Endoscopic Sinus Surgery
Functional Endoscopic Sinus Surgery (FESS): A Minimally Invasive Treatment for Chronic Sinus Issues
Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive procedure used to treat chronic sinus conditions. Surgeons use a nasal endoscope a thin tube equipped with a light and camera to access the sinuses without external incisions. This technique helps relieve nasal congestion, sinus infections, and blockages, restoring proper sinus function.
Who Needs Endoscopic Sinus Surgery?
Your doctor may recommend FESS if you experience:
- Chronic sinus infections (sinusitis)
- Nasal polyps (benign growths inside the nose)
- Nasal obstruction or blockage
- Sinus or nasal tumors
- Persistent congestion, pain, or drainage’
- Difficulty breathing through the nose
- Loss of sense of smell (anosmia)
Goals of Endoscopic Sinus Surgery include:
- Reduce the frequency and severity of sinus infections
- Improve sinus drainage and airflow
- Enhance the sense of smell
- Clear nasal blockages for better breathing
- Allow nasal rinses to reach the sinuses for cleaning and medication delivery
Why Is It Called Functional Endoscopic Sinus Surgery?
The term “functional” refers to the surgery goal of restoring normal sinus function. It is sometimes simply called endoscopic sinus surgery (ESS).
When Is Functional Endoscopic Sinus Surgery Needed?
FESS is recommended for individuals with chronic sinus inflammation or infections that do not improve with medications such as antibiotics or allergy treatments.
Sinusitis occurs when the lining of the sinuses swells, trapping mucus that would normally drain through the nose. This fluid buildup can lead to bacterial infections. If medications and other treatments fail, surgery may be necessary especially if nasal polyps are present.
How Does Your Doctor Determine If You Need FESS?
Your healthcare provider will review your medical history and do a physical examination.
Diagnostic Tests May Include:
Nasal Endoscopy: A small camera examines the nasal passages and sinuses for inflammation or infection.
CT Scan: Provides detailed images of the sinuses to identify affected areas.
How Is Functional Endoscopic Sinus Surgery Performed?
FESS is a standard procedure for chronic sinus conditions. It continues to evolve with new surgical techniques. Here an overview of the process:
depending upon the extent of the disease FESS can be done in local anesthesia or preferably general anesthesia.
- Decongestant medication is applied to shrink nasal tissues
- A nasal endoscopy is performed to reassess the sinuses
- Local anesthesia is injected to numb the area
- Using an endoscope, the surgeon gently enters the nasal passages
- Surgical tools like microdebrider remove small bone fragments, inflamed tissue, or polyps blocking the sinuses
- A rotating burr may be used to drill remove the inflammed bones
- Absorbent packing may be placed in the nose to control bleeding and discharge
Post-Surgery Care & Recovery
After the procedure, patient has packs inside the nose , for stability of the operated septum as well to prevent bleeding, which normally are removed after 24 to 48 hours.
patient is given optimum medical management, intravenous medications, and change of dressing at regular intervals until discharge
General Recovery Guidelines:
- Avoid blowing your nose for at least seven days. If you sneeze, do so with your mouth open
- Expect nasal discharge with some blood stained mucus for a few days to weeks
- Refrain from strenuous activity for14 days
- Use saline rinses to clean the nasal passages, as recommended by your doctor
- come for regular follow up which involves nasal endoscopy and cleaning of the nasal passage and sinuses of the retained secretions and old blood and mucus.
FESS is an effective and widely used treatment for chronic sinusitis and nasal polyps, helping patients breathe more easily and experience fewer sinus infections.
What Are Nasal Polyps?
Nasal polyps are soft, painless, and noncancerous growths that develop in the mucosal lining of the nasal passages and sinuses. They typically appear on both sides of the nose and may cause nasal congestion, difficulty breathing, and sinus infections.
Appearance of Nasal Polyps:
- Small polyps resemble teardrops
- Larger polyps look like peeled grapes and may appear pink, yellow, or gray
Another term for nasal polyps is nasal polyposis.
Symptoms of Nasal Polyps
Small nasal polyps may not cause noticeable symptoms, but larger ones can lead to:
- Nasal congestion (stuffy nose)
- Runny nose (rhinorrhea)
- Headaches
- Loss of taste and smell
- Nosebleeds
- Postnasal drip (mucus dripping down the throat)
- Sinus pressure
- Snoring
When polyps grow large enough, they can block your nasal passages and sinuses, leading to:
- Frequent asthma attacks (in people with asthma)
- Repeated sinus infections (sinusitis)
- Sleep apnea or other sleep disorders
- Difficulty breathing, even in people who don’t have asthma
What Causes Nasal Polyps?
