Acute Sinusitis Surgery
What is acute sinusitis surgery?
Sinusitis is an infection or inflammation of the mucous membranes inside the nose and facial sinuses (as depicted in the adjacent graphic). Inflammation of these mucous membranes can result in swelling and blockage, which can in turn lead to reduced drainage of the nasal passages and painful pressure. Sinuses that are unable to drain properly become a breeding ground for bacteria. Symptoms of sinusitis include severe nasal congestion, yellow or green discharge, fever, and a reduced sense of taste and smell.
Normally, sinusitis improves on its own with only conservative treatment like fluids, decongestants, and vitamin C. When symptoms persist for more than 7 days or symptoms increase in severity, a visit to the doctor is recommended in order to determine the nature of the infection and the possible need for treatment. Blockage of the sinuses might be caused by anything from foreign objects (as is often the case with children) to naturally small sinus passageways, to having had many sinus infections that cause thickening of the sinus cavities and channels. Knowing that there is actually a sinus infection is also important. The differential diagnosis for having just some of the symptoms includes allergies, migraines, and nasal polyps. Both acute and chronic sinus infections should be documented by endoscopic sinus examination.
Acute sinusitis surgery
In the presence of complications or the failure of appropriate medical management, acute sinusitis surgery may be recommended by the doctor. The goal of acute sinusitis surgery is to improve drainage of the sinuses by removing the sinus blockages and thereby allowing normal nasal mucosa function to return. This could mean removing:
- swollen or damaged tissue
- infected tissue
- bone (in order to create a wider opening for drainage)
- growths like nasal polyps
- foreign objects
The two major types of acute sinusitis surgery are endoscopic surgery and traditional sinus surgery.
Endoscopic Sinus Surgery
Endoscopic sinus surgery is accomplished with an endoscope that is inserted into the nasal cavity through the nostrils. A CAT scan of the sinuses is used for a guide to show the areas of infection and abnormal anatomy. The endoscope allows a doctor to view the inside of the sinus and determine which sinuses are infected and the cause of the blockage. After a determination is made, the proper surgical instruments are inserted into the nasal cavity alongside the endoscope and used to remove swollen and infected tissue. Typically, a rotating burr or laser is used to remove small amounts of tissue and bone under anesthesia. The procedure generally takes anywhere from 60 to 180 minutes. This is known as a FESS, which is a Functional Endoscopic Sinus Surgery.
Traditional Sinusitis Surgery
Traditional sinus surgery differs from endoscopic surgery because a direct incision is made in the external skin so that the surgeon can operate on the infected sinus(es) directly. Traditional open sinus surgery is usually done when the surgeon believes that endoscopic surgery would provide insufficient access to the sinuses. This surgery is almost never performed today except for surgery of tumors.
Post Surgery Care
In both cases, bleeding and discomfort are universal symptoms post-surgery. Weekly visits to the surgeon may be required until crusting and blockage from the healing sinuses is removed. Recovery regimens may include:
- Using saltwater nasal washes.
- Avoiding activities that strain the nasal cavities, like blowing of the nose or exercising.
- Using humidifiers at home.
- Avoiding getting overheated or dusty environments.
Acute sinusitis surgery patients may be prescribed additional medications for pain management and antibiotics if there is an increased risk of infection.
Is packing the nose still required today?
No. Dr. Bennett does not find any value in packing placement inside the nose for most patients. Historically, especially in the days before endoscopic surgery, surgeons would place several feet of gauze in each side of the nose. This is very painful during both recovery and removal. The packing does not necessarily decrease bleeding and can lead to additional scarring or infections inside the nose.