Treatment: Endoscopic Sinus Surgery (ESS)

Why you might need Endoscopic Sinus Surgery (ESS)

The sinuses are air pockets that are connected to the nasal cavity. Sinusitis is usually caused by a blockage of the sinus opening, which could be caused by infections, irritants, allergies or a structural abnormality, or by chronic inflammation.

Endoscopic Sinus Surgery is the name for surgical procedures performed when medical methods such as antibiotics and nasal steroid sprays have been found to be unsuccessful in treating sinus conditions. It has been found to be very effective in around 90% of patients, the risk of major complications in low and most cases can be performed as a day case procedure.

Treatment Info

Prior to the surgery taking place, your consultant will usually arrange for a CT scan to assist with diagnosis and planning the procedure. This will take place at our dedicated imaging and diagnostics centre.

Usually, the procedure uses an endoscope (a thin tube with a camera on the end) that is inserted through the nostrils, so that there are no visible cuts or scars. The surgeon will remove any swellings or pieces of bone that may be blocking your sinuses and this will allow any inflammation to subside and symptoms of sinusitis should begin to reduce.

The procedure is usually carried out under general anaesthetic but can also be done with just a local anaesthetic to your nose in selected cases.

Endoscopic Sinus Surgery Risks

All surgical procedures have risks involved and your surgeon will discuss these with you before undertaking the procedure. The following are possible complications with FESS, but they are rare and your consultant will discuss their likelihood before you agree to go ahead with surgery.

• Bleeding – this is a risk in any operation, and it is normal for small amounts of blood to drain from the nose following the operation. It is extremely rare for major bleeding to occur and a transfusion to be needed.
• Eye problems – As the sinuses are close to the eye socket, it is possible for this surgery to result in minor bleeding into the eye socket, often appearing as bruising around the eye (occurs in approximately 1 in 500 operations). This should get better on its own, but it is important that you do not blow your nose in the days after your surgery until told by your surgeon that it is possible. In very rare cases, more serious bleeding or injury may occur in the eye socket causing swelling that could lead to double vision or, extremely rarely, loss of sight. In this case you would be required to see an eye specialist who may recommend further surgery.
• Spinal fluid leak – The sinuses are also close to the thin bone at the base of the brain which, if damaged during surgery, could lead to cerebrospinal fluid leaking into the nose (occurs in approximately 1 in 1500 operations). If this does happen, it is normally repaired at the same time as the original surgery but rarely further surgery may be required to stop the leak. In extremely uncommon cases, infection from the sinuses may spread into the spinal fluid and cause meningitis.

Endoscopic Sinus Surgery Aftercare

After the operation has been completed, you will feel like your nose is blocked. Your doctor will usually advise rinsing with salt water to help with this. If any dressings have been left within the nose, your doctor will confirm whether they need to be removed at a later date or if they will dissolve by themselves.

You may experience mild pain after the operation, but this should be treatable with over the counter painkillers such as paracetamol or ibuprofen. If you start to develop severe headaches, you should speak to your doctor.

For the first 48 hours after your surgery, you should not blow your nose and your doctor will confirm when you should be able to gently do so. It is normal for mucus or blood-stained fluid to drip from the nose within two weeks of completion of your surgery, but if you experience heavy bleeding you should see your doctor.

Avoiding dusty or smoky environments is very important during your recovery.

You will usually be able to go home on the day of your surgery. Before you leave, a follow-up appointment may be arranged. Following your operation, you should rest at home for at least a week and most people can go back to their normal daily activities within 10-14 days.