The goal of endoscopic sinus surgery is to unblock the nasal passages. It involves using instruments to open the sinuses and a small, camera-mounted tube or endoscope. Surgery can cause complications, ranging from bleeding to eye damage.

This article explains endoscopic sinus surgery (ESS) and its purpose. It will describe what happens before, during, and after surgery and consider risks and alternative treatments.

A medical professional preparing an endoscope for sinus surgery.Share on Pinterest
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ESS is a surgical treatment for various sinus problems. The most common use of ESS is for treating chronic sinusitis, but it is also a treatment for other conditions, such as tumors and polyps. Doctors may also use it for treating complicated cases of acute sinusitis.

Sinusitis is an inflammation of the sinuses. The sinuses are networks of cavities within and around the skull. Sinuses can cause symptoms, including facial pain and nasal congestion when inflamed.

There are different kinds of sinusitis. Healthcare professionals define chronic sinusitis as a sinus inflammation lasting over 12 weeks. Acute sinusitis is sinus inflammation lasting fewer than 4 weeks.

ESS aims to restore function by opening up the natural drainage pathways rather than making new openings. Surgery can reduce the symptoms of sinusitis and make sinus inflammation less likely to recur. Surgeons can achieve these goals by:

  • widening sinuses
  • draining sinus abscesses
  • removing sinus air pockets
  • removing sinus blockages

Surgeons may also remove damaged sinus mucosa. A mucosa is a lining that can create mucus. However, during ESS, surgeons will leave any undamaged mucosa in place.

Before surgery, a doctor may prescribe medications, such as antibiotics or oral steroids, to prime the sinuses for surgery. A person should take them exactly as the prescription states.

According to a 2020 article, other important steps in preparing for ESS include:

  • Discontinuing medications: Some medications can increase the likelihood of bleeding during surgery. These include anticoagulants, antiplatelet agents, and some nonsteroidal anti-inflammatory drugs (NSAIDs). People should speak with a doctor about stopping taking these medications before surgery.
  • Dietary changes: Some foods and supplements could make surgical bleeding more likely. These include garlic, ginger, and vitamin E. People should stop consuming these for at least 1 week before surgery.

If a person smokes, a doctor may recommend stopping for at least 3 weeks before surgery and at least 4 weeks after. Smoking may lead to scarring, poor healing, and surgery failure.

ESS takes place under local or general anesthesia. Different types of anesthesia are relevant to different surgical goals. Some types of anesthesia are unsuitable for certain people, so a doctor will discuss the options before surgery.

ESS usually takes but can vary widely depending on the severity of the condition. It begins once the anesthesia takes effect.

ESS involves the use of an endoscope, which is a thin rod that contains a light and camera. By placing this endoscope within the sinuses, surgeons can make precise interventions.

The surgeon passes the endoscope through one nostril and connects the other end to a screen, which displays the inside of the sinuses. Surgeons may also use a navigation system that matches the location of their instruments to a preoperative CT scan.

Using special tools, surgeons operate within the sinuses. The details of the operation will vary according to the need of the individual.

After the operation, people may spend 1–3 hours in a recovery room. Many people feel well enough to go home the same day.

Some doctors use packing inside the nasal cavity. Most doctors will use absorbable packing that does not require removal. A person may have a drip pad under the nose to collect blood. It is common to experience some bleeding for 3–5 days after sinus surgery.

Research suggests that postoperative pain is relatively low after ESS. Various medications can help, such as acetaminophen and NSAIDs.

Some medications can reduce the risk of sinusitis recurrence. They include oral steroids and antibiotics. Doctors tailor their advice about medications to each individual.

Other tips that may help with recovery include:

  • Avoid heavy lifting for at least 10 days.
  • Return to exercise slowly. In the first week after surgery, do about half the usual amount and increase activity levels 2 weeks after surgery.
  • Avoid blowing the nose or putting anything into it for about 10 days.
  • Follow the doctor’s advice about using nasal washes and rinses.
  • Keep all doctor’s appointments.

Any surgery comes with a certain amount of risk. A 2019 review details some complications of ESS.

Infection is a fairly common complication. Bleeding also occurs regularly and can happen due to damage to the mucosa. Bleeding can also result from trauma to various arteries, including:

  • sphenopalatine artery
  • anterior ethmoidal artery
  • internal carotid artery

Sometimes, surgery causes damage to muscles around the eyes, optic nerves, and nasolacrimal duct. ESS can also cause cerebrospinal fluid rhinorrhea. This is when cerebrospinal fluid drains through the nose.

ESS can improve sinusitis symptoms, but it is not a cure. People may need to continue taking sinus medications after a successful ESS procedure.

Doctors usually only recommend surgery when other treatment options are unsuccessful. Research shows that Several kinds of medication can help manage symptoms or cure the underlying cause of sinusitis. These include:

Nasal washes and nasal humidification may also help with symptom management. Anyone with sinusitis should discuss different treatment options with a doctor.

The outlook for sinusitis varies greatly.

Antibiotics can often treat acute bacterial sinusitis. Typically, acute viral sinusitis either resolves on its own or responds well to antibiotic treatment. By contrast, acute fungal sinusitis is life threatening for some people with certain autoimmune conditions.

There is evidence that untreated chronic sinusitis can significantly impair a person’s quality of life. However, medical treatment is often successful. ESS may improve symptoms in around 75% of people with chronic sinusitis.

ESS is a relatively safe and effective procedure that helps reduce the symptoms of sinus inflammation and infection.

The procedure takes 1-2 hours, and a person can usually go home the same day. People may have to discontinue certain medications and take other precautions before surgery to maximize its chances of success.

Recovery takes several months, and a person may need follow-up doctor’s appointments for 3–4 months.

There are several alternatives to surgery, such as decongestants, steroids, and nasal washes.