What is Endoscopic Sinus Surgery?

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What is the meaning of Endoscopic Sinus Surgery?

Endoscopic sinus surgery, also known as Functional Endoscopic Sinus Surgery (FESS), is a non-invasive procedure performed to get rid of the obstructions caused by the drainage of sinuses. This endoscope-guided surgery is called functional as we try to restore the normal functioning of the sinuses.

Sinuses are air-filled pouches around the nose that help in the ventilation of air, give buoyancy to the skull, help in voice production, and most importantly, produce mucus that lines the sinuses and traps microorganisms thus preventing infections. These sinuses drain into the nasal cavity.

There are 4 pairs of sinuses:

1. Frontal Sinus: Above the eyes
2. Maxillary Sinus: Below the eyes
3. Ethmoidal Sinus: Between the eyes
4. Sphenoidal Sinus: Behind the eyes (this sinus is in very close contact with the base of the skull and hence may cause Cerebrospinal fluid leak if injured)

FESS is a type of surgical procedure which is considered an effective treatment for chronic sinusitis (inflammation of sinuses) if the medications don’t help. Natural sinus drainage channels often tend to swell and therefore can get blocked, causing pain and difficulty breathing. Sinus surgery helps reduce the discomfort caused by this obstruction and provides symptomatic relief. Endoscopic sinus surgery may also be required in the case of nasal polyps and tumours. 

Let us tell you in detail about endoscopic sinus surgery in today’s article.

• What is the purpose of Endoscopic Sinus Surgery?
• What are the symptoms of Endoscopic Sinus Surgery?
• Preparation before Endoscopic Sinus Surgery
• What is the procedure of Endoscopic Sinus Surgery?
• Care after Endoscopic Sinus Surgery
• What are the risks of Endoscopic Sinus Surgery?
• What is the cost of Endoscopic Sinus Surgery in India?

What is the purpose of Endoscopic Sinus Surgery?

Endoscopic sinus surgery is done to release the obstruction of the sinuses caused by :

1. Chronic Sinusitis (Inflammation of the sinuses) ( Know more about- What is Chronic Sinusitis ? )
   
2. Polyps (Mushroom like abnormal tissue growths inside the nose)
3. Tumours
4. Frontoethmoidal mucocele (Swelling of the glands in the sinuses)

The nose is in very close contact with the eye socket (orbit), the base of the skull, and the pituitary fossa. So this surgery can be used to access these structures as well. Some of the cases where this surgery can be used for conditions not related to the nose are:

1. Optic nerve decompression
2. Orbital decompression
3. Drainage of orbital abscess
4. Opening of the lacrimal sac (tear sac) directly into the nose in cases of nasolacrimal duct obstruction ( a duct that drains your tears into the nasal cavity)
5. Repairing any CSF(Cerebrospinal fluid) leaks from the base of the skull ( Know more about- What is Cerebrospinal Fluid Leaks and Treatments ? )
6. For approaching the pituitary gland

What are the symptoms of Endoscopic Sinus Surgery?

Sinus obstruction is one of the most important reasons to do a FESS surgery. We need to identify a nasal obstruction and contact an otolaryngologist as early as possible. A few symptoms that you need to look out for are:

• Nasal inflammation
• Nasal obstruction causing difficulty in breathing
• Thick discoloured nasal discharge
• Drainage at the back of your throat (postnasal drip)
• Headache (tenderness around your eyes, forehead, cheeks, and nose)  ( Know more about- What is Migraine? )
  
• Anosmia (loss of smell)
• Ageusia (loss of taste)
• Dry Cough
• Hoarse voice (Know more about-What is Hoarseness in Voice?Causes, Symptoms, Treatments, Prevention)
• Throat pain
• Throat infection
• Earache
• Pain in the jaw and teeth
• Fatigue

Preparation before Endoscopic Sinus Surgery

• Nasal endoscopy is the best for diagnosing sinusitis and other sinus-related disorders. It involves inserting an endoscope(a fibre optic tube with a camera attached to it) inside the nasal cavity to look inside the nose.
• Imaging tests such as CT scans and MRI scans are also useful to assess irregularities in the nose and obtaining clear and precise images.
• Nasal and sinus cultures are essential in which the culture is taken and examined under a microscope to identify the type of sinus infection.
• The patient is asked to stop some of his regular medicines preoperatively. The patient is also asked if they have any allergies. The patient is strictly instructed to do complete fasting a few hours before surgery for effective anaesthesia. 

