Chronic sinusitis is an illness characterized by prolonged infection and inflammation of the lining of the nose and the sinuses. Patients with chronic sinusitis experience a variety of symptoms, including facial pressure, nasal congestion, discolored nasal discharge, and "postnasal drip." A diagnosis of sinusitis should be made only after careful evaluation by your doctor. Most patients with sinus infections can be successfully treated with medications. For the majority of patients with sinusitis, surgery is not required.

For a small percentage of patients, however, medications alone are not adequate to completely clear their infections. In these patients, infections recur soon after completing even long courses of medication. Such patients who fail to respond well to medications often require surgery. After reviewing your medical history and x-ray studies, your ear, nose, and throat specialist can help you determine if you are a surgical candidate.

What is endoscopic sinus surgery?

Endoscopic sinus surgery is a procedure designed to open the natural drainage pathways of the sinuses to restore their function and health. In chronic sinusitis, the sinuses are unable to drain adequately due to inflammation of the drainage pathways. As a result, nasal secretions become trapped in the sinuses and become chronically infected.

The goal of surgery is to carefully remove the thin, delicate bone and mucous membranes that block the drainage pathways of the sinuses. The term "endoscopic" refers to the use of small fiberoptic telescopes that allow all of the surgery to be performed through the nostrils, without the need for any skin incisions. Endoscopic sinus surgery is generally performed on an outpatient basis.

What can I expect before, during, and after surgery?

Before surgery:  In preparation for your surgery, your physician may prescribe a preoperative regimen of medications for you in order to optimize the condition of your sinuses for surgery. The medications may include antibiotics and/or oral steroids. If any preoperative medications are deemed necessary by your physician, please be sure to start the medications on the appropriate day and to adhere closely to the prescription.

In addition, you should avoid taking aspirin and all aspirin-related products for at least 14 days prior to surgery. Aspirin, ibuprophen (Motrin/Advil), naproxen (Aleve), other nonsteroidal anti-inflammatories (NSAIDS), vitamin E (multivitamin is OK), gingko biloba, garlic (tablets), and ginseng. These medications can thin the blood and create excessive bleeding during surgery and in the postoperative period. Tylenol is safe and may be taken any time up to the day of surgery. St. John's wort should also be avoided for 2 weeks prior to surgery because of possible interactions with anesthesia medications.

If you smoke, it is critical that you stop smoking for at least three weeks prior to surgery (and at least four weeks after surgery). Smoking during this critical window can seriously interfere with the success of the operation, resulting in excessive scarring and failure of the operation. Your primary care physician can help direct you to resources to assist you with smoking cessation.

Finally, it is important that you inform your primary care physician that you are planning to have sinus surgery. Your primary care physician can be of great assistance in helping to make sure that you are medically cleared for surgery. Most of the necessary preoperative testing will be performed here at OHSU on the day of your preoperative visit, but occasionally we will request old records from your primary care physician. We will make every effort to keep your primary care physician informed regarding your medical status both before and after your surgery.

During surgery:  In most cases, you will receive general anesthesia for your surgery. With a general anesthetic, you will be asleep for the entire procedure. However, if you have a preference for local anesthesia, please let your doctor know as this may also be an option in some cases.

After your surgery is completed, you will spend one hour in the recovery room, followed by an additional recovery period of 1-2 hours in the Short Stay unit. Most patients feel well enough to go home the day of surgery. Some patients may require a one-night stay in the hospital if they need additional recovery time or if they have other medical problems that require special medical attention. You will most likely go home without nasal packing.

After surgery:  The first postoperative visit is made on the morning following surgery to have your nose cleared of any old blood. Other patients will not need to return until one week after surgery. Your visit schedule will be determined by your doctor and will usually consist of 3-4 visits over the first 6 weeks. Thereafter, your visits will be spaced a few months apart, depending on how well your sinuses are healing. It is essential that you return for all scheduled follow-up appointments, as careful postoperative care is critical to the success of your surgery. After 3-4 months, most patients' sinuses have healed nearly completely, and visits for maintenance care are then made a few times per year.

What are the risks of surgery?

As with any surgical procedure, endoscopic sinus surgery has associated risks. Although the chance of a complication occurring is very small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.

Bleeding:  Most sinus surgery involves some degree of blood loss, which is generally well tolerated by the patient. However, on occasion, significant bleeding may require termination of the procedure. Although most patients do not require nasal packing, a few patients will require a small nasal pack to be removed the next day. Blood transfusion is rarely necessary and is given only if the patient's health would otherwise be compromised.

Recurrence of disease:  Although endoscopic sinus surgery provides significant symptomatic benefits for the vast majority of patients, surgery is not a cure for sinusitis. Therefore, you can expect to continue with your sinus medications even after successful sinus surgery, although in general your requirements for such medications should be lessened. In some instances, additional "touch-up" surgery may be necessary to optimize your surgical outcome.

Spinal fluid leak:  Because the sinuses are located in close proximity to the brain, there is a rare chance of creating a leak of spinal fluid (the fluid lining the brain) or injuring the brain. Should the rare complication of a spinal fluid leak occur, it may create a potential pathway for infection, which could result in meningitis. If a spinal fluid leak were to occur, it might require surgical closure and extend your hospitalization.

Visual problems:  There have been isolated reports of visual loss after sinus surgery. The potential for recovery in such cases is not good. Fortunately, such a complication is extremely rare. Double vision has also been reported following sinus surgery. Persistent tearing of the eye can result from surgery, but this problem usually resolves on its own.

Other risks:  Other uncommon risks of surgery include alteration of sense of smell or taste; persistence and/or worsening of sinus symptoms and facial pain; and swelling or bruising of the area around the eye.

Some patients have a deviation of the nasal septum that needs to be corrected at the time of surgery through a short procedure called septoplasty. If you require septoplasty, there are additional risks associated with this procedure. The primary risks are bleeding or infection in the area of the septum; numbness of the front teeth; the development of a hole through the septum (septal perforation); or recurrence of septal deviation. There is a very small risk that such occurrences could alter the external appearance of the nose.

What will my activity restrictions be during the postoperative recovery period?

For the first two weeks following surgery, you should not blow your nose. A saline spray may be used several times per day to relieve nasal irritation. In addition, you should not perform exercise or any other exertional activity for at least two weeks following surgery. This includes no bending, lifting (more than about 10 lbs.), or straining. Your surgeon will be able to advise you when it is safe to begin exercising again. You should plan on taking one to two weeks off from work to recover from surgery.

Conclusion

We at the Oregon Sinus Center are committed to providing you with the highest level of care in a comfortable and caring environment. We want you to have as complete an understanding as possible about your sinus condition and about our recommendations for treatment. Please feel free to ask questions about any aspect of your care, and we will be happy to make sure that all of your questions have been answered.