Endoscopic Sinus Surgery


	Cases of chronic sinus infection, nasal polyps, headache, nasal stuffiness and post nasal discharge are quite common .A recent, new and revolutionary method known as Nasal Endoscopy and Endoscopic Sinus Surgery is now available, both for early and precise diagnosis and treatment. The old myth that sinus infections are not curable needs to be changed now with the availability of endoscopic sinus surgery. Hardly there is any cavity in the body, which had remained unexplored in the present era of endoscopies. The hidden areas inside nose can be precisely visualized, assessed and effectively treated with the help of nasal telescopes. The state of art of new technology of endoscopic sinus surgery is very significant contribution in the recent times to cure sinusitis and nasal polyps & sinus headaches. The aim of the endoscopic sinus surgery is to clear the polyps and diseased ethmoid cells to re-establish ventilation and drainage of the frontal, sphenoid and maxillary sinuses through their enlarged passages. Depending on the findings of C.T. of sinuses and nasal endoscopy, one can plan and deal with the affected areas by endoscopic surgery. The polyps from nasal cavity and from all the involved sinuses can be removed endoscopically. Endoscopic surgery is performed under L.A. or G.A. I prefer L.A. except in children. Endocamera can be attached with the nasal telescope and the entire procedure can be demonstrated and recorded. With the help of nasal telescopes of various angles. We can do endoscopic turbinoplasty, endoscopic septoplasty and endoscopic D.C.R. besides dealing with other nasal and sinus diseases. Another recent introduction is Balloon Sinusplasty in sinus diseases, especially when sinus openings are narrow or blocked. The most recent introduction in endoscopic surgery is the use of lasers, microdebrider and image guided surgery, which helps to reduce operative bleeding to carry on the endoscopic surgery more efficiently and safely while preserving the mucosa, which helps for quick healing. Diagnostic nasal endoscopy has now become an O.P.D. routine procedure to diagnose nasal lesions at an early stage, which are normally missed on routine anterior rhinoscopy. Many anatomical variations in the nasal cavity will predispose to recurrence of disease in the sinuses e.g. concha bullosa, deviated nasal septum, enlarged uncinate process etc. In these cases Endoscopic Sinus Surgery becomes essential.
	Frequently asked questions :
	What is Endoscopic Sinus Surgery This minimally invasive surgical technique is done with help of telescopic aided vision. This new technique helps to clean and enlarge the sinus openings that in turn help to drain sinuses to cure the sinusitis. The telescopes are negotiated through nasal and sinus pathways allowing the surgeon to open and enlarge the natural drainage passages of your sinuses under direct vision. This allows for drainage of mucopus from the sinuses and helps to prevent future infections as well. When do we need sinus surgery Endoscopic sinus surgery is required in patients of nasal polyps or sinusitis due to allergy or infection. Infection & allergic reaction causes normal sinus mucosa to swell, which blocks the sinus openings. When there is nasal blockage due to formation of polyps or nasal blockage does not improve with adequate medical & conservative therapy, then endoscopic sinus surgery has a great role to play. What investigations are required for Endoscopic Sinus Surgery Before endoscopic sinuses surgery, a CT Scan of sinuses is done to see how your sinuses are formed and how bad they are. The CT Scan is also used to know about the extent of disease in the sinuses, as well as it acts as a guideline or roadmap to navigate through the sinuses with the telescopes. Beside this, a routine haemogram & urine tests are required. What kind of Anaesthesia is used & how much time is taken for this surgery Endoscopic sinus surgery is performed under local or general anesthesia. Absolute control of blood pressure is essential before surgery in hypertensive patients as this surgery may require hypotensive anaesthesia. The duration of surgery depends upon the extent of disease and blockage in the sinuses. Surgical time usually takes 1-2 hours. This procedure requires an overnight stay in the hospital. How much rest is required after surgery Your nasal packs are removed on 2nd day of surgery and after that you will feel better. Within 3-4 days, you can return to work & lead normal life. What are my chances of recurrence of disease Chance of recurrence of disease especially in cases of polyps is 2-3%. Regular Endoscopic follow up after Endoscopic sinus surgery is absolutely mandatory which minimizes the recurrence rate. Is this surgery absolutely safe without complications Complications should not happen in expert hands and it is a safe surgery. The risks and possible rare complications will be discussed with you during consultation, which depend on the extent of disease, especially in cases of advanced disease.
	Post Surgical care After Endoscopic Sinus Surgery : Semisolid diet for 1-2 days and then normal diet. Nasal packs will be removed after 2-3 days if nasal septum is also corrected. Nasal drops as per instructions given to you after removal of the nasal packs. Steam inhalations to provide humidity morning and evening for about 3-4 weeks. JAL NEETI- Hypertonic saline nasal douches or irrigation twice a day for six weeks from second postoperative day or after the removal of nasal packs. Nasal douches will clean the thick discharge and crusts from the nasal cavities and help for speedy healing and recovery. Antibiotics for about one week or as advised. Short course of systemic steroids in nasal polyposis. Topical steroids nasal sprays. Patients are given instructions in postoperative period regarding the use of nasal sprays and the patient should not stop these of their own. Careful cleaning of crusts with suction aspiration of discharge once a week for 3 weeks under endoscopic control. You will be given dates for subsequent nasal endoscopic examination for exact assessment and follow-up. Healing after endoscopic nasal and sinus surgery generally takes about eight weeks. The long term endoscopic follow up is very important for your best interest and benefit in these endoscopic sinus surgery techniques to achieve long lasting successful results.