Endoscopic Sinus Surgery

History

Sinus surgery has been around for decades and advancements throughout the years have progressed to make it safer and less invasive. Originally, sinus surgery was performed by making incisions on the face and removing the bone of the sinuses through those incisions. Surgical technique quickly improved so that some surgeons were capable of doing the surgery through the nose with headlights not too different than what you would see a miner wear. In the early 90’s, endoscopes were developed that made it possible to perform these surgeries entirely through the nose with close-up, detailed visualization improving both safety and efficacy. In the mid 2000’s balloon sinuplasty was introduced as another development in the treatment of sinus disease and has offered a new tool in the treatment of sinus disease.

Problem

One question often asked is “Why do we have sinuses?” The simplest explanation is that they serve as airbags for the brain. Essentially, if there is impact to the head from the front, the sinuses act as a buffer to prevent that impact from directly being transmitted to the brain. They may also serve to amplify and resonate our voices. Because they are hollow, they need to have a way to self clean so that debris, infections, allergens and other foreign invaders could be cleared out and not accumulate. Mucociliary clearance is the mechanism for this cleaning. The sinuses have a mucus lining that under a microscope looks like a carpet.

The “fibers” of the carpet are called cilia that beat in rhythm to sweep mucus (and the trapped debris) out of the sinuses (hence, mucociliary clearance). However, we have very large sinuses with very small exits. When those exits become inflamed by infection, allergy, or other irritation, they can narrow even further to the point that they are completely blocked. Mucus is trapped and bacteria can then grow in the trapped space causing further inflammation, pressure, pain, fever, etc.

Procedure

All treatment for sinusitis is geared toward improving the mucociliary clearance. Antibiotics treat the infection, but also reduce the inflammation they cause allowing the exits to widen and the sinuses to drain appropriately. Nasal sprays try to decrease inflammation around those same exits. Nasal saline irrigation tries to remove the irritants that cause inflammation within the nose. Surgery is just the next step. Functional Endoscopic Sinus Surgery (FESS) is the gold standard currently for the surgical treatment of sinusitis. It simply means widening the natural exits of the sinuses so that they can drain and do not become blocked. Prior to about 2006 the technique for FESS had been fluctuating as data was collected on how to achieve the best outcomes.

Since about that time, the technique reached a point that is quite refined and only small adjustments have been made, including the use of the new balloon sinuplasty method. Altogether, patients report satisfaction rates higher than 90% with FESS even a year after the procedure. Furthermore, the comfort level is far better than what it was several years ago. Most patients don’t even use the entire post-op prescribed pain medication because they don’t find that they need it.

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Who is a Candidate

Any patient with recurrent or chronic sinusitis is a potential candidate for sinus surgery. Surgery is rarely a necessary requirement to treat sinusitis. Usually, it is an option that is available among a spectrum of choices. For most patients, medical therapy can control or resolve their sinus problems. For others, allergy treatment can do the same. For those who fail to respond to these more conservative options, surgery is the next possible step. If you’re interested in discussing options for the treatment of your sinusitis, please feel free to schedule an appointment with us at your convenience.