General Information about Endoscopic Sinus Surgery (ESS)

Endoscopic sinus surgery is an operation in which the surgeon examines the interior of the nose and the openings to the paranasal sinuses. Using state of the art micro telescopes and instruments, abnormal and obstructive tissues are then removed. In most cases the surgery is performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort.

Whereas, in the past, attention has often been directed towards the removal of all sinus mucosa from the major sinuses, the endoscopic approach relies on the principle that sinus disease is reversible if the underlying obstruction can be identified and corrected. A careful diagnostic workup is therefore important and consists of examination, CT scans of the sinuses, nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected blood tests. Surgery is usually recommended only after medical therapy has failed.

Potential surgical complications include bleeding, bruising around the eyes, swelling, scarring inside the nose, and infection. Rare complications include the possibility for intracranial entry and spinal fluid leak. The ethmoid sinus is located under and adjacent to the brain, and the fluid that surrounds the brain can leak through into the nose. If this happens, there is the potential for infection which can result in meningitis. Because the endoscopes used in surgery allow visualization of the ethmoid sinuses, this complication is uncommon. Double vision and loss of vision have been reported after ethmoid surgery. Fortunately, this is a rare complication. No surgery is always successful. This is the best sinus procedure available today.

The advantage of endoscopic sinus surgery is the philosophical recognition that the surgical goal is to open the natural drainage channels, thereby restoring normal physiologic function. This differs greatly from past procedures, which were ablative and destructive. Other advantages over past sinus surgeries are: diminished post operative discomfort, minimal nasal packing, decreased bleeding, shorter recover time, and most importantly, a 90% success rate.

Instructions Before Endoscopic Sinus Surgery

Because of potential bleeding problems, aspirin, Advil, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAIDs) must not be used for 10 days preceding and 10 days following surgery.

A complete history and physical examination , possibly including laboratory work, chest x-ray, and/or EKG, must be completed before surgery. Generally, Endoscopic sinus surgery is done on an outpatient basis. You will need to arrange to have someone drive you home after surgery.

After Endoscopic Sinus Surgery

Dressing : Light red to clear drainage from the nose is normal for 5-10 days following surgery. The outside gauze dressing needs to be changed when soiled or saturated. A 4 x 4 gauze pad folded in half over the nostrils, held in place with a strip of paper tape is sufficient. Dressing is usually kept in place for 2 days. You are required to come to the clinic for its removal.

Packing : Nasal packing is usually used after surgery. Do not attempt to blow the nose with packing in place. It is normal to have bad breath or small a foul odor while the packing is in place. In many cases we use packing material that slowly absorbs over time. If you have this type of packing it does not need to be removed after surgery.

Medications : Headache, sinus, or nasal discomfort is common after surgery and you should have medication for this. Antibiotics and/or a moisturizing saline spray may be prescribed.

Activity : No swimming or strenuous activities should be performed for 10-14 days after surgery as this might cause bleeding. You may resume your routine work from the 5 th day onwards.

Diet : Eat and drink normally. Avoid alcoholic beverages while taking medications.

Follow-up : You will need to be seen by your doctor for follow-up every 10 days following surgery for post operative cleaning. Specific instructions will be given to you at the time of discharge. An appointment is necessary and should be made before leaving the hospital.

Saline Irrigations : Ten days after your nasal surgery, saline irrigations are recommended to reduce crusting and to keep the sinus opening clear. Mix 1 teaspoon table salt and 1 tablespoon baking soda in ½ liter boiled, warm water. Lean over a sink and irrigate both nasal passages. Irrigate twice a day, morning and evening.

Call the doctor or come immediately if any of the following occur :

• Excessive, bright red bleeding  
• A lot of clear watery drainage form the nose, or profuse salty tasting drainage down the throat  
• Double or blurred vision  
• Decreased ability to move or close eyes, or eye pain  
• Fever over 101 degrees Fahrenheit  
• Stiffness or pain in the neck or decreased alertness  

If you have any questions or concerns, please call the Clinic. Please speak to either the assistant ENT surgeons or Dr. Sanjay after 4:00 pm . If you desire to speak to Dr. Ashim Desai, please call between 8:00pm and 10:00 pm .