Endoscopic sinus surgery

Published by Bupa's Health Information Team, March 2011.

This factsheet is for people who are having endoscopic sinus surgery, or who would like information about it.

Endoscopic sinus surgery is used to treat persistent sinusitis (inflammation of the sinuses). A narrow, flexible, tube-like telescopic camera is put into the nose and the sinuses are unblocked using special instruments.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

Animation - where the sinuses are found

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About endoscopic sinus surgery

Your sinuses are air-filled spaces in your cheekbones and forehead that connect to your nose. They have a lining that produces mucus, which keeps your nose and sinuses moist, and helps to trap any dust and bacteria that you breathe in. The mucus drains away to the back of your throat where you swallow it.

                      The location of the frontal, ethmoid and sphenoid sinuses

Sinusitis is an inflammation of your sinuses. It is usually caused by an allergy, an infection, for example a cold or flu, or exposure to an irritant such as smoke. When your sinuses become inflamed, the lining swells and mucus can't drain away properly. This can make you feel 'blocked up' and give you a runny nose and a feeling of pressure and pain in your face and head. Many people with sinusitis also have a reduced sense of smell.

Chronic sinusitis is sinusitis that lasts for more than 12 weeks. If you have chronic sinusitis and other treatments such as nasal sprays or drops haven't worked, you may be offered endoscopic sinus surgery to open up and unblock your sinuses. Endoscopic sinus surgery can also be done to remove a blockage, for example a polyp. Nasal polyps are fleshy swellings of the lining of the nose.

What are the alternatives?

Painkillers and nasal decongestants may also help to ease your symptoms. However, they can't be used to treat polyps or chronic sinusitis and you shouldn't take them long term.

Chronic sinusitis can be treated in other ways. Your GP may be able to prescribe a short course of oral steroids to reduce the inflammation and sometimes antibiotics can be used to treat an infection.

If these treatments don't work and the sinusitis is affecting your day-to-day life, your GP may refer you to a surgeon specialising in ear, nose and throat surgery. Endoscopic sinus surgery may be one of your options.

Preparing for endoscopic sinus surgery

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Endoscopic sinus surgery is often done as a day case. This means you will be able to go home the same day. However, this depends on how much surgery is needed and the time of your operation. Some people may need to stay overnight in hospital.

The operation is usually done under general anaesthesia, which means you will be asleep during the procedure. You can also have endoscopic sinus surgery done under local anaesthesia, which means that you will be awake during the procedure but your nose and sinuses will be numb. If you're having the operation under local anaesthesia, you may be offered a sedative to help you relax.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during endoscopic sinus surgery

A narrow, flexible, tube-like telescopic camera called an endoscope is carefully inserted into one of your nostrils. This allows your surgeon to see the inside of your nose and sinuses clearly. He or she will use small, specialised instruments to remove blockages and open up your sinuses. Sometimes a small balloon is inflated where there is a blockage in order to clear it.

At the end of the operation, absorbent dressings may be put in your nose to reduce any bleeding. Your surgeon may also insert splints (thin plastic sheets) inside your nose to help support it.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

If you have dressings in your nose, they may feel uncomfortable and your nose may feel blocked. These will be taken out within 24 hours of your operation. If you have splints in your nose, these may be left in for longer and removed at a later date.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. If you go home the same day, have a friend or relative stay with you for the first 24 hours after your operation.

Recovering from endoscopic sinus surgery

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

It's normal for your nose to feel blocked after endoscopic sinus surgery. This can last for a few weeks after the procedure. Don't blow your nose for the first 48 hours after your operation. Your surgeon will tell you when you can start to gently blow your nose.

You may notice some mucus or blood-stained fluid coming from your nose for up to two weeks after your operation. This is normal.

Most people are able to go back to work between one and two weeks after endoscopic sinus surgery. If you lift or carry heavy objects as part of your job, you're likely to be off work for at least two weeks. Your surgeon will talk to you about the best time to return to work.

What are the risks?

As with every procedure, there are some risks associated with endoscopic sinus surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

These are the unwanted but mostly temporary effects you get after having the procedure. The side-effects for endoscopic sinus surgery include:

• mild pain
  
• blocked nose
  
• bruising around your eyes
  
• blood-stained fluid or mucus from your nose

Complications

Complications are when problems occur during or after the operation. Most people aren't affected. The main complications of endoscopic sinus surgery are listed below.

• Bleeding. You may have a small amount of bleeding from your nose, which is usually not serious. If this happens, you may need to have packing in your nose.
  
• Damage to your eye sockets. Your sinuses are close to your eye sockets and sometimes endoscopic sinus surgery can cause a small amount of bleeding into the socket. This is usually mild and causes a bruise. The bleeding can be more severe and cause your eye to swell or give you double vision, but this is rare. Blowing your nose can make the bleeding worse.
  
• Leaking spinal fluid. Your sinuses are also very close to the bone at the bottom of your brain, where your spinal column is. Very rarely this bone can be damaged during the operation, which can cause fluid from your spinal column to leak out. If this happens, you may need another operation to repair it.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.