Endoscopic sinus surgery (nasal polyps, sinusitis)

Endoscopic sinus surgery is a surgical treatment used to solve different nasal and sinus problems, using endoscopes that are introduced through the nostrils without leaving external scars.

Thanks to endoscopic nasosinusal surgery, inflammatory and infectious pathologies such as chronic sinusitis, nasal polyps, mucoceles, closure of cerebrospinal fluid fistulas, extraction of foreign bodies, control of epistaxis (nosebleeds) or tumours can be eliminated. 

In addition, this surgical procedure is fully recommended to resolve ophthalmological conditions such as orbital and orbital nerve decompression and even dacryocystorhinostomy (release of the tear ducts).

The nostrils

The nostrils are two cavities separated by the sagittal septum, located above the mouth. This formation communicates with the outside world through the nostrils and with the pharynx through the choanae. Inside, there are the nasal vibrissae that filter the air we breathe in, as well as the mucus-secreting cells that line the internal walls and collect the dust particles that enter with the air.

There is also the cellular structure called the pituitary, which covers the deepest part of the nostrils. We can differentiate between the yellow pituitary, which is connected to the central nervous system and is responsible for capturing all the odours present in the air.

And on the other hand, the red pituitary, formed by the blood vessels present in the nose and which fulfils the function of heating the air we inhale, so that it does not reach the lungs cold and any microorganisms that may be present in the air die.

The sinuses

The sinuses are air-filled cavities in the bones of the skull. We all have four sinus cavities on each side of our nose, which include the maxillary, frontal, ethmoidal and sphenoidal sinuses. 

These cavities fulfil multiple functions, such as: filtering the air we breathe, helping with phonation when we speak, they are part of our olfactory system, as well as regulating our internal temperature. 

In addition, these structures are responsible for producing a type of fluid that coats the bone and adheres to the adjacent cartilage, which helps to contain and protect our organism from bacteria, as well as humidifying and heating the air.

Both structures can be affected by various pathologies that appear due to the overexertion of protecting the organism and the respiratory system from allergic reactions, bacteria, viruses or fungi. As a general rule, the diseases that can develop are of an inflammatory or infectious nature, which we explain in more detail in the following section.

What limitations can the nasal passages and sinuses suffer from?

As we have already mentioned, the nasal passages and paranasal sinuses can suffer limitations in their functioning due to infections and inflammation caused by external agents such as bacteria, fungi, viruses or recurrent allergies.

The most common conditions are sinusitis, rhinitis and their subsequent complications such as polyps and purulent mucus. When these problems occur, inflammation of the structures that make up the nasal passages and paranasal sinuses appears. It is also common for the mucus produced by the paranasal cavities to harbour bacteria that cause infections, aggravating the symptoms and making it impossible for drug treatments to take effect.

The different pathologies can cause symptoms such as nasal obstruction or congestion, facial pain, nasal secretion, purulent rhinorrhoea, total or partial loss of smell, the appearance of polyps and mucous oedemas.

The reasons for performing endoscopic sinus surgery are diverse, although they are all focused on alleviating the discomfort caused to the patient, due to the problems affecting the nasal and sinus passages.

As we mentioned earlier, the function of these structures is to help the respiratory system to function correctly, as well as to protect our organism from germs present in the air, but there are cases in which their work is overstressed and they become inflamed and infected. When this happens and pharmacological treatments do not work, specialists recommend resorting to endoscopic sinus surgery.

Cases in which a patient is a candidate for nasal and sinus surgery include the following:

• Acute, chronic or recurrent sinusitis: the onset of sinusitis occurs when there is an overgrowth of bacteria and germs in the sinuses, causing a viral or bacterial infection. Although it is possible to treat sinusitis with medication, problems may recur or fail to subside, so if treatment with medication fails to make the symptoms disappear, the only definitive solution is endoscopic sinus surgery.
• Nasal polyps: these are abnormal growths of the internal nasal tissue or mucosa. They usually appear due to prolonged irritation or inflammation of the nose. They can be solved with nasal inhalers or pills, which reduce their size. However, as in the previous case, surgical treatment is much more effective.
• Epistaxis: these are recurrent nosebleeds. They usually occur due to trauma or deviation of the nasal structure, causing the blood vessels to rupture and bleeding occurs. Endoscopic sinus surgery is necessary to restore the normal functioning of the nasal passages.
• Nasal and sinus tumours: the only remedy for this type of problem is usually surgical treatment, regardless of the type of tumour or the aerodigestive area in which it appears.

Before deciding whether or not to have surgery, you should request a free consultation with our specialist in Otolaryngology Surgery through Operarme's website, so that you can meet him/her in a face-to-face consultation and he/she can assess whether or not the intervention is indicated. 

We recommend that you bring to the consultation any medical evidence you have about the problem, as this will help the doctor in his or her assessment.

After requesting the consultation through the website, one of our patient service advisors will call you to confirm the date of the consultation and answer any questions you may have. However, you can also request information at any time by calling at +34 91 141 33 56, or sending a contact form.

Do you need surgery to eliminate nasal polyps?

