Chronic sinusitis surgery: duration, cost and step by step

• Chronic sinusitis limits us in various functions of our bodies such as filtering air, perceiving odours or draining mucous fluid.
• The operation for chronic sinusitis involves endoscopic sinus surgery that aims to alleviate or reduce the discomfort caused to the patient.
• It is a minimally invasive surgery, as it can be performed on an outpatient basis, meaning that the patient can return home the same day as the operation.

Endoscopic sinus surgery is performed when nasal and sinus inflammation is permanent and nasal polyps arise. 

The aim of this operation is to alleviate or reduce the discomfort caused to the patient by the problems affecting the nasal and sinus passages.

This surgical procedure is a major advance in the field of Otorhinolaryngology, as it has significantly reduced complications and postoperative discomfort. 

The aim of the operation is to get the nasosinusal mucosa back to normal, opening the drainage orifices to eliminate infections and clean the sinuses. 

The operation lasts between 1 and 3 hours, although more details will be given later, and can be performed on an outpatient basis so there is no need for hospitalisation. However, Operarme includes one day of hospitalisation for safety reasons.

Sinusitis accepts pharmacological treatment but there are cases where the disease presents permanent symptoms, such as nasal and sinus inflammation, infection and the appearance of nasal polyps, making surgical intervention the only option for resolving sinusitis.

As we have just mentioned, sinusitis affects the paranasal sinuses, but what limitations does this disease place on the functioning of the nasal sinus structures and where are they located?

• On the one hand, there are the nostrils, which are responsible for: filtering the air we breathe, perceiving odours, collecting particles in the air present and warming the air so that the lungs do not receive it cold, functions that sinusitis directly limits. These pits are the cavities separated by the sagittal septum located above our mouth.
• On the other hand, there are the sinuses between the facial bones and the head. The disease affects the drainage of the mucous fluid inside them, the division of the air that circulates through the respiratory tract and the lubrication of the nose to keep it free of particles and bacteria.

So what situations become compelling reasons to undergo sinus surgery?

When drugs do not work on the inflamed and infected area, the right thing to do is to resort to endoscopic sinus surgery. There are several reasons for deciding to undergo sinus surgery. Thus, the patient is characterised by one of the following diseases:

• Sinusitis, acute or chronic, because as we have already mentioned, there are times when drugs do not make the symptoms disappear and the only solution is surgery. Sinusitis involves an increase in bacteria and germs in the sinuses causing a viral or bacterial infection.
• Nasal polyps are abnormal growths of the internal nasal tissue or mucosa that appear due to prolonged irritation or inflammation of the nose, caused by sinusitis. In the same case as above, they are usually treated with drugs, specifically nasal inhalers or pills to reduce swelling, but surgical treatment is much more effective.
• Episodes of epistaxis are nosebleeds caused by trauma to the blood vessels on the surface of the nasal cavity. When these are injured, blood leaks occur. Endoscopic sinus surgery improves the quality of life of the patient by correcting the functioning of the nasal passages.
• With regard to the appearance of nasal and sinus tumours, the only solution is surgical treatment, regardless of the type of tumour or the area in which it is located.

In order to determine the best treatment for sinusitis, which as we will see below is surgery in severe cases of chronic sinusitis, it is necessary to carry out a correct diagnosis. 

For this reason, here are the different tests and examinations that the ENT specialist may need to carry out:

• Rhinoscopy. This involves performing a nasal endoscopy in which a tube is inserted into the cavity in order to carry out an exploration and examination of the paranasal sinuses.
• Computerised tomography. This test is performed with a scanner that emits X-rays. The machine rotates around the patient creating separate images of the body area, called slices, to view the sinus openings and check the condition of the tissues and bones.
• Magnetic resonance imaging. This test closely follows the CT scan method except that the MRI does not emit X-rays. This test checks for tumours or infections in the sinuses.
• Transillumination. The test is performed by reducing the intensity of the lights in the room or turning them off directly, so that when the specialist projects the spotlight, it can be seen more easily.
• Finally, pressure will be applied to the sinus area to check for pain and possible inflammation or infection.

Sinusitis is a condition of the sinuses. These sinuses are air-filled cavities located in the bones of the skull and are responsible for filtering the air we inhale, as well as helping us with phonation when speaking and distinguishing smells. 

Therefore when the sinuses, which are cavities that surround our nostrils, become inflamed, sinusitis, also known as rhinosinusitis, occurs.

This disease causes some limitations in the nasal passages and sinuses due to inflammation and infections caused by bacteria, fungi, viruses or recurrent allergies. This is when nasal polyps or the accumulation of purulent mucus appear as a result, so that breathing through the nose can become costly and difficult.

