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Health care information for sinusitis sufferers |
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Health care information for sinusitis sufferers |
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Treatment OptionsSurgical Treatment OptionsAdenoidectomy | Endoscopic Sinus Surgery | Ethmoidectomy |Extended Endscopic Frontal Sinus Surgery | Frontal Sinusotomy | FESS (Functional Endoscopic Sinus Surgery) | Maxillary Sinusotomy | Open Frontal Sinus Surgery | Polypectomy | Reduction Removal of Inferior Turbinate | Reduction Removal of Middle Turbinate | Septoplasty | Sphenoidotomy | Tumor Removal Endoscopic Sinus Surgery Obstructions in the ethmoid sinus region can also affect the maxillary, frontal, and sphenoid sinuses. When an otolaryngologist (ENT specialist) performs surgery in the ethmoid sinus region, the goal is usually to remove obstructions that block natural drainage and create an increased risk of infection, as well as to remove inflamed tissue and bone. Endoscopic sinus surgery offers a way to clear blockage while disturbing as little healthy tissue as possible. Because it is less invasive than other surgical methods, it increases the chance of rapid recovery. The doctor may also recommend endoscopic surgery to remove polyps or to straighten the septum. Endoscopic surgery is typically perfomed either as an outpatient procedure or with an overnight hospital stay. The surgery usually lasts from one to three or more hours, and the patient may receive general anesthesia or, less commonly, sedation through local anesthesia. After surgery, the sinus is packed with temporary sponges or sterile packing at the surgical site, but the nose itself is not completely packed. This allows natural nasal breathing to continue without interruption. Unless other medical conditions complicate recovery, you can expect to go home the same day as your surgery – or by the next morning at the latest. If your doctor recommends sinus surgery, the severity and extent of your sinus problem will be carefully considered. For instance, you may require only a limited procedure, such as clearing the middle meatus area, or your doctor may recommend clearing other sinuses as well. If you receive general anesthesia, you will be asleep during surgery. If your anesthetic is local, you will be sedated and comfortable - but you may hear some "crunching" sounds and the doctor talking during your procedure. Since the middle meatus is at the intersection of the sinuses, clearing just this area may in some cases be sufficient to alleviate problems in other sinuses, too. This is especially true if you don't suffer from widespread disease and severe chronic problems. Clearing the middle meatus involves opening up the front of the ethmoid sinus. The doctor may also remove small polyps growing in the middle meatus and may widen the entrance to the maxillary sinus. If the ethmoid sinus is badly blocked and inflamed, a more extensive procedure could be required. In this case, your doctor will explore farther into the ethmoid sinus, opening additional bony partitions that block drainage or harbor inflammation, and/or removing larger polyps. Pain after surgery is usually mild. You can anticipate an early return to work, although you may feel tired and should restrict activity somewhat for a week or two. Full recovery takes several weeks, and severe inflammation may take months to settle down completely. That is why continued medical therapy following surgery is essential. Expect dried blood, mucus and crusting to occur inside the nose. Your doctor may recommend nasal irrigation or salt-water sprays and antibiotic lubricants to facilitate normal sinus activity. Since tap water has the potential to introduce infection into the nose, particularly during the immediate postoperative period, special irrigation techniques may be recommended to reduce this potential. Your doctor may also ask that you avoid swimming, at least in chlorinated pools, for a number of weeks after surgery. Medical therapy may include antibiotics, topical nasal steroid sprays, antihistamines, decongestants, and a tapering course of oral steroids. The degree and type of medical therapy will depend on your particular problem and post surgical response. Endoscopy provides a good monitoring tool after surgery. Using a nasal optical tube, your doctor can monitor the healing process, remove scar tissue when necessary, and adjust medical therapy if indicated. Do not neglect expert post-operative care. It is essential to prevent scar formation and promote normal healing. Complications that may Occur Following Endoscopic Sinus Surgery Infection Infection and inflammation can follow any surgical procedure, including sinus surgery. If you experience continued obstruction, pressure, pain and an unpleasant discharge, there may be a more serious problem. If this happens, your doctor may take a culture and recommend a change in your antibiotic therapy or other medical treatment. Keep in mind that in cases of long-term chronic sinusitis, it usually takes some time for inflammation to completely subside. Bleeding Durring recovery from endoscopic sinus surgery, the region of the surgery will be somewhat raw for a time. A bloody nasal discharge is normal. This discharge may mix with secretions and pool in the sinuses, causing dripping from the nose when you lean forwards during the first few days post-surgery. Occasionally, heavier bleeding may require packing or cauterization. Recurrence or Persistence of Disease Although there is an excellent chance that endoscopic sinus surgery will improve symptoms of chronic sinusitis, it is not a guarantee. Inflammation and infection may persist and require further intervention, maybe even additional surgery. There are multiple underlying causes for chronic sinusitis, including hereditary tendencies, environmental factors, and smoking. That is why it is so important that you manage your condition appropriately after surgery, whether that means allergy-proofing your home, lifestyle changes, undergoing immunotherapy or using the medications your doctor prescribes. Smoking in the postoperative period carries a high risk of further sinus problems. Voice Change Voice resonance is developed partially within the sinuses. Altering the structures of the sinus through surgery can affect resonance. Therefore, singers, public speakers, actors and others who value their distinctive voice resonance should understand the possibility of some change in their voice before they decide to undergo endoscopic or other sinus surgery. Injury to the Eye Eye complications after endoscopic sinus surgery are rare. Occasionally, double vision develops in the aftermath of swelling or bleeding in the orbital cavity around the eye. Most of the time, this problem disappears on its own. In a minority of cases, there is scarring. If the muscles that move the eye are directly injured, double vision can be permanent, but this complication is very uncommon. Visual loss in an eye, the most catastrophic of all eye complications, is extremely rare. It can, however, occur when there is excessive bleeding in the orbital cavity or in the case of direct damage to the optic nerve. While eye injuries can lead to very serious complications, they occur in only a very small number of cases. Injury to the Brain The incidence of brain complications following sinus surgery is very low. However, leakage of the fluid surrounding the brain, known as cerebrospinal fluid or CSF, is a remote possibility. If the surgeon spots a leak or opening during surgery, he or she may be able to close it immediately. In this situation, the only repercussion may be a slightly longer hospital stay and/or extended recuperation period, but if the leak is not discovered during surgery, or if there was some direct damage to the brain, it could lead to serious complications. If you experience a clear watery discharge running out of your nose when you lean forward after surgery, bring it to the attention of your physician immediately. A CSF leak creates a potential pathway for the spread of infection and in some cases could result in meningitis or intracranial (brain) infection. Please note that these are worst-case scenarios that are very unlikely to occur. Email This Article To A Friend Printer-friendly Version Find an ENT Professional Near You
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