Surgery will be suggested by your doctor when maximal medical treatment has failed. By maximal medical treatment, we refer to different and adequate types of therapy, with medications that have proved their efficacy during large clinical trials.
If the medical treatments prescribed by your doctor fail to control your symptoms, sinus surgery may be suggested.
The standard procedure for chronic rhinosinusitis is Functional Endoscopic Sinus Surgery (FESS). The goal for every patient undergoing sinus surgery is to remove the disease in key areas, restore adequate aeration and drainage of the sinuses, remove nasal polyps if present, and restore normal nasal functioning.
The surgeon will insert a small tube with a tiny camera into the nostrils and guide it into the sinus cavities. The diseased tissues will be removed using additional instruments. During the operation, the surgeon may also remove the disease in key areas in order to restore adequate aeration and drainage of the sinuses. Endoscopic surgery is usually performed as an outpatient procedure.
Sinus surgery offers a significant improvement in patients' quality of life. In particular, sinus surgery will relieve most of the symptoms that are attributable to chronic sinusitis such as nose obstruction, runny nose, nasal secretions in the throat, and facial pain. The effects of surgery on reduced smell vary strongly between patients and depend on the extent of the disease. Surgery is also expected to improve patients' sleep quality, work performance and daytime fatigue.
Sinus surgery is a challenging procedure and despite the availability of new instrumentation, complications during surgery may still occur. The major complications include bleeding, intracranial injury (inside the skull), and visual disturbances. Examples of minor complications include effusion of blood around the eye ('blue eye') or redness of the skin around the eye, watery eyes, scar formation inside the nose and persistence of the disease.
In approximately 20% of patients undergoing surgery, symptoms will recur. Poorer surgical outcomes were shown in patients with:
Best post-operative care
The best post-operative care after sinus surgery is intensive and frequent rinsing of the nose and sinuses with large amounts of saline water and (re-)starting your nasal medication, for instance, nasal corticosteroid sprays. You will also see your ENT doctor more frequently during the first weeks to months after sinus surgery. These extra visits are used for cleaning your nose and sinuses for example of blood crusts and giving extra care if necessary.
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