Sinus disease, endoscopic and nasal surgery

Endoscopic sinus surgery covers the procedures used to treat inflammatory and infectious disease of the sinuses. These operations once required an incision on the face. Today they are performed with an endoscope — a miniature camera passed through the nostrils — with no external incision.

Surgery is never the first option

Before considering surgery, we first treat with nasal sprays and rinses over several weeks or months, sometimes together with medication. Surgery is offered only when that medical treatment has not given the hoped-for results.

Surgical indications

Chronic sinusitis unresponsive to medical treatment
Recurrent sinusitis
Nasal polyposis
Antrochoanal polyp
Mucocele
Removal of sinus tumours
Cerebrospinal fluid (CSF) leak
Orbital decompression
Optic nerve decompression
Dacryocystorhinostomy (DCR)
Removal of foreign bodies
Control of nosebleeds

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Acute or chronic sinusitis

Acute sinusitis usually follows a cold: the nose blocks, secretions thicken, the face becomes painful. It most often resolves on its own or with medical treatment. Sinusitis is called chronic when symptoms persist beyond twelve weeks: a permanently blocked nose, discharge, facial pressure, reduced or absent sense of smell, fatigue. It is this chronic form, or acute sinusitis that returns several times a year, that warrants an ENT assessment.

Finding the cause

Examination of the nose with a flexible endoscope allows the nasal passages, the sinus openings and any polyps to be seen directly — something a simple examination with a light cannot show. A CT scan of the sinuses completes the assessment when surgery is being considered: it maps the anatomy of each sinus. An allergic component is frequently associated and is looked for routinely.

Medical treatment first

Saline nasal rinses, corticosteroid sprays, treatment of allergy, and antibiotics in documented bacterial infection: most patients improve without surgery. A properly conducted course of medical treatment is in fact a prerequisite before any operation is considered.

Endoscopic sinus surgery

When symptoms resist, endoscopic surgery widens the natural openings of the sinuses to restore their ventilation and drainage. Everything is done through the nostrils with a camera: there is no incision on the face and no visible scar. The procedure is performed under general anaesthesia. Septal surgery and turbinate reduction, which address nasal obstruction, are sometimes carried out at the same time.

What needs prompt assessment

One-sided nasal obstruction, repeated nosebleeds from the same side, pain or swelling around the eye, or visual disturbance associated with sinusitis all warrant consultation without delay.