Endoscopic Sinus Surgery

What is sinusitis?

The sinuses are air-filled spaces at the front of the skull that are connected to the inside of your nose. Sinusitis rs an. Infection of the mucous membrane that lines the sinuses. It causes symptoms of pain, a blocked nose, discharge, reduced sense of smell and the feeling of mucus at the back of your nose or throat (post nasal drip).

Your surgeon has recommended endoscopic sinus surgery. However, it is your decision to go ahead with the operation or not. This document will give you information about the benefits and risks to help you make an informed decision.

If you have any questions that this document does not answer, you should ask your surgeon or any member of the healthcare team.

How does sinusitis happen?

The mucous membrane that lines the sinuses produces mucus, which helps to keep the air you breathe clean, warm and moist. if the opening between a sinus and the inside of your nose gets blocked, the mucus gets trapped and causes the mucous membrane to get infected.

Sinusitis may be temporary, for example, after a cold, or it may continue, for example, if you have nasal allergies or polyps.

What are the benefits of surgery?

The aim of surgery is to widen the passage between the sinus and your nose so that mucus does not become trapped anymore. This should prevent the sinusitis from coming back.

Are there any alternatives to surgery?

Antibiotics may help to clear the infection. If your sinusitis is caused by an allergy, you may be able to prevent sinusitis by avoiding the ‘triggers’ of your allergy or by taking medication, such as antihistamines or a nasal steroid spray.

If you use a nasal steroid spray for a long time, you can reduce the size of polyps, which may mean that you do not need surgery.

Your doctor would have tried these options before recommending surgery.

What will happen if l decide not to have the operation?

You will continue to have sinusitis. Sinusitis is not serious but it can be unpleasant. Symptoms can be worse at some times than others, particularly if you also suffer from hay fever or other allergies.

What does the operation involve?

Endoscopic sinus surgery is usually performed under a general anaesthetic but a local anaesthetic can be used. Your anaesthetist will discuss the options with you and will recommend the best form of anaesthesia for you. The operation usually takes between one and two hours. Endoscopic sinus surgery is performed through your nose and does not result in any facial scars or change to the outside shape of your nose.

Your surgeon will use an endoscope to examine your nasal passages. They will use special instruments to remove any polyps and to widen the passages from your sinuses into your nose. The surgery may be limited to just the sinuses at the front of your nose or may involve all the sinuses. Your surgeon will discuss this with you.

For the first night your nose may be packed with dressings to prevent it bleeding.

What should I do about my medication?

You should continue your normal medication unless you are told othenrvise. Let your surgeon know if you are on warfarin or clopidogrel. Follow your surgeon’s advice about stopping this medication before the operation.

What can I do to help make the operation a success?

Lifestyle changes

If you smoke, try to stop smoking now. Stopping smoking several weeks or more before an operation may reduce your chances of getting complications and will improve your long-term health.

For help and advice on stopping smoking, go to www.gosmokefree.co.uk.

You have a higher chance of developing complications if you are overweight.

For advice on maintaining a healthy weight, go to www.eatwell.gov.uk.

Exercise

Regular exercise can reduce the risk of heart disease and other medical conditions. improve how your lungs work, boost your immune system. help you to control your weight and Improve your mood. Exercise should help to prepare you for the operation. help with your recovery and improve your long-term health.

For information on how exercise can help you. go to www.eidoactive.co.uk.

Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

What complications can happen?

The healthcare team will try to make your Operation as safe as possible. However, complications can happen. Some of these can be serious and can even cause death. You should ask your doctor if there is anything you do not understand. Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you.

The complications fall into three categories.

  • Complications of anaesthesia
  •  General complications of any operation
  •  Specific complications of this operation

1. Complications of anaesthesia

Your anaesthetist will be able to discuss with you the possible complications of having an anaesthetic.

2. General complications of any operation

Pain, which happens with every operation. The healthcare team will try to reduce your pain. They will give you medication to control the pain and it is important that you take it as you are told.

Bleeding during or after surgery. if it is heavy, you may need a blood transfusion.

Blood clots in the legs, which can occasionally move through the bloodstream to the lungs, making it difficult for you to breath, Nurses will encourage you to get out of bed soon after surgery to reduce the risk of blood clots.

3. Specific complications of this operation

Infection (risk: 1 in 100). if this happens, you may start to bleed about a week to ten days after your operation. You will need to come back to hospital and may have your nose repacked. You will also need to have antibiotics.

Damage to the bone around your eye (risk: 1 in 500). The orbit (the bone around your eye) is separated from the sinuses by a thin piece of bone. if this bone ls damaged, you may get bruising around your eye.

Blindness This can very rarely happen if the optic nerve or the eye itself is damaged during the operation.

Leak of fluid from the brain (risk: 1 in 1,700). The front of the brain is separated from the nose by a thin piece of bone. If this bone is damaged. fluid from around your brain (cerebral spinal fluid or CSF) may leak out if this happens, any damage can usually be repaired during the operation.

 

How soon will I recover?

In hospital

After the Operation you will be transferred to the recovery area. You should be able to go home on the same day. However. your doctor may recommend that you stay a little longer.

If you are worried about anything, in hospital or at home. ask a member of the healthcare team. They should be able to reassure you or identify and treat any complications.

Returning to normal activities

Your surgeon will tell you When you can return to normal activities.

You should not b ow your nose for at least a week after the operation. After this time you will blow out thick bloody mucus. Your nose will continue to feel blocked for quite a few weeks after the Operation.

Your surgeon will prescribe a nasal spray or drops for you to use, You may also need to use a nasal cleansing kit (nasal douche) to keep your nose clean. You may also be given a course of antibiotics to reduce the risk of infection.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

Do not drive until you are confident about controlling your vehicle and always check.

with your doctor and insurance company first.

The future

Most people make a good recovery. if your sinusitis is caused by an allergic reaction or polyps, you may need to continue with a nasal spray.

if you had polyps, they may come back again even if you use a nasal spray (risk: 4 in 10).

Summary

ln hospital

After the operation you will be transferred to the recovery area and then to the ward. You may be able to go home the same day. if you do go home the same day, a responsible adult should take you home in a car or taxi, and stay with you for at least 24 hours.

if a head bandage has been used, it will be removed the morning after surgery and you should be able to go home that day. However, your doctor may recommend that you stay a little longer. ‘ If you are worried about anything, in hospital or at home, ask a member of the healthcare team. They should be able to reassure you or identify and treat any complications.

Returning to normal activities

Your surgeon will tell you when you can return to normal activities. You should stay off work for two weeks. You will be able to fly without having a y problems with your ear.

Regular exercise should help you to return to normal activities as soon as possible Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

Do not drive for at least 24 hours after the operation and not until you are confident about controlling your vehicle. Always check with your doctor and insurance company first.

The future

Most people make a good recovery. You will be seen in the outpatient clinic two to three weeks after the operation to remove the pack (if one has been inserted) and to check the graft. Sometimes ear drops are prescribed at this visit.

You should protect your ear from water, using cotton wool and Vaseline, until your surgeon is satisfied that the graft has worked. If the graft Is successful, you should not get ear infections and you will be able to swim and bathe as normal

Summary

Sinusitis is not serious but it can cause unpleasant symptoms. if medication does not help, endoscopic sinus surgery should help prevent the sinusitis from coming back. However, you may still need to take medication and the problem can happen again.

Surgery is usually safe and effective. However, complications can happen. You need to know about them to help you to make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early.

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