Some of the symptoms caused by sinusitis can be obstruction of the nasal passages or congestion, pain in the face, nasal secretion and purulent rhinorrhoea, which would mean a loss of transparency in the mucosa, thus adopting a greenish, yellow or brown colour and a bad smell, sticky and viscous. 

It would also lead to partial or total loss of sense of smell, the appearance of polyps and mucous oedema.

With regard to the types of sinusitis, there are two categories depending on the length of time that the disease lasts, acute sinusitis and chronic sinusitis. As well as having this difference based on the time of contraction, they share other differences in relation to their causes, symptoms and treatments.

Acute sinusitis

In acute sinusitis, the symptoms do not last more than four weeks and are usually caused by a common cold or, in the worst case, a bacterial infection. 

In most cases, acute sinusitis usually clears up with a week or ten days of medication or even some home remedies. If the disease does not resolve within a maximum of twelve weeks, it could lead to serious infections and other complications and, in this case, we would be dealing with chronic sinusitis.

Chronic sinusitis

On the other hand, and as we have just mentioned, the symptoms of chronic sinusitis persist for more than three months and often bring with them infections, sinus enlargement or a deviated nasal septum. In this type of sinusitis, bacteria and fungi are very present and cause infections that are difficult to treat. 

In addition, the symptoms are not as obvious and present themselves in different ways:

• With the obstruction of the nasal passages
• Appearance of mucoid rhinorrhoea and, with it, the total loss of transparency, adopting a yellow, greenish, brown, foul-smelling and highly viscous colour, adhering to the mucosa and appearing in the form of lumps and causing a blockage in the nasosinusal orifices.
• Through hyposmia, conditioning the ability to perceive odours and partially reducing it.
• Pain in the face, swelling and pressure in the area of the forehead, eyes and cheeks. This pain increases if the area is touched or if the head is lowered.

Sinusitis operation involves endoscopic sinus surgery. It is a minimally invasive surgical procedure in which an intervention is performed in the nasal cavities and paranasal sinuses, mainly to relieve or reduce the discomfort caused by sinusitis in the patient, as well as to solve the problems that affect the nasal passages.

The aim of this operation is to restore the nasosinusal mucosa to normal. 

This is achieved by making an opening in the drainage orifices to eliminate infections and clean the sinuses.

The surgery can be performed on an outpatient basis so that you can return home as soon as possible, if not on the day of the operation. In the case of operations performed at Operarme, patients usually spend one night in hospital under observation to determine that the surgery has gone well.

Preoperative period for chronic sinusitis surgery

There is a waiting period of approximately 7 to 10 days between the surgeon's assessment appointment and the time of surgery. This is determined by the availability of the operating theatre and the need for a preoperative examination. 

Therefore, during this time, you will undergo various tests such as:

• Electrocardiogram: with this test, the surgeon and the anaesthetist will know your cardiovascular health.
• Blood test: the purpose of this test is to determine that you do not have any abnormalities or pathologies such as infections that can delay surgery until it is under control.
• Chest x-ray: this test is only performed if the doctor considers it appropriate to ensure that there is no trace of infection and your trachea is straight so that, if you request it, you may require intubation.

Once the preoperative period is over, you will have a brief consultation with the anaesthesiologist in which the specialist will determine whether you are suitable for endoscopic sinus surgery. 

This will be decided after asking you a few questions about your lifestyle, medical history and previous surgeries. 

Once the decision has been made that you are suitable, you will only need a couple of instructions from the anaesthesiologist and then the last step will be the operation.

This surgery is usually performed under general anaesthesia; however, it can be performed under local anaesthesia, sedation and patient analgesia, but always according to the surgeon's criteria.

Below we will detail the four steps to be followed by the specialist in the intervention.

The surgery: step by step

As soon as you arrive at the hospital, you will need to hand in all the necessary documentation at the admissions desk before you can proceed to the operating theatre area. There you will be provided with surgical clothes so that you can dress in them. 

Once you have done all of the above, you will meet the surgeon with whom you had your consultation, the anaesthetist and a member of the nursing team. At this point the surgery will begin.