Nasal polyps form due to chronic allergy and inflammation, but doctors are still researching why some individuals develop them while others don’t.
Common Causes & Risk Factors:
- Asthma
- Allergic rhinitis (hay fever)
- Chronic sinus infections
- Cystic fibrosis
- Hypersensitivity to certain NSAIDs (nonsteroidal anti-inflammatory drugs)
Some genetic mutations may make individuals more susceptible to nasal inflammation and polyp growth.
Functional Endoscopic Sinus Surgery (FESS) is a safe and effective procedure for chronic sinusitis, nasal blockages, and nasal polyps.
Allergic fungal sinusitis (AFS)
Allergic fungal sinusitis (AFS) is a common type of fungal infection in the sinuses. The infecting fungi are found in the environment and cause an allergic reaction which results in thick fungal debris, sticky mucus and blockage of the infected sinus. Patients with AFS may have allergies, nasal polyps and may have asthma. As a result of the condition, most patients develop chronic sinusitis which may affect their sense of smell. Left untreated, this condition may lead to displacement of the eyeball and vision loss.
Although AFS can occur at any age, allergic fungal sinusitis is more common in adolescents and young adults. After the initial exposure during normal nasal respiration, an inflammatory reaction occurs, causing tissue edema. This results in sinus obstruction and a slowing or stoppage of normal sinus drainage, creating an ideal environment for the fungus to grow.
Patients often have a history of allergies and nasal polyps and many have asthma and chronic sinusitis.
Allergic fungal sinusitis Treatment
Surgical removal of the thick fungal debris and mucin in the infected sinuses with adequate widening of involved sinuses is the most effective way to treat AFS. Steroids are given before and after the surgery for few weeks to months, oral antifungal may be added. Recurrence of AFS is not uncommon and patients may require additional surgeries especially if patient is negligent on follow ups and medical management that includes medicines and most importantly nasal douches.
Immunotherapy and anti-inflammatory therapy may also be used to eliminate the fungal colonies.
Invasive fungal sinusitis
Invasive fungal sinusitis is a serious infection that begins in the sinuses after certain types of fungus are inhaled. It irritates sinuses and can spread quickly to the eyes, blood vessels and central nervous system (CNS).
Symptoms of invasive fungal sinusitis
There are two types of invasive fungal sinusitis. Both can be life threatening. Acute invasive fungal sinusitis, which spreads quickly, is a medical emergency. Chronic invasive fungal sinusitis spreads more slowly and is sometimes mistaken for a sinus infection.
People with acute invasive fungal sinusitis are usually very ill and have some or all of the following symptoms:
- Change in mental status
- Changes in vision
- Congestion and nasal discharge
- Facial pain, numbness and/or swelling
- Fever
- Headache
Symptoms of chronic invasive fungal sinusitis include:
- Congestion, drainage
- Facial pain and pressure, much like that of a long-standing sinus infection
Invasive fungal sinusitis Treatment
Acute invasive fungal sinusitis is a medical emergency. Once you receive a diagnosis, you’ll need surgery right away to remove all dead and infected nasal and sinus tissue.
The chronic type also requires surgery and long-term medical therapy.
Minimally invasive surgery for invasive fungal sinusitis
Through the Endoscopic Endonasal Approach (EEA), surgeons can directly access the infected tissue through the natural corridor of the nose.
This state-of-the-art treatment allows surgeons to remove the infected tissue through the nose and nasal cavities, without making an open incision.
Benefits of EEA include:
- No incisions to heal.
- No disfigurement.
- Faster recovery time.
Follow-up treatment for invasive fungal sinusitis
Treatment also includes follow-up with antifungal drugs.
People with invasive fungal sinusitis need to remain under long-term observation by a doctor, as recurrence is common.
CSF leak
A CSF leak is a very serious condition, and patients who have tears in their dura with persistent CSF leaks need repair as soon as possible to reduce headache pain and the chance of meningitis.
Nasal CSF Leak (CSF Rhinorrhea)
Surgery for endoscopic nasal CSF leak closure, which is performed entirely through the nostrils, does not require cutting through the skin. The CSF leak is repaired using your own tissue from the nose or with a biomaterial graft. Length of stay in the hospital depends on the size of the leak — most patients are in the hospital for a few days after surgery. Some patients may require a lumbar drain that is removed before going home.
