What does endoscopic sinus surgery involve?

From solving breathing problems to recovering your sense of smell, there are countless reasons why you might be considering endoscopic sinus surgery. As there are many aspects to think about before deciding whether or not to go through such a procedure, Mr Miran Pankhania is here to talk you through them all.

What is endoscopic sinus surgery?

Endoscopic Sinus Surgery is a minimally invasive procedure – which doesn´t leave any external scars or bruising - to treat inflammatory conditions affecting the sinuses. It allows your surgeon to strip the diseased nasal lining from your nose and sinuses so that a healthier, thinner lining can grow back as it heals after surgery.

For which conditions is it used?

ESS is excellent for clearing nasal polyps which improves breathing and can sometimes help recover the sense of smell lost to nasal blockage. It is also helpful in recurrent sinus infections where the cause is not dental in origin. ESS also has a role in treating septal and palatal perforations which may have caused problems with bleeding, crusting, and whistling from the nose.

How effective is this type of surgery?

ESS can be curative in the right circumstances e.g. for recurrent infections, but unfortunately for people with inflammatory diseases such as nasal polyps, the disease will eventually come back. ESS aims to improve quality of life whilst reducing your exposure to oral steroids which can result in significant long term side effects. ESS in conjunction with sinus irrigation and steroid nasal sprays which aren't absorbed from your nose, can help keep the polyps away as long as possible so you can breathe and smell normally again.

What happens during the surgery?

During surgery, I carefully identify the openings to your sinuses and remove the inflammatory or infected tissue from the nose and sinuses. The utmost care is taken to avoid damage to important nearby body parts such as your eyes and brain. The opening to each of the sinuses is made wider to prevent future blockage and increase the chances of symptom improvement. Wider openings also make it easier to get anti-inflammatory medication into the sinuses to help in both the short-term healing process and prevent disease recurrence in patients with nasal polyps.

What is recovery like?

After surgery you may wake up with a mild headache and some blood-stained snot. This is normal and easily controlled with simple pain relief. The blood-stained snot will last approximately one week and as your sinuses recover, old congealed blood and crust will also come away. These are equivalent to a graze on your knee and a scab which forms after, which then allows new skin to grow underneath as things heal over. Using sinus irrigation and nasal steroids helps smooth this healing process and prevents infection, as after all, the nose is a relatively dirty place!

Who is a candidate for this surgery?

If you have two or more of the following symptoms, you could be a candidate for sinus surgery. Symptoms that raise a suspicion of sinus disease include reduction or loss of ability to smell, nasal obstruction, facial pain, and "purulent rhinorrhoea," this is thick pus which you may blow out or feel running down the back of your throat. It is foul tasting and smelling and very suggestive of infection. Your symptoms will be put into context during your consultation to ensure there is no alternative solution or treatment which may be less risky than surgery. Other conditions which often get passed off as sinusitis include dental infections or things which can't be treated surgically such as migraine, cluster headache, or trigeminal neuralgia. It is important to consider facial pain symptoms carefully as they can get worse after surgery if there is no obvious sinus disease and this can be very difficult to treat.

Mr Pankhania is a well-respected surgeon who specialises in ear, nose and throat procedures. Visit his profile to book a consultation with him.