Surgical treatment may be necessary to alleviate chronic cases of sinusitis. Most cases, however, are resolved with medical therapy. Surgery is usually only recommended for those patients, who experience recurrent or persistent problems despite proper medical treatment. The concept of surgical treatment is based on restoring the natural function of the sinuses. Mucous produced within the sinus moves toward the natural opening of the sinus and results in stagnation of the mucous creating a culture media for growth of bacteria.
New Treatment for Nasal Polyps
Washington University otolaryngologists are among the first in the United States to offer a breakthrough new innovation for treating nasal polyps quickly and easily in the physician’s office, under local anesthesia.
Millions of Americans – up to four percent of the population – have nasal polyposis, also called nasal polyps. Nasal polyps are benign growths in the lining of the nasal passages or sinuses that can cause breathing problems, loss of sense of smell and taste, difficulty sleeping, runny nose, and frequent infections.
Polyp removal, or polypectomy, relieves symptoms by immediately improving airflow through the nasal passages. Traditionally performed in the operating room under general anesthesia, polypectomy can now be performed during a routine physician office visit under local anesthetic using a new, hand-held device that removes polyps quickly, easily, and virtually painlessly.
John Schneider, MD, director of rhinology, says, “This new treatment offers a much-needed alternative for patients with difficulty sleeping, breathing and losing their senses of smell and taste due to nasal polyps. Results are immediate, and patients, many of whom have been suffering for years, are thrilled to now have a minimally invasive option that does not involve a long recovery time, or the side effects and possible limited effectiveness of steroid medications.”
For more information or appointments, call (314) 362-7509.
Functional Endoscopic Sinus Surgery (FESS)
Functional endoscopic sinus surgery, is performed through the nose using endoscopes with visualization by high definition video monitoring. There are no incisions on the face nor inside the mouth. It is performed under general anesthesia usually as an outpatient with discharge the same day.
The surgery is directed at the involved sinuses as demonstrated by the pre-operative CT scan. Many surgeries are performed under image-guided technique which guides the surgeon by accurate localization of the instruments during the procedure as visualized on a computer, three-dimensional image.
Any of the sinuses can be approached by this surgical technique, including the maxillary sinuses in the cheeks, the ethmoid sinuses between the eyes, the frontal sinuses in the forehead and the sphenoid sinuses centrally located behind the eyes. By using this technique, polyps are removed, the septum may be straightened and the turbinates can be reduced in size.
Care of the nose and sinus area after surgery involves flushing of the nose with saline by the patient and postoperative office visit within the first two weeks. Antibiotics and steroids may also be prescribed.
At the office visit the nose is cleaned of mucous and crusts and patients usually continue the saline irrigations for weeks to months. Swelling or discoloration of the nose and face usually do not occur. Usually patients may return to regular aciivities within several days. Long-term care of the sinus area may include intranasal sprays, allergy testing and treatment and discontinuance of abusive habits such as smoking.
In most cases, good long-term results are achieved, but recurrent disease may occur depending on history of polyps, allergy, smoking and immunologic problems.
The complication rate of endoscopic sinus surgery is very low because of more widespread subspeciality training of sinus surgeons and also more precise techniques of sinus instrumentation.