ear, nose, and throat specialist<\/a> will prescribe many medications (antibiotics, decongestants, nasal steroid sprays, antihistamines) and procedures (flushing) for treating acute sinusitis. There are occasions when physician and patient find that the infections are recurrent and\/or non-responsive to the medication. When this occurs, surgery to enlarge the openings that drain the sinuses is an option.<\/p>\n\n\n\nA recommendation for sinus surgery in the early 20th century would easily alarm the patient. In that era, the surgeon would have to perform an invasive procedure, reaching the sinuses by entering through the cheek area, often resulting in scarring and possible disfigurement. Today, these concerns have been eradicated with the latest advances in medicine. A trained surgeon can now treat sinusitis with minimal discomfort, a brief convalescence, and few complications.<\/p>\n\n\n\n
A clinical history of the patient will be created before any surgery is performed. A careful diagnostic workup is necessary to identify the underlying cause of acute or chronic sinusitis, which is often found in the anterior ethmoid area, where the maxillary and frontal sinuses connect with the nose. This may necessitate a sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected blood tests to determine an operative strategy. Note: Sinus X\u2013rays have limited utility in the diagnosis of acute sinusitis and are of no value in the evaluation of chronic sinusitis.<\/p>\n\n\n
Sinus Surgical Options<\/h2>\n\nFunctional Endoscopic Sinus Surgery (FESS) with VTI (Computer Guidance)<\/h3>\n\n\n
Sinus surgery is indicated when medical therapy has failed to treat sinus problems\/ infections. We are careful to evaluate each patient individually based on their symptoms and CT scan findings, to determine if surgery is necessary. If surgery is needed, it generally can be performed as an outpatient.<\/p>\n\n\n\n
The procedure takes about 1 \u00bd -3 hours depending on the amount of surgery that is needed. It is performed under a general. We use small telescopes (similar to the size of a pen) that are passed through the nose to visualize the anatomic structures within the nose and sinuses. Small manual forceps and electric swiveling instruments are used along with suction devices to clean out the sinus cavities and enlarge their openings so that future sinus material can drain out more easily.<\/p>\n\n\n\n
Generally, no external or visible incisions are necessary. The procedure does involve working close to the eye (orbit) and the brain; so potential for injuries to these areas is possible, but unlikely (less than 1% of the time). Following surgery, some pain can exist for 1-7 days, and sometimes packing may need to be removed from the nose following surgery (at the post operative visit). Occasionally, a second trip to the operating room may be needed about 2- 6 weeks following surgery to clean out the nasal\/sinus cavities. The surgery is successful in improving sinus problems about 85 % of the time. Occasionally, revision sinus surgery is needed years later.<\/p>\n\n\n\n
We often utilize technology called Image Guidance in the surgical suite. The Image Guidance system is like GPS for the sinuses. This device allows us to pinpoint the location of our instruments within that particular patient as we work during the surgical procedure. This allows the surgeon to have the greatest accuracy and location of anatomic structures during surgery. It has been a great advance in our field. Our practice was one of the first in the Midwest to start using this technology in about 1994.<\/p>\n\n\n
Two Weeks Before Surgery<\/h4>\n\n\n
Do not take non-steroidal anti-inflammatory drugs (NSAIDs) for two weeks prior to surgery. Medications in this family include: aspirin, ibuprofen, Advil, Motrin, Aleve, naproxen, Celebrex and others. These medicines increase the risk of bleeding. Also, discontinue all homeopathic alternative medicines such as ginkgo biloba, garlic, fish oil, dong quai, feverfew or ginseng. These too may increase bleeding.\u00a0Tylenol (acetaminophen) is not an NSAID, therefore, can be taken prior to surgery.<\/p>\n\n\n