Endoscopic Sinus Surgery

Endoscopic Sinus Surgical Procedure

Why Does Someone Need Endoscopic Sinus Surgery?

The sinuses are hollow, air-filled spaces in the skull that sit just above, between, and below the eyes and are connected to the nose. The mucous membrane that lines the sinuses produces mucus to help keep the sinuses warm and moist and keep the air you breathe clean.

When that mucous membrane gets infected or inflamed for prolonged periods, it is called sinusitis, an illness that can cause many issues. Those who experience chronic sinusitis can have varying symptoms, but the most common symptoms include pain, congestion, drainage, discharge, reduced sense of smell, and fatigue.

The cause of inflammation or infection in the sinuses can vary and can include:

  • Air pollution
  • Allergies
  • Nasal polyps
  • Abnormal nasal and sinus anatomy
  • Reactions to viruses, fungi, or bacteria
  • Sinus or nasal tumors
  • Nasal obstruction or a blockage

If a doctor suspects sinusitis, they will likely try less invasive treatments first before resorting to surgery. This can include the use of nasal sprays, decongestants, antibiotics, antihistamines, and steroids.

For the majority of patients, sinusitis is often effectively treated using the medications listed above. However, there is a small percentage of those who continue to have problems with sinusitis and recurrent infections. In these cases, endoscopic nasal surgery will likely be recommended.

What are the Pros and Cons of Endoscopic Sinus Surgery?

Every surgery comes with risks, including endoscopic sinus surgery. It’s important for all patients to understand what to expect and consider the pros and cons to determine if the surgery is the right option for them.

The Pros of Endoscopic Sinus Surgery

  • Can reduce the number of sinus infections
  • Can reduce the severity of sinus infections
  • Can improve sinusitis symptoms
  • Can improve drainage of the sinuses
  • Can improve airflow through the nasal cavity
  • Can improve the sense of smell
  • Can allow for easier access to the sinuses for medication delivery
  • Requires little recovery time
  • Pain after the surgery is typically minimal
  • Results are effective and usually permanent

The Cons of Endoscopic Sinus Surgery

  • Bleeding: There is always at least some minor blood loss with any surgery. However, there are rare cases where more severe and excessive bleeding can occur during or after sinus surgery. If this occurs, you may require nasal packing to stop the bleeding.
  • Infection: Infection is also a common risk that accompanies surgery. If an infection does occur, your doctor will prescribe antibiotics. In some cases, antibiotics may automatically be given after surgery, and only stronger antibiotics will be provided if an infection does occur.
  • Recurrence of disease: While endoscopic nasal surgery or sinus surgery is almost always effective and permanent, infections can reoccur in some cases. If this happens, you may need to have revision surgery to optimize your outcome.
  • Vision problems: As the sinuses are very close to the eyes, some patients have reported visual disturbances after the surgery, such as double vision. In very rare cases, loss of vision could happen if the optic nerve is damaged. There can also be issues with excessive tearing if the tear ducts are damaged during surgery.
  • Spinal fluid leak: The sinuses are also located beneath the bone that separates the nose from the brain. Though it is extremely rare for this bone to become damaged during surgery, if it does, it can lead to a cerebrospinal fluid leak, which would require additional surgery and hospitalization.
  • Additional risks: Many other risks can accompany sinus surgery, some of which may include changes in nasal breathing or sense of smell, numbness in the teeth, alteration of taste, change in voice, or worsening of sinus symptoms.

If chronic sinus problems have outlasted every other treatment, chat with us to find a sinus surgeon near you who performs endoscopic sinus surgery and can help you decide whether it's time.

What to Expect: What is Endoscopic Sinus Surgery?

Endoscopic sinus surgery is a procedure designed to open the naturally formed drainage pathways of the sinuses to restore their function. The procedure is only performed if other less invasive treatments do not work.

How Much Does it Cost?

The cost of endoscopic nasal surgery or sinus endoscopic surgery can vary a great deal, depending on insurance coverage or the doctor performing the surgery. Most insurances do cover the cost of this surgery, but only if there is sufficient proof that the surgery is required and that other treatments did not work.

The average cost of endoscopic sinus surgery is around $40,000, but your out-of-pocket costs, including copays and deductibles, will vary depending on your insurance plan. How experienced the surgeon who is performing the surgery can also play a role in the cost if your procedure is not covered by insurance.

A more experienced surgeon, for example, will cost more money, but it’s important to choose a surgeon that has extensive experience as it will reduce the likelihood of something going wrong during surgery.

With all the costs involved, patients can pay anywhere from $120 to $80,000 for an endoscopic sinus surgery—again, depending on their insurance coverage and the doctor that performs the surgery.

What Happens Before Endoscopic Sinus Surgery?

Before your endoscopic sinus surgery, your doctor or the surgical team will likely sit down to discuss what to expect and what you should do to prepare for the surgery. It is important to pay attention to these instructions as they are given to ensure the success of the surgery and reduce the risk of complications.