What is the procedure of Endoscopic Sinus Surgery?

• Endoscopic sinus surgery involves removing diseased sinus tissue (polyp within the nose, tumour, or a part of the bone and inflamed mucous membrane) and in turn, improving sinus drainage channels for easy discharge.
• The endoscope is a thin, flexible fibre optic tube that is guided through the nasal passages to observe the internal pathways.
• The patient is prepped for surgery and put under general anaesthesia so that he is unconscious during the procedure.
• An appropriate endoscope is introduced into the nasal cavity through the nostrils to visualise the internal structures.
• The first step of FESS is uncinectomy which means the removal of the uncinate process. The uncinate process is a bony projection inside the nose which is about the drainage site of the sinuses. Uncinectomy is done to get a better view of the sinuses and some extra space for surgery.
• The next step involves widening up the openings of all the sinuses to drain the accumulated fluid and relieve sinusitis.
• Appropriate surgical methods are used to eradicate polyps or tumour masses in the drainage channel, and the enlarged pathways in case of inflammation. 
• The nose is in very close contact with the eye socket(orbit) and the base of the skull and the pituitary fossa which bears the pituitary gland. So this surgery can also be used to access these closely related structures.
• Another approach to relieving sinus obstruction is to use balloon sinuplasty, in which the drainage opening is widened by inflating a balloon. It includes faster recovery, however, there are more chances of sinus relapses.
•  Endoscopic sinus surgery results in improved airflow through the nasal passages and better discharge which eases breathing.

Care after Endoscopic Sinus Surgery

• The patient must avoid blowing their nose and causing any strain to the nose after surgery as it may cause bleeding.
• The patient should not engage in any kind of strenuous activity like lifting heavy items or bending down for at least 2 weeks after the surgery.
• Doctors may recommend nasal saline spray that helps reduce nasal discomfort and uneasiness.
• Patients will have to perform sinus irrigations which soothe the nose and cleans the residues of the sinus.
• In case of abnormal discharge from the nose and nose bleeding, the patient should immediately contact their otolaryngologist.

What are the risks of Endoscopic Sinus Surgery?

Sinus surgery involves many risks, including:

• Haemorrhage, that is, bleeding from the nose (most common complication)
• Injury to the surrounding nerves (optic nerve) and arteries (internal carotid artery) (most serious complication)
• Recurrence of sinusitis
• Damage to the base of the skull resulting in meningitis or leakage of CSF
• Synechiae formation i.e formation of unnecessary attachments between the walls of the nose during healing. This can be prevented by giving a drug called mitomycin C
• Excessive bleeding during surgery
• Chronic nasal drainage
• Nasal infection
• Failure to correct sinus.
• Impaired senses such as vision, hearing, smell, taste, or touch. ( Know more about- What is Blurred Vision? )

What is the cost of Endoscopic Sinus Surgery in India?

The total cost of endoscopic sinus surgery in India can range from around INR 2,50,000 to INR 3,00,000. However, the cost of endoscopic sinus surgery may vary across different hospitals.

If you are coming from abroad, in addition to the cost of endoscopic sinus surgery, there will be the cost of staying in a hotel, living, and local travel. Apart from this, after the procedure, the patient stays in the hospital for 2 days and in the hotel for 5 days for recovery. So, the total cost of Endoscopic Sinus Surgery in India will be around INR 3,00,000 to INR 4,00,000.

We hope that we could answer your questions regarding Endoscopic Sinus Surgery through this article.

If you want more information and the treatment for Endoscopic Sinus Surgery, then you can contact an ENT Specialist.

We only aim to provide you with information through this article. We do not recommend any medicine or treatment to anyone. Only a doctor can give you the best advice and correct treatment plan.