Patient Guide
Endoscopic sinus surgery, from start to finish.
A guide for patients preparing for endoscopic sinus surgery (ESS): what the operation is, who it helps, how sinus problems are diagnosed, how to prepare, the risks, and what to expect afterward.
General guidance only. Your written instructions, and anything Dr. Khetani's office tells you directly, take precedence over this page.
The Operation
What is endoscopic sinus surgery?
Endoscopic sinus surgery is a minimally invasive surgical technique in which diseased or obstructing tissue is removed from the sinuses, with the goal of improving or restoring normal sinus function. Thin telescopes give a clear view of the nose and sinus cavities from the inside, so the operation generally avoids any external incision.
The surgery generally involves opening the ethmoid sinuses, the group of small chambers between the eyes. Opening them permits inspection of, and access to, the neighbouring sinuses: the maxillary, frontal and sphenoid. Diseased tissue can then be removed from these sinuses where necessary.
The technique focuses on preserving as much normal tissue as possible, which permits rapid healing and the resumption of normal nasal and sinus function. The operation can generally be performed on an outpatient basis: home the same day, after a period in recovery.
Ethmoid first · Access to maxillary, frontal & sphenoid
Fig. The drainage pathways the endoscope follows.
Who It's For
Who needs this operation?
Endoscopic sinus surgery is generally intended for people with chronic sinus problems, or recurrent acute sinus problems, that have not responded to other medical therapies: the rinses, sprays and courses of medication that are always tried first.
Whether that describes your situation is established at consultation, not assumed. The assessment that decides it is described below.
Before Surgery Is Considered
How sinus problems are diagnosed.
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History & examination
The diagnosis of sinus problems is based on your history and a physical examination: what you've experienced, for how long, and what has already been tried.
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Nasal & sinus endoscopy
The examination includes nasal and sinus endoscopy, a thin camera passed into the nose after a topical spray, giving a direct view of the sinus openings.
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CT scan
A CT scan is usually required to accurately assess the areas involved. It is the map the operation is planned on.
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Medical therapy first
Medical therapy may be recommended based on this assessment. It is only if that therapy fails that someone is considered a candidate for surgery.
Getting Ready
Preparing for the operation.
Two things matter most in the run-up to surgery: taking what is prescribed, and stopping what interferes with clotting.
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You may be prescribed
In some cases, starting oral steroids (prednisone) or antibiotics is recommended in the pre-operative period. You will be given specific instructions if this is necessary for you.
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Stop before surgery
Do not take aspirin or ibuprofen for at least 10 days before surgery. They interfere with clotting and can cause significant bleeding problems during and after the operation. If another physician has prescribed a blood thinner or anti-inflammatory, don't stop it on your own; the office will coordinate with the prescribing physician.
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Your written instructions
You will receive written pre-operative instructions covering fasting, medications and arrival time. They are specific to your operation and take precedence over this page.
The Honest Part
What are the risks?
Serious complications are uncommon, and Dr. Khetani reviews the realistic risks of your operation before anything is decided. These are the ones this guide covers: bleeding, a leak of the fluid around the brain, changes in smell, visual problems, anesthesia, and a small group of less serious effects around the eye and teeth.
The risk of bleeding is relatively low with this technique. On rare occasions, significant bleeding may require ending the procedure and placing nasal packing. Bleeding after surgery could require nasal packing and admission to hospital. A blood transfusion is very rarely necessary.
All operations on the ethmoid sinuses carry a very rare risk of creating a leak of cerebrospinal fluid, the fluid that surrounds the brain. Should this occur, it creates a potential pathway for infection that could result in meningitis. A CSF leak would extend your hospitalization and may require further surgery to repair.
Permanent loss of, or a decrease in, the sense of smell can occur following surgery. In many patients, however, smell is already reduced before surgery by the disease itself, and it will often improve after the operation.
Although extremely rare, there are occasional reports of visual loss after sinus surgery. Usually the loss of vision involves only one side, and the chance of recovery is not good. Temporary or prolonged double vision has also been reported after this operation; it is also quite rare.
With newer medications and techniques, serious complications of general anesthesia are uncommon. They remain possible, however, and you are welcome to discuss them with the anesthesiologist before your operation.
Although rare, you may experience tearing of the eye, numbness or discomfort in the upper teeth, or swelling and bruising around the eye. These reflect how close the sinuses sit to those structures.
Recovery
What can I expect after surgery?
Within a day or so you will be able to resume normal daily activities. You will likely be asked to remain off work for up to two weeks after surgery, depending on what your work involves, and there will usually be one office visit during this time.
The day-by-day detail, what is normal, what to do and what to avoid, and the symptoms that should prompt a call, lives on its own page, written to be easy to use on a phone while you recover.
The Long View
Will surgery cure my sinus problems?
The honest answer: it is possible that the disease may not be cured by the operation, or that it may recur at a later time. If that should happen, further surgery could become necessary.
It is also important to emphasize that medical therapy, for example a steroid sinus rinse such as budesonide, is usually continued after surgery, especially where allergies or nasal polyps play a role in the sinus disease. This may help to prevent or control recurrences.
Overall, the majority of patients have significant improvement in their symptoms with the combination of surgery and continued medical therapy. Surgery opens the anatomy; the ongoing care keeps it working.
If something worries you after surgery
Contact the office at (905) 639-2244 during office hours with post-operative questions. For heavy bleeding, difficulty breathing, high fever, severe pain, vision changes or any emergency, do not wait for a call back; go to your nearest emergency department or call 911. The warning symptoms are listed in the post-operative instructions.
Related Patient Information
Keep reading.
This guide is general patient education, based on the practice's patient information material. It is not medical advice about your case, and the instructions provided directly by Dr. Khetani and his care team for your individual treatment take priority.
Dr. Justin Khetani · Otolaryngology, Head & Neck Surgery · 1435 Plains Rd E, Unit 5, Burlington, ON L7R 3P9 · ENT office (905) 639-2244