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The First Decision: Am I Ready for Surgery? : Understanding Alternatives

The first step in consulting with your doctor about undergoing sinus surgery is the simple awareness that surgery is a big decision.

Doctors typically recommend that his or her patient exhaust all viable methods of treatment before turning to surgery. In general, once a patient is initially diagnosed with acute or chronic sinusitis, doctors will recommend conservative medical treatment. One option is a course, or several courses, of antibiotics, decongestants, antihistamines or other medications over a period of time. This is an attempt to treat the inflammation or bacterial and fungal infections to a point where the body is able to handle the infection on its own.

You should make several lifestyle changes to help alleviate your sinus issues. For example, quitting smoking and/or taking steps to avoid harmful pollutants, allergens and other bacteria in the home and outdoor environment may serve as an effective solution. Specifically, these steps act to preserve the health of the sinus and nasal cilia, which can reduce further instances of acute and/or chronic sinusitis.

Another alternative switches the focus in eliminating sinus complications from treatment to prevention. Sometimes, merely following a strict regime of nasal sprays containing steroids, in conjunction with saline sprays or other similar nasal washing products may be all that is needed to purge your sinus woes. While this appears to be a simple and basic approach, for many patients, it serves as an extremely effective & easy method for preventing the onset of sinus inflammation and blockages. Dr. Bennett reminds patients that it is important to be diligent and to remember to use the nasal sprays and saline rinses as your doctor recommends.

If these and other alternative treatment plans have failed and your doctor advocates for sinus surgery, this decision must be based on a variety of assessments relating to the following:

 (1)  Severity of symptoms

 (2)  Results of a CT scan and

 (3) General physical condition*

 *Children or adults over age 60 should take extra care in understanding the risks and complications involved in going forward with any form of sinus surgery

The Second Decision: Which Surgery is Right for Me?

If you have carefully considered your doctor’s input, and feel comfortable with the decision to move forward with surgery, the next decision is to determine which type of surgery will provide the most effective results based on your symptoms.

Sinus surgery has changed greatly since its inception. There have been groundbreaking advances in the ability to visualize inside the sinuses as well as in micro-surgical equipment and image-guidance. The following are the three commonly used types of sinus surgery:

 (1) Functional Endoscopic Sinus Surgery (FESS) –

Full Article

 (2) Balloon Sinuplasty Surgery –

Full Article

 (3) Traditional Sinus Surgery –

Full Article

Each of the three procedures listed above accomplishes the same goal in different ways. All three clear blocked sinus passages and aim to restore healthy functioning of your sinuses.

Although only the FESS and Balloon sinuplasty are commonly performed today, knowledge of the methods, risks, complications, and recovery expectations of all three procedures will allow you to make the most informed decision with your doctor.

See Dr. Bennett’s Three-Part Guide to Sinus Surgery articles for an in-depth overview of the most common types of sinus surgery

FACT SHEET: Option 1 – Functional Endoscopic Sinus Surgery

      The most common procedure that maximizes results & minimizes risks

  • The modern and most common surgical method for sufferers of chronic sinusitis and recurrent acute sinusitis
  • Patients typically receive general anesthesia, but local anesthesia may be appropriate in some cases
  • Two Step Process:

              (1) A surgeon inserts an endoscope into the nasal cavity with a fiberoptic

              lens to identify the specific obstruction 

              (2) A surgeon then uses several fine instruments to cut and remove the   

              infected tissue or bone and open passages

  • Following surgery, the nose is covered in a sponge dressing to catch blood or drainage from the nose; aftercare will be important because the nose must be free of crust-build up. Flushing the nose via a nasal rinse 2-3 times daily is  has been shown to speed healing
  •  Patients typically experience full results after one or two months
  • No external incisions are needed, with all surgery taking place through the nostrils
  • Typically performed under in one to three hours, however some cases may take longer depending upon:

– The severity of the patient’s condition and amount of blockage

-The experience and thoroughness of the surgeon

– The sinuses on which the surgeon is operating

  • A very serious risk is blindness due to optic nerve damage, although the risk is extremely low; the most common major complication is cerebrospinal fluid leak. This risk is also low (0.2% of cases, nationally)
  • Most commonly-reported results are an elimination of nasal obstruction and facial pain 

     FACT SHEET:  Option 2 – Balloon Sinuplasty Surgery

      Highlights: Relatively safe, less-invasive, allows for a speedy recovery & potentially long-lasting results

  • A newer form of sinus surgery; less invasive than FESS and often performed by doctors in their office
  • Sometimes referred to as Balloon sinus dilation (BSD)
  • Symptoms triggering the need for a BSD procedure are the same or less severe than those experienced by patients undergoing a standard functional endoscopic sinus surgery (FESS)
  • Limited to the frontal, sphenoid, and maxillary sinuses only; appropriate patients who consider this option have disease limited to these sinuses.
  • Patients with ethmoid disease (very common), pansinus polyposis (polyps existing in all of the sinuses), severe fungal disease or possible tumor(s) are not candidates for BSD alone as tissue is not removed by use of the balloon
  • Patients may receive either general anesthesia or local anesthesia for the procedure
  • There is a low complication rate, but the procedure is not without risks, which include bleeding, subsequent infection, and possible eye injury or blindness
  • A return to work and normal activities is 2 days, on average, for those patients who select the in-office procedure
  •   Five-Step Process 

               (1) Insertion of a sinus guide catheter into one nostril under endoscopic 

               visualization to the blocked sinus opening

               (2) A guide-wire that is inserted through the catheter into the blocked sinus

               (3) A small balloon is advanced over the guide-wire into the sinus and sinus   

               and blocked sinus opening 

              (4) The surgeon gently inflates the balloon to “reshape” the nasal cavity and

               expand bone of the nasal passage

               (5) The balloon is deflated and then removed


FACT SHEET:  Option 3 – Traditional Sinus Surgery

       A rarely used option of last resort for the chronic sufferer

  • An option for patients who have experienced a failed FESS operation, have severe complications of sinusitis or have tumors in or adjacent to the nasal cavities and sinuses such as:

(1) A severe case of pus-filled sinuses

(2) A severe infection in the facial bones; or

(3) A severe brain abscess

  • The most invasive type of surgery – the surgeon makes an incision in the mouth or facial skin to access the sinuses directly to remove the tumor or infected tissue
  • After surgery, the nose is packed with gauze in order to prevent bleeding and absorb drainage.
  • Aftercare may include changing the packing multiple times per day, and irrigating the sinuses
  • Involves a higher incidence of more serious risks, