Endoscopic Sinus Surgery
Sinus problems can develop because of a blockage of the
sinus cavities. The symptoms that are typically encountered
- sinus headaches,
- facial headaches,
- facial pressure or pain,
- nasal congestion,
- recurrent sinus infections,
- postnasal drip and drainage,
- decreased sense of smell,
- decreased breathing through the nose.
Sinus problems can be quite chronic in nature, can affect
the quality of life, and can lead to a decreased sense of
energy. The sinus cavities are hollow chambers inside of
the head and face that can become repeatedly infected and
need to be surgically opened to reduce the symptoms. Millions
of people are plagued by blocked sinus cavities that do
not respond well to medication and have to be opened with
endoscopic sinus surgery. Endoscopic sinus surgery opens
the internal sinuses. It also involves removing polyps on
the inside of the sinuses as well. All of the surgery is
done from the inside of the nose using telescopes. The recovery
is less painful, and there is no visible bruising or scarring
on the outside portion of the nose. "Endoscopic"
sinus surgery is a telescope that allows Dr. Portuese to
view the inside of the patient's sinuses.
There are four sets of sinuses inside everyones's face:
- frontal sinuses,
- maxillary sinuses,
- ethmoid sinuses,
- sphenoid sinuses.
Each one of these sinuses has a narrow passageway through which aeration occurs,
and through which the mucus drain out of the sinuses and into the nasal cavity.
From the nasal cavity, the mucus drains down the back of the throat. When the
sinuses are blocked, this becomes a sinus infection with all the accompanying
symptoms of headaches, facial pain, and pressure. Sinus problems can be a recurring
and ongoing problem that can develop either from one sinus being blocked or
multiple sinuses being blocked.
Dr. Portuese will take a thorough medical history on patients to try to evaluate
the symptoms and the cause of their sinus problems. It is important to know
that allergy medication, antibiotics, decongestants, and nasal sprays have
no longer helped the problem. Examination of the nose can be done with a
magnified nasal scope and a headlight, looking for mucus, infection, redness,
polyps, and obstruction. If the medical history is suggestive of long-term
sinus infection, and the examination also supports what the medical history
shows, then a CT scan, which is a computer x-ray, of the sinuses is performed.
This is typically done at an x-ray center and takes approximately 15-20 minutes
to perform. The CT scan gives a very clear three-dimensional, cross-sectional
view of the sinuses. This is a road map as to where Dr. Portuese will operate
inside the sinuses and nose.
The decision to perform endoscopic sinus surgery really depends upon medical
history, physical examination, and CT scan findings of polyps inside the
sinuses. The decision to perform the surgery is dependent upon the severity
of symptoms. When the symptoms are recurrent, become bothersome and medicatons
have failed, then endoscopic sinus surgery in indicated.
Endoscopic sinus surgery is done under general anesthesia in our Medicare-certified
outpatient surgery center. Magnified endoscopes (telescopes) with instrumentation
are used to open up the blocked sinuses. Special attention is usually directed
at the middle meatus, which is the area where most sinus cavities drain into
the nose. Polyps are removed with the endoscopes. If the ethmoid sinuses are
blocked, an ethmoidectomy will be performed to remove the ethmoid air cell.
The maxillary sinuses are opened only if needed, provided they have polyps
or the skin lining on the inside of the sinuses is swollen. This procedure
takes 30-45 minutes to perform, and two sponges are placed inside the nose
to help with bleeding. These are removed by the patient the following day.
If you have further questions about Endoscopic Sinus Surgery, please feel free
to contact our office.
General anesthesia is used for Endoscopic Sinus Surgery. Board certified physician
anesthesiologists are present to monitor the anesthesia and the patient's vital
signs while Dr. Portuese performs the surgery. Therefore, patients must have
transportation arrangements and someone to take care of them for the first
After the surgery, patients will typically be kept in the recovery room for
approximately one or two hours, depending upon how they feel. They are then
discharged home in the care of a family member or friend. There is a mild
amount of oozing which drains down the back of the throat, for which the
sponges do help. The patients will remove the sponges themselves the day
after surgery. Most patients wear a moustache dressing to help prevent the
drainage from coming down the front portion of their nose. Patients are asked
to use salt water rinses four times a day with a Waterpik for the first month
Full instructions are given to the patients. Humidification in the bedroom
at night wil help keep the mucus and blood from drying up inside the nose,
which can be helpful in the healing phase. There are several things in the
first two weeks of the postoperative phase which should not be done. This
includes blowing the nose, so as to not put any pressure on the nose. There
should be no exercising, straining, heavy lifting, or bending forward. Travel
plans by airplane should be curtailed for the first two weeks after surgery.
Visits to Dr. Portueses's office are performed at one week, two weeks, four
weeks, three months, six months, and again at one year after surgery. It
is also important to be allergy tested, since the polyps located inside the
nose are allergic nasal polyps caused by allergies. It is thought that if
the allergies can be kept under control the polyps may be curtailed from