St Marks Hospitals

Endoscopic Sinus Surgery

July 14, 2008 – 3:05 pm

What Is Endoscopic Sinus Surgery?
Endoscopic sinus surgery - also called endoscopy or sinoscopy - is a procedure used to remove blockages in the sinuses (the spaces filled with air in some of the bones of the skull). These blockages cause sinusitis, a condition in which the sinuses swell and become clogged, causing pain and impaired breathing.

A thin, lighted instrument called an endoscope is inserted into the nose, and the doctor looks inside through an eyepiece. Much like a telescope with a wide-angle camera lens, the endoscope beams light into different parts of the nose and sinuses, allowing the doctor to see what is causing blockages. Surgical instruments can then be used along with the endoscope to remove the blockages and improve breathing.

This surgery does not involve cutting through the skin, as it is performed entirely through the nostrils. Therefore, most people can go home the same day.

Endoscopic sinus surgery is a relatively new procedure designed to increase the amount of air flowing through the sinuses and allow mucus The fluid made by the lining of the nose and sinuses, which carries dust and other particles out of the nose to drain properly out of the nose. The procedure can:

• Relieve nasal blockages
• Relieve facial pain
• Improve breathing
• Improve the sense of smell and taste

Endoscopic sinus surgery is an effective procedure to correct:

• Sinusitis
• Deviated septum A crooked condition of the partition separating the left and right sides of the nose, in which the partition separating the left and right sides of the nose is crooked
• Polyps, a noncancerous water-filled swelling
• Tumors, a swelling caused by an uncontrolled growth of cells

However, it seems to be less effective for those with post-nasal drip or allergies that are caused by airborne particles which cannot be avoided, such as dust and ragweed.

Facts about endoscopic sinus surgery

• 80% to 90% of people report a considerable reduction in symptoms after endoscopic sinus surgery.
• Endoscopic sinus surgery was introduced in the 1960s but did not become widely used in the U.S. until the 1980s.
• The endoscope, which utilizes fiberoptic technology, allows doctors to see inside the sinuses without cutting the face, and makes it possible to see parts of the sinuses that were formerly difficult to reach.
• 35 million Americans - about 14% of the population - experience symptoms of sinusitis every year.
• It is estimated that 1% to 2% of adults in the U.S. have lost their sense of smell and taste to a significant degree.

What Conditions Are Treated With This Surgery?
Endoscopic sinus surgery is used to treat:

• Sinusitis
• Deviated septum
• Polyps
• Tumors

Sinusitis
Sinusitis is a common condition that usually is easy to treat with medication. It feels much like a head cold, with a blocked, stuffy, or runny nose.

Sinusitis is actually a swelling of the inner lining of the sinuses. This swelling causes the openings of the nose to be blocked so that the mucus inside can no longer drain out. When the mucus cannot drain, the pressure of the blocked fluid creates pain in the face and impairs breathing. For most people, sinusitis is a temporary condition that goes away with simple treatment. If the symptoms continue for a significant period of time without responding to medication, or if the symptoms are especially severe, surgery may bring about permanent relief. However, surgery for sinusitis is considered a last resort and will not be recommended unless all other courses of treatment have been exhausted over a period of time with little or no results.

Sinusitis can be the result of:

• A cold that lingers
• A bacterial or viral infection
• Swelling due to allergies
• Having small sinus openings

Deviated Septum
The partition separating the left and right sides of the nose, called the septum The partition separating the left and right sides of the nose, is sometimes crooked. This crooked condition is called a deviated septum. Some people are born with this abnormality, but sometimes it is the result of an injury. Very few people have a perfectly straight septum, but endoscopic sinus surgery is only recommended for those whose septum is crooked enough to cause significant sinus blockage. The surgery can then straighten the septum and improve breathing.

Polyps
A polyp A noncancerous water-filled swelling, also called a cyst, is a benign Not cancerous (noncancerous) water-filled swelling about the size of a grape, which develops in the sinuses and causes blockage. They most frequently occur in people who have asthma A disorder of the lungs that causes wheezing, coughing, and excess. Polyps can sometimes be reduced in size with medication. However, endoscopic sinus surgery has proven to be an excellent method with which to remove polyps and restore normal breathing.

Tumors.
A tumor A swelling caused by an uncontrolled growth of cells, which can be noncancerous or cancerous is a swelling caused by an uncontrolled growth of cells that creates new tissue. It is not water-filled like a polyp. A tumor can be noncancerous or cancerous. Tumors in the sinuses are quite uncommon but can sometimes be removed with endoscopic sinus surgery. However, more extensive surgery is often necessary.

Can endoscopic sinus surgery be performed on children?
Endoscopic sinus surgery is a difficult procedure to perform on children because their sinuses are small and not fully developed. When the sinuses have fully developed, sinusitis symptoms sometimes stop on their own. Therefore, unless there is a nasal obstruction such as a polyp, most doctors will prefer to treat a child with medication.