Request a free and immediate appointment with our specialists in Otorhinolaryngology

Make an appointment

On the day of the appointment, the doctor will review the reports you provide and will conduct a medical interview about the discomfort caused by the inflammation of the nasal cavities and sinuses. The specialist will also carry out an examination of the area in order to familiarise himself or herself with your case, making a more accurate diagnosis and determining the most appropriate treatment for you.

During this consultation, the specialist will explain what endoscopic sinus surgery (ESS) consists of and will answer any questions you may have about it. Do not hesitate to ask the doctor any questions you may have about the intervention or the state of the pathology, so that you can make the best decision.

In the event that you and the specialist decide that the ESS operation is the best option for your case, the date of the surgery can be set during the same consultation. In any case, our patient service team will contact you and manage the whole process, preoperative, admission date, consultations…

As for any surgical intervention, a preoperative study must be carried out during which the following tests are performed:

• Blood tests: to rule out signs of infection or other factors that may complicate the operation.
• Chest x-ray: this test helps to rule out respiratory problems and is usually performed only when the specialist deems it necessary.
• Electrocardiogram: this allows the specialist to know the health of your heart.
• Bone computed tomography (CT or CAT scan): thanks to this test, the anatomy of the paranasal sinuses and nasal cavities can be observed, as well as possible variations caused by the disease. It can also detect the presence of mucoceles, polyps, mucous content or bone involvement. This test must be provided by the patient or paid for separately in order to make the diagnosis. Contact our patient care team for more information.

Anaesthesia for endoscopic sinus surgery (ESS)

The operation is usually performed under general anaesthesia, although occasionally it can be performed under local anaesthesia associated, in this case, with sedation and analgesia of the patient, according to criteria to be assessed by the surgeon.

In addition, throughout the surgical procedure, the anaesthetist will monitor your vital signs, pulse, blood pressure, oxygenation and anaesthesia levels. You will also continue to be administered drugs during the surgery to control pain and aid postoperative recovery.

Endoscopic sinus surgery (ESS) is considered a minimally invasive procedure, which can be performed on an outpatient basis, i.e. you can return home the same day of the intervention without being admitted to hospital, always depending on the surgeon's indications. 

Below we explain how the day of the operation will go:

Once at the hospital, you will have to hand in the necessary documentation at the admissions desk. After that, you will be accompanied to the operating theatre area where you will be asked to undress and get dressed in your surgical clothes.

Once you have been prepared for surgery, you will be taken to the operating theatre, where you will meet the surgeon with whom you had your consultation, the anaesthetist and a member of the nursing team. 

After you have been positioned on the stretcher, the surgery will begin:

1. The first step will be to give you a general anaesthetic, which will be administered by the anaesthetist who attended to you during the pre-operative period.
2. Once the anaesthetic has taken effect, the surgeon will apply a nasal decongestant to reduce the swelling of the mucous membranes of the nasal passages.
3. As soon as the drug takes effect, the nasal wall is dissected. To do this, a very fine, rigid optical fibre is introduced through the nostril to obtain a direct view of the opening of the sinuses and, using special surgical instruments for this type of surgery, the surgeon will proceed to resect the abnormal or obstructive tissue.
4. After removing the obstructive tissue, the specialist will check the bleeding points and, depending on the case, a nasal packing will be left in place to prevent bleeding. In addition, silicone sheets will be placed to prevent adhesions from one wall to the other, as well as to avoid the formation of abnormal scars.

At the end of the endoscopic sinus surgery, you will go to the post-surgical room where you will recover from the effects of the anaesthesia and will be monitored by the nursing team. Depending on the complexity of the surgery, you may be discharged the same day or you will remain in hospital for one or more days until you are ready to continue your recovery at home.

Endoscopic sinus surgery lasts approximately 1 to 3 hours, depending directly on the complexity of each case.

Once out of the operating theatre, you will be transferred to the post-surgical ward where you will recover from the effects of the anaesthesia. During recovery in the hospital, you have nothing to worry about, this stage is not usually painful and the most frequent discomforts are temporary nasal obstruction as a result of tissue inflammation, as well as increased mucus production and crusting.

To remedy these discomforts, you will be prescribed frequent nasal washes with saline solution and a moisturising nasal ointment that should be applied until indicated by your specialist.

On the other hand, depending on the complexity of the surgery, you may experience some post-surgical symptoms such as fatigue, nasal congestion, slight bleeding or discomfort. Your doctor will prescribe drugs to reduce these discomforts, usually steroids and antibiotics.

The length of the recovery process usually depends on each patient, although improvement is generally noted 3-5 days after surgery and full recovery after 2 weeks.

The main advantage of endoscopic sinus surgery is that it corrects problems caused by infection and inflammation of the nasal and sinus passages, re-establishing their correct functioning and improving the patient's quality of life.

It also stands out for being a minimally invasive technique, which produces less intraoperative bleeding, is a much faster procedure than those that precede it and leaves no external facial scars.

Beyond the common complications of any type of surgery such as infection, bleeding or problems with anaesthesia, which occur rarely in general and are minimal in ESS in particular, there are risks such as bleeding, mentioned above, which usually resolve after the first few days of recovery and rarely persist.

Do you need surgery to eliminate nasal polyps?

Request a free and immediate appointment with our specialists in Otorhinolaryngology

Make an appointment