Sinus surgery is recommended for patients who have not responded well to medical interventions and therapies, and who suffer from persistent or recurrent symptoms of sinusitis.
Unfortunately, medical management of sinusitis symptoms with prescription medications as well as over-the-counter medications just doesn’t work for all patients. These medications simply fail to provide long-term relief and as a result sinusitis symptoms persist.
Alternatively, for these patients, an ENT (ear, nose, and throat) doctor may recommend sinus surgery as corrective treatment and may suggest further workup to see if there is some structural blockage impeding sinus function. If there is such a blockage, sinus surgery is effective in removing the obstruction, opening the sinuses, and restoring natural drainage. It is also effective in reducing nose and sinus inflammation and keeping the drainage pathways open and functioning properly.
What is Sinusitis?
Sinusitis, also known as a sinus infection or rhinosinusitis, is an inflammation of the mucosa-lined, air-filled spaces in your skull that connect to the nose and throat. When the sinuses become inflamed, blocked or swollen, normal mucus drainage may not occur trapping air and other fluids, creating vacuums and/or pressure. This pressure can cause pain, which can sometimes be intense. Clogged sinuses may also lead to infections.
What Causes a Nasal Obstruction?
Nasal obstruction can have many causes. For some patients, allergies lead to swelling of the nasal and sinus lining, which causes congestion and blockage. For other patients, the blockage may be due to a simple anatomical obstruction, such as enlarged adenoids, a polyp in the nasal passage, a deviated septum, enlarged turbinates or narrow nasal passages.
What Surgical Options are Available?
There are a few surgical options available for patients who don’t respond to medical management of their sinusitis symptoms.
Balloon sinuplasty (BSP) is a less invasive endoscopic sinus procedure for chronic sinusitis patients seeking relief from uncomfortable sinus pain symptoms. During this non-invasive procedure, a tiny balloon is placed into the nose to reach the blocked sinuses and is then inflated to restructure the sinus opening. Congested sinus cavities are safely drained, reducing the recurrence of symptoms and providing patients with long-lasting, much-needed relief. To learn more about this procedure, check out our page on Balloon Sinuplasty.
If your doctor doesn’t need to remove anything from your sinuses, you may be a good candidate for this procedure.
Functional Endoscopic Sinus Surgery (FESS)
FESS is a minimally invasive, outpatient procedure that is recommended for patients who have a structural component contributing to their sinus blockage. For this procedure, the surgeon uses a small, lighted endoscope to view and access the sinuses. The sinus ostia are then identified and enlarged as a means to restore natural sinus drainage and to allow the sinus lining to return to its normal, healthy state. FESS is all about restoring function. Obstructive tissue and bone are carefully removed taking care to preserve the sinus lining.
How Are FESS and Balloon Sinuplasty Different?
The main differences between the two procedures are:
- Balloon Sinuplasty is performed in the doctor’s office. FESS is usually performed as an outpatient procedure.
- FESS involves making incisions that are very precise in order to remove or minimize problematic bone or tissue within the nasal passages. Balloon Sinuplasty doesn’t involve any cutting of bone or tissue.
- Balloon Sinuplasty is used when enlarging a blocked sinus passage is sufficient. FESS is used to help correct more significant physicalproblems such as removing nasal polyps or correcting a deviated septum.
Are There Any Similarities Between These Procedures?
- Both procedures are less invasive treatment options.
- The procedures take less time to perform than traditional sinus surgeries and the methods allow for quicker and more often painless recovery times.
- Normal activity can resume within a few days to a week.
Who is An Ideal Candidate for FESS?
The FESS procedure is clinically indicated for patients with chronic sinusitis, and for whom appropriate medical treatment has failed.
Patients with chronic sinusitis often report the following symptoms:
- Nasal congestion
- Purulent drainage (consisting of pus)
- Postnasal drip
- Facial pressure and headache
- Diminished sense of smell (hyposmia)
- Loss of smell (anosmia)
- Nasal obstruction
Since other conditions can mimic symptoms of chronic sinusitis, it is essential to rule out other conditions that may be causing the symptoms. To ensure sinus surgery is clinically indicated for the patient, an ENT doctor will review the patient’s medical history and conduct a complete physical examination, including nasal endoscopy and CT scans, if appropriate.
FESS is also appropriately indicated for patients who have other conditions, such as nasal tumors and nasal polyps.
Functional Endoscopic Sinus Surgery (FESS) FAQs
FESS can sometimes be done as an in-office procedure under sedation and local anesthesia, but it can also be done at an ambulatory surgery center or a hospital operating room under general anesthesia. It often depends on the preference of your surgeon.
Many surgeons perform FESS without nasal packing. If nasal packing is used, it is inserted to prevent excessive postoperative bleeding. Talk to your surgeon about his/her standard practice
If you need sutures, dissolvable sutures are used for FESS.
Generally, FESS can take anywhere from 1-2 hours. The length of time varies for each patient, as additional procedures might be added on and done at the same time (e.g., septoplasty). Talk to your surgeon about the details of your case during your pre-op visit.
Time off for recovery usually depends on the type of procedure performed as well as the type of anesthesia used. For patients who have nasal and sinus procedures performed under general anesthesia, patients may need to take 3-4 days off of work. During this time, patients are advised to refrain from heavy lifting or vigorous activity for 1-2 weeks.
If patients have an in-office procedure done under local anesthesia, they should take 1-2 days off from work, and follow any post-surgery advice their surgeon provides them.
Most patients find that any post-operative pain can easily be managed with regular or extra-strength Tylenol.
Typically, patients can expect to have some fatigue, nasal stuffiness, and mild nasal drainage after surgery. The stuffiness usually results from swelling after the procedure and starts to improve after the first week.
The FESS procedure offers several benefits to the patient, including decreased sinus-related facial pressure, congestion, nasal obstruction, rhinorrhea (watery discharge from the nose), and headache. Overall, patients report significant improvement after a FESS procedure and better quality of life.
There should be no change to the facial or nasal appearance after surgery, as the procedure is performed in a minimally-invasive fashion with the sinuses accessed with small endoscopes placed in the nostrils.
After a FESS procedure, most patients have found that they do well with minimal to no medication because their sinus passages have been restored to their natural state. For other patients, they report that they still have issues with inflammation and infection, but with the sinuses now open, medication can reach the sinus lining and reduce inflammation quite effectively. As for treating sinus infections, these same patients report that they need less medication to clear the infection than they did before having sinus surgery.