surgery is one of the most commonly performed operations. Using modern
equipment called endoscopes,
surgery can almost always be performed
through the nose and on an outpatient basis. However, sinus surgery is
used only as a last resort and most patients do not understand what
surgery does or even what sinuses are. Sinuses are bony air cavities which
surround the nose. They lighten the head, resonate the sound of one's voice
and may help protect the cranium against blunt trauma. If the
become blocked they can become infected producing discomfort. However,
most "sinus" problems seen in my patients are actually problems of the main
nasal passages caused by smoking or allergies. The perinasal
often normal even though the patient has symptoms of nasal drainage, pressure
and airway obstruction. The only sure way of diagnosing sinus disease is
with sinus x-rays or CT scan.
Before having sinus surgery a patient should almost always have tried and failed
medical therapy. Sinus
surgery may have to be performed sooner in cases of
severe acute sinusitis, massive
polyps, disease causing bone
expansion or erosion, and in cases of suspected tumors. Nasal polyps are often refractory to medical therapy. Unfortunately, their
presence has also been shown to predict a poorer surgical outcome.
View Abstract Dursun et al. also found
that allergy and previous polypectomy (removal of nasal polyps)
predicted a poor outcome from endoscopic sinus surgery.
Soler et al. also found poor outcomes in patients with nasal
(mucosal) eosinophilia (an indicator of nasal allergy).
Revision rates for endoscopic sinus surgery "occurs at a high rate,
especially in patients with asthma, Samter's triad, or frontal sinus
polypectomy without ethmoidectomy has been shown to have a similar
reoperation rate and a lower complication rate. Both procedures
produced imporvement in symptoms but ethmoidectpmy patients experienced
less congestion and pain.
In addition, headaches are
usually not caused by sinus disease and thus may not respond to surgery.
View Abstract If a patient
smokes, it is unlikely that symptoms of nasal drainage, airway
obstruction and nasal pressure will respond to surgery. Finally, if
a patient's sinuses are not blocked on CT scan it is unlikely the patients
symptoms will improve by draining the sinuses.
operation is usually day surgery and the nose is packed for 1 to 3 days. A
small self retaining plastic stent may be left in the nose and removed 7 to 10 days later-
see picture to the right.
At 7 to 14 days post-op
is performed in the office for removal of clots and cleansing of the
surgical cavity. The picture on the right shows the three week
post-operative result. Note that the sinus cavities are wide open
and there is little scaring after stent removal.
Pictures to Enlarge
picture on the left shows a widely open
endoscopic sinus surgery.
is small and may have been partially resected by the
Click on pictures to enlarge
Headaches are not often caused by
treatments and surgery may not be effective. Surgery for
"sinus headaches" is debated and results cannot be guaranteed. Shields has
shown that there was no correlation between the severity of pain and the severity
of sinus symptoms. This brings into question whether
causing the symptoms at all. One explanation is that most of this pain is caused
by tension headaches and migraines. The patients just assume the pain is
disease because of the mass marketing of
medications they see
Smoking causes a severe and refractory nasal inflammation and symptoms to
almost all types of medications and surgical interventions. The
lining of the inside of the nose is a single layer of highly specialized
cells. Theses cells secrete liquid to lubricate the nose and have
cilia to clear the secretions and trapped debris. Smoke damages this
delicate lining. If one smokes a half pack or 10 cigarettes per day then one is blowing
smoke about 200 times through the nose. If you had burning watery eyes and
were sticking your eyes in the smoke of a fire 200 times or even 10 times a day,
do you think you would get better? Do you think that medications or
surgery would help the burning and watering? Or would you stop exposing
your eyes to smoke? Thus, QUIT SMOKING !!! Some nationally
known sinus surgeons consider smoking a contraindication to performing sinus
Children: In children who failed medical
therapy, Ramadan (2004) found that they may benefit from surgery.
Following certain criteria, performance of an adenoidectomy alone improved
52% of children and performance of an adenoidectomy and endoscopic sinus
surgery (ESS) improved 83% of children.
View AbstractRamadan (2003) also found
that ESS was not effective in the treatment of chronic sinusitis in
children under the age of 3. When performed for children under the age of
6, revision surgery at a later time may be required. ESS was most
beneficial in children older than 6 years of age and in all children,
regardless of age, that developed a complication from sinusitis.
It will sometimes be recommended that a second look ESS is performed 2 to
4 weeks after the first surgery. This procedure is designed to clean the
sinuses and remove excessive scar tissue. However, the benefit to the
patient has been questioned by several authors and probably should not
routinely be performed.
Sinus Surgery: Review the CT scan, anatomy of the sinuses, to see
the vital structures which are next to the sinuses that can be injured
Go To Sinus CT Scans
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