About The Sinuses
The sinuses are spaces filled with air in some of the bones of the skull. Air passes in and out of these spaces, and mucus drains through them and out of the nose. They also reduce the weight of the skull and give our voices a nicer sound. There are four main pairs of sinus openings, sometimes called sinus cavities, in the face:

• Maxillary - in the cheekbones
• Ethmoid - between the eye sockets
• Frontal - in the forehead and above the eyebrows
• Sphenoid - deep in the head at the back of the nose

Each of these pairs of sinus openings has a channel that leads to the nose. These channels are quite narrow, and when the lining of the channels becomes swollen, blockage results. This lining is called the mucous membrane. This same mucous membrane forms the inner lining of the nose.

The mucous membrane in the nose and sinuses is our personal air conditioner. It warms, moistens, and cleans the air. The mucous membrane creates a clear, wet, slightly sticky mucus that gathers any dust, smoke, bacteria, or virus particles that may have been in the air. Tiny hairs along the membrane called cilia act as tiny oars, moving the mucus along much like a conveyor belt through the sinuses and out the nose.

When the mucus containing the unwanted particles reaches the nose and throat, the body prompts us to swallow, spit, sneeze, or cough it out of the body. When a cold or allergy prevents the cilia from moving the mucus through, the nose becomes blocked. The mucous membrane is also one of the body’s front-line defense systems. It releases chemicals that help to destroy bacteria and viruses before they can attack.

If a virus, bacteria, allergen Any substance that causes an allergic reaction because the immune system recognizes it as foreign or dangerous or other irritant is strong enough to prevent the mucous membrane and cilia from doing their job, blockages can occur in any of the pairs of sinus openings. Endoscopic sinus surgery can correct chronic or severe blockages in one or more of the maxillary, ethmoid, frontal, or sphenoid sinuses The pair of sinus cavities located deep in the head at the back of the nose.

What Causes Sinusitis?
The potential causes of sinusitis A condition of the sinuses that causes swelling and blockage in the nose, resulting in impaired breathing include:

• Virus
• Bacteria
• Fungus A parasitic plant or mold that can be microscopic and thus, ingested or inhaled
• Allergies
• Asthma A disorder of the lungs that causes wheezing, coughing, and excess
• Poor air quality
• Extremes of temperature and humidity
• Dehydration Too much loss of water from the body tissues
• Excessive nose blowing
• Foreign objects placed in the nose
• Stress
• Diseased teeth
• Hormonal imbalances
• Medication side effects
• Low immune system
• Deviated septum A crooked condition of the partition separating the left and right sides of the nose
• Small sinus openings
• Polyps
• Tumors

Most cases of sinusitis can be easily treated by a family doctor. However, in those cases where the sufferer has chronic sinusitis or repeated attacks of acute sinusitis that have not responded to medication, endoscopic sinus surgery may be the answer. This is especially true in the case of nasal obstructions such as polyps.

There are two types of sinusitis:

• Acute sinusitis means that the symptoms of the condition are temporary, usually lasting no more than 30 days. However, the symptoms of acute sinusitis are more severe and painful than the symptoms of chronic sinusitis.
• Chronic sinusitis means that the symptoms of sinusitis occur frequently or for long periods of time. The symptoms are usually more annoying than painful. However, those with chronic sinusitis are more likely to have recurring attacks of acute sinusitis, which can be quite painful.

What Are The Symptoms Of Sinusitis?
Symptoms of sinusitis vary from person to person. The most common symptoms are:

• Stuffy or runny nose
• Clear, thin discharge from the nose (as in chronic sinusitis), or thick yellow or green discharge from the nose, sometimes tinged with blood (as in acute sinusitis)
• Sneezing and/or coughing
• Pain over the bridge of the nose
• Headache that is worse in the morning, when bending forward, or when riding an elevator
• Post-nasal drip from the nose into the throat
• Frequent throat clearing
• Itchy eyes and/or nose
• Impaired sense of smell and/or taste
• Bad breath
• Fever and chills
• Pain in the roof of the mouth or teeth
• Face and eye pain

Less common symptoms, which may or may not be accompanied by a stuffy nose, are:

• Earache, feeling of fullness in the ear, swelling, and tenderness behind the ear, and/or ear popping due to mucus in the eustachian tube A tube in the inner ear that connects with the nose and throat of the ear
• Sore throat and hoarse voice caused by infected post-nasal drip
• Swelling of the eye area due to spread of infection from the sinuses to the eye
• Severe headache with vomiting, a very rare symptom, indicates the possibility of meningitis An infection or inflammation of the membranes of the brain and spinal cord or the spread of infection into the brain.