Such instructions that you might receive before endoscopic nasal surgery can include the following:

  • Taking certain medications: You may be prescribed medications such as antibiotics and/or oral steroids, and you should pay close attention to when to start taking them.
  • Avoid certain medications: Before the start of surgery, you will also likely be asked to avoid taking certain meds that could interfere with the surgery. This may include aspirin, ibuprofen, naproxen, or other NSAIDs. This is because these medications can thin the blood and result in excessive bleeding. You may also be asked to avoid certain supplements, such as fish oil, vitamin E, Ginkgo Biloba, ginseng, and St. John's Wort, as these could interfere with the surgery and your recovery.
  • Stop smoking: If you are a smoker, you will be asked to stop smoking around three to four weeks prior to surgery. You will also be asked to abstain from smoking for at least a month after surgery. This is because smoking can increase scar tissue and inhibit the healing process, which means the surgery will be more likely to fail.

You will also likely be called in for a preoperative physical exam before the surgery so that your doctor can give you the medical clearance to have the surgery. This may include ordering labs.

What Happens During Endoscopic Sinus Surgery?

The operation itself is typically an outpatient procedure, meaning you will not have to remain in the hospital afterward. It is performed under general anesthesia and typically takes about one to two hours. However, if you prefer local anesthesia, let your doctor know, as this may be an option.

During the surgery, the surgeon will insert an endoscope—a thin camera rod with a light—into the nostril. They will then use this to magnify the image of the sinuses and get a closer look at the sinus tissues and membranes.

Once the issue is located, the surgeon will use specialized instruments and the endoscope to open the sinuses and remove the blockage. This could involve removing the swollen mucous membrane or removing nasal polyps or scar tissue.

If a deviated septum is the source of the problem, the septum will be operated on to straighten it. The turbinates—bony structures inside the sinuses—may also be operated on to reduce their size.

After the surgery is concluded, the surgeon may pack the nose to reduce bleeding. You will then spend a few hours in the recovery room until you wake up. If everything looks good and you feel okay, you will be sent home that same day, likely without any nasal packing.

Endoscopic Sinus Surgery Recovery

After the surgery, you can expect mild bleeding for up to two days and will likely be a little fatigued for around one to two weeks while you recover. You may also have some mild swelling around the nose, upper lips, cheeks, or eyes. It is also common for there to be some nasal congestion and discharge for the first few weeks following the surgery.

Your doctor will provide you with thorough instructions, which may include rest, avoiding blowing your nose, and the recommended use of certain medications or treatments. Specifically, you should avoid straining, heavy lifting, and nose blowing for around ten days after surgery. You should also avoid NSAIDs for up to two weeks after surgery. Steroid nasal sprays should not be used for two weeks.

However, nasal rinses and saline sprays are recommended. For example, you may be asked to use a nasal saline spray every two to three hours to make your nose more comfortable and to keep it moist. You can purchase a saline spray over the counter at any pharmacy.

You will also likely be asked to perform sinus irrigation at home after the surgery. You can do this with a sinus rinse kit. Irrigate at least twice daily or follow any other instructions provided by your doctor. This will help keep the sinuses clean and remove any debris left behind after surgery.

You should be able to return to your regularly scheduled activities and routine about one to two weeks after the surgery, but it may take up to an entire month or two for you to feel completely normal again. You will also likely need to check in with your doctor regularly for three to four months after the surgery to make sure your sinuses are healing properly.

Are There Side Effects?

Typical side effects of endoscopic sinus surgery include:

  • Pain: There may be some mild pain and pressure in the sinuses for several days following the surgery. You may take Tylenol or acetaminophen, but do not take NSAIDs like ibuprofen (Advil) or naproxen.
  • Bleeding: Bloody discharge is normal for three to five days after surgery, especially when irrigating the sinuses. If steady bleeding occurs, tilt your head back and breathe gently. You can dab with a tissue, but do not blow or stick anything in your nose. Using a nasal saline spray can help.
  • Fatigue: It is normal to feel tired for about a week after sinus surgery, so plan to take a week off to rest.
  • Nasal congestion: Nasal congestion is also typical for a few weeks after the surgery. If the surgery was a success, your breathing should return to normal in about two to three weeks.
  • Discharge: Some discharge may also occur and last for the same duration of time as the congestion.

When to Call Your Doctor

If you have any questions or concerns, don’t hesitate to call your doctor. However, some signs may indicate a more serious problem, and you should call right away or seek emergency medical care at an ER, which may include:

  • A fever of 101 or higher
  • Trouble breathing or swallowing
  • Vision loss
  • Constant clear watery discharge from the nose
  • Excessive bleeding that won’t stop
  • Extreme pain
  • Severe headaches and neck stiffness
  • Severe diarrhea
  • Loss of consciousness

What is the Goal of Endoscopic Sinus Surgery?

The ultimate goal of endoscopic sinus surgery is to widen the passage in the sinuses to avoid mucus getting trapped and becoming infected or inflamed. This should help alleviate sinusitis symptoms and prevent it from recurring in the future.

Overall, the goal of the surgery is to reduce infections, improve drainage and airflow, and help improve the sense of smell. Success rates for sinus endoscopic surgery are high, and rarely are additional surgeries needed.

Find the right surgeon for you.

Find a doctor Contact us