1. The first thing to do is to give you a general anaesthetic. This will be done by the anaesthetist who was with you during the pre-operative period.
2. When the anaesthesia takes effect, the surgeon will use a nasal decongestant to reduce the swelling of the mucous membranes of the nasal passages.
3. Once the drug has taken effect, dissection of the nasal wall will begin. To proceed with the operation, a very fine, rigid optical fibre is introduced into the nostril to obtain a direct view of the opening of the sinuses. After reaching the problem area, the surgeon will use surgical instruments necessary for this type of surgery and will resect the abnormal or obstructive tissue.
4. When the obstructing tissue is removed, the surgeon will check the bleeding sites and, depending on the resolution, will either place a nasal packing to prevent bleeding or use silicone sheets to prevent wall-to-wall adhesions and the formation of abnormal scars.

Once the endoscopic sinus surgery is finished, you will go to the post-surgical room to recover from the effects of the anaesthesia, where you will be monitored by the nursing team. As we have already mentioned, the operation is minimally invasive so, depending directly on the complexity of each case, you may be discharged the same day or remain hospitalised for one or several days until you are ready to continue with the recovery and healing process at home.

Normally, the time you have to wait from the assessment appointment with the specialist until the time of the intervention is approximately 7 to 10 days. This time interval is determined and varies depending on the availability of the operating theatre and the need for a pre-operative procedure.

Endoscopic nasosinusal surgery is performed over a period of approximately 1 to 3 hours.

No external incisions are made during the operation, as the procedure is performed using a camera with different angles. This is inserted through the nostril and guides the specialist to the paranasal sinuses to see the obstructions and/or lesions with definition. 

In this way, as we have already indicated, this type of intervention means that in the vast majority of cases, the patient can go home the same day, and on their own feet, from the operation due to the fact that it is not very invasive. 

However, at Operarme, in addition to spending a night in hospital under observation, we consider it important that the patient goes with a companion or requests the free transfer service offered by the company to return home on the day of discharge. It is not advisable to drive immediately after surgery due to the inflammation of the operated area.

This operation is performed under general anaesthesia but can also be performed under local anaesthesia, sedation and patient analgesia, but always taking into account the criteria of the specialist.

Postoperative period for chronic sinusitis surgery

When you wake up from the anaesthesia, you will be transferred to the recovery room where you will stay until you recover from all the symptoms of the anaesthesia and eliminate it completely from your body.

When the patient wakes up from the operation you may feel that your nose is blocked, but this is to stop it from bleeding. This blockage can last for a couple of days. 

Once the plugs have been removed, the pressure on the face becomes evident and, as recommended by the doctor, you should avoid blowing your nose and, on the contrary, use a few drops of saline solution to clean the secretions. 

Bleeding during these days is normal and the only thing the patient should do during this time is rest.

It is true that the patient can leave the same day of the operation under his or her own steam. However, in some cases you can leave the hospital the same day after surgery, although it is usually best to stay in hospital for at least one day. 

As for returning to work, if it is not a job that requires physical effort, there will be no problem in starting as soon as possible. On the other hand, if your work requires some effort, you will not be able to return to work until two weeks after you are discharged from hospital.

The doctor will advise you about medication, as some medications, such as aspirin or anti-inflammatory drugs, increase the risk of bleeding in the next few days. The specialist will also prescribe your own treatment and its duration. 

In addition, you will be informed about the diet you should follow, as well as light, soft and fresh meals, during the first hours after the operation and until the anaesthesia is completely eliminated from your body.

Therefore, recovery after sinusitis surgery usually lasts between 3 and 5 days, although this depends on each patient.

Contracting a sinusitis operation through Operarme to solve sinusitis includes everything necessary in the price to be able to carry out the surgical intervention with the greatest possible safety and effectiveness for the patient.

We offer a fixed price, with all the necessary elements, of 4.890 €.

What does sinusitis surgery include?

Below is a breakdown of everything included in the price of endoscopic sinus surgery at Operarme.

• Free and immediate consultation.
• Stay in a single room with a spare bed and a full day's hospitality and linen service for the patient for 1 day.
• Booking and use of operating theatre
• Surgical instruments, equipment and materials.
• Preoperative study (blood tests, electrocardiogram and chest x-ray according to medical indications).
• Stay in the post-surgical recovery room, monitoring and necessary treatments.
• Medical fees and assistants until medical discharge.
• Anaesthesiologist fees.
• Medical complications insurance.

In this way, the patient should not have to worry about anything other than their health and, for this reason, Operarme includes a free transfer service so that they do not have to worry about transport. 

Thus, a taxi will pick you up on the day of your admission and return you to your home when the doctor discharges you. You can find out more about this service by clicking here.

Request a free surgical assessment consultation with our ENT specialist so that he/she can assess your sinusitis case and decide which option is the right one for your health problem.

If you would like to request a consultation, you can do so by clicking below: