamines, nasal sprays, and allergy therapy. Failure of medical therapy leads to consideration of sinus surgery. Classic sinus surgery involves incisions under the lip or in the fold between the nose and the eye and placement of a window to drain the cheek sinus; it is rarely required today.
Since the early 1970s in Europe, and since 1984 in the United States, a new approach to sinus disease has evolved. Diagnosis no longer relies on using reflected light off a mirror worn on the specialist's head to examine the nose, but rather a small endoscope is used that allows a complete view of the deep recesses of the nasal cavity that could not previously be seen. This office procedure, combined with detailed imaging, provides fine detail of the drainage passages of the air spaces (the paranasal sinuses) situated between the nose, eyes, and brain.
A critical area, known as the osteomeatal complex, is responsible for the majority of sinus drainage into the nose; this confluence combines the drainage of the anterior ethmoid, frontal, and maxillary sinuses. Obstruction of this area leads to rhinosinusitis and its resultant symptoms. In the operating room, with the image magnified on the TV monitor, the obstructed area can be opened by working through the nose or via the mouth. This new approach results in relief of symptoms in 80 to 90 percent of patients.
What to Expect Before Surgery
After informing the doctor about your symptoms, your nose is examined with an endoscope. Medical treatment will be initiated when infection is present. If indicated, a CT scan will be ordered. Endoscopic surgery will be recommended if your symptoms are debilitating and test findings are consistent with disease in the affected area. The risks, options, and benefits of endoscopic surgery will be discussed prior to scheduling surgery. The risks of the procedure include bleeding and infection, as with any surgical procedure. In addition, the surgery takes place close to the eye and floor of the brain. Visual changes, and even blindness, as well as leakage of spinal fluid and anosmia (loss of sense of smell), although rare, have been reported with this procedure.
What to Expect During Surgery
Appropriate blood work and X-rays (usually CT scanning) are obtained. If necessary, a medical consultation will be obtained before surgery. Arrival to the hospital occurs on the morning of surgery; you should not eat or drink after midnight prior to admission. Surgery may be performed under local anesthesia with sedation or general anesthesia. This will depend on your preference, as well as the extent of the disease — although general anesthesia is usually selected. In the unusual case the disease is extensive, or if bleeding is excessive, only one side may be done at a time. A minority of patients require a temporary dressing (packing) in the nose after surgery, which usually removed the following day. Patients may be discharged on the day of surgery. Those who have not fully recovered from the general anesthetic, or have other health concerns, may stay one night.
What to Expect After Surgery
Upon discharge the nurse will give you instructions, which include refraining from blowing your nose and avoidance of strenuous activities for three weeks. The first appointment will be within a week after discharge and return office visits are weekly for several weeks, and then as needed. One can expect some stuffiness and crusting for approximately two to four weeks after surgery. You will be started on a salt-water spray to minimize the crusting that takes place. Many patients are back to work or school the week following surgery and back to full-time activity within three weeks.