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Who Qualified For Endoscopic Sinus Surgery?
Patients with chronic sinus problems documented by X-ray who do not respond to medical therapy are candidates for endoscopic sinus surgery. Symptoms of sinus disease can include facial pain (above or below the eyes or in the temples), fullness or pressure, blocked nasal breathing, persistent nasal odor, postnasal drainage or drip, and occasional headaches. Occasionally sinus problems can cause hoarseness due to drainage or cough. Patients with nasalpolyps almost always have sinus disease because polyps block sinus drainage. However, many of these symptoms can also occur in the absence of sinus disease. Allergy or chronic nasal congestion are examples of problems causing symptoms similar to sinusitis but not helped by endoscopic surgery. Your doctor is capable of deciding whether or not you have sinusitis.

Most people who have proven sinus disease do not need surgery but can be treated medically using antibiotics, decongestants or perhaps allergy treatment. Your doctor can best decide on appropriate medical therapy.

Surgery may be necessary if medical therapy is not successful. Usually this is due to the fact an infected or inflamed area does not clear up with antibiotics or returns when antibiotics are stopped. The decision for surgery will be made by you and your doctor.

If it is decided that surgery is necessary, surgery will be scheduled as an outpatient procedure depending on your overall health. Any patient undergoing outpatient surgery should understand that hospitalization may be necessary if any problems occur. Usually nasal packing is not required and return visits will be made one to two days after surgery to clean the nose. Visits will then occur once a week for two to three weeks until the nose has healed and then every three to four months. You will participate in your care by taking prescribed medications and irrigating your nose with salt water. If packing is required, you will return one to two days after surgery for removal.

Occasionally further endoscopic surgery may be necessary for disease which recurs. Endoscopic surgery, while a marked improvement in the treatment of sinus disease, does not always cure everyone. Some patients, especially those with nasal polyps, may have recurrent disease.

What Is Functional Endoscopic Sinus Surgery?
Functional endoscopic sinus surgery differs from conventional intranasal surgery in that it stresses careful diagnostic work-up to identify precisely the cause of disease. Sometimes the clinic exam with the telescope or the special X-ray studies (CAT scan) may identify disease which ordinarily would not have been found.

The principle of endoscopic surgery is that when the underlying cause of disease is found, that problem is corrected eliminating the need for more extensive surgery. Secondary sinus disease caused by the primary anatomic blockage will usually resolve when the primary problem is corrected. Usually the main area of obstruction is the ethmoid sinus into which all other sinuses drain.

The advantage of endoscopic sinus surgery is that, in general, less surgery is needed, normal tissues are injured less, and surgery can be performed without nasal packing. Discomfort also is less post-operatively. The special telescope techniques are similar to conventional intranasal surgery differing in that better visualization is obtained with the telescope which allows problems in other sinuses to be taken care of as well.

In general, the complications and risks of endoscopic surgery are the same as those for conventional intranasal sinus surgery; however, because of better visualization and special instrumentation, the risks of surgery are reduced. Nevertheless, each patient should be aware of the potential complications.

Bleeding is a possibility in any nasal or sinus surgery because of the extensive blood supply. Occasionally significant bleeding may occur requiring termination of the procedure and nasal packing. This usually requires hospitalization for observation. Blood transfusions are rare as is the need for subsequent surgery to control bleeding. However, certain precautions are necessary, such as the avoidance of all medication containing aspirin or ibuprofen (NSAIDS) for one to two weeks prior to surgery.

Failure To Cure The Problem Of Recurrent Disease
Disease may not be cured by endoscopic surgery or may recur at a later time. While endoscopic surgery reduces the chances of this occurring, risk of persistent or recurrent disease is a possibility which could require subsequent surgery.

Postoperative Discharge
Post surgical blood-tinged drainage or clots may occur up to one to two weeks after surgery. This is expected and will clear over time . Blowing of the nose should not be attempted for one week post surgery.

Blood Transfusion
Blood replacement is rarely needed. If it is, certain risks are known. Infection may occur from infected blood; fortunately, this is rare.

Other Risks
You may note some numbness or discomfort in the front and upper teeth temporarily. Swelling, bruising, "black eye", and lip numbness may also occur, but usually resolve in one to two weeks. Air may collect under the skin around the eye post operatively. This rapidly resolves. Symptoms may return or in some cases worsen such as sinus pain or discomfort, increased nasal
obstruction or discharge. Smell may be decreased or absent after surgery, but this is rare. Scarring may occur in the nose but usually does not cause a problem. Occasionally, the scarring may need to be removed.

Alternatives To Surgery
Medical therapy, if successful, is the treatment of choice for sinus disease. If medical therapy is unsuccessful, the patient may choose to live with their sxs rather than undergo surgery. Besides endoscopic surgery, conventional sinus surgery is also available. This should be discussed with your surgeon. Depending on the extent of disease, progression of sinus disease may lead to orbital complication (loss of vision), brain abscess or infection, loss of smell, and intracranial cysts or masses.

Spinal Fluid Leak
Since the area just above the nose is the brain, there is a risk of entering the thin wall separating nose from brain during surgery. A thin clear fluid, which surrounds the brain, can then leak into the nose. This fluid can become infected and a meningitis could occur. However, this is rare. If a leak does occur it may be able to be stopped during surgery. If not, it may close on its own. Surgery to close the hole is necessary if the leak persists. Better visualization often helps to reduce this complication even further. Any surgery involving removal of polyps or extensive sinus disease runs this risk.

Loss of Vision
Any extensive sinus surgery in the nose may result in loss of vision. While endoscopic guidance reduces this risk, blindness in one or both eyes may occur. Fortunately this complication is very rare. Temporary or prolonged double vision has been reported but is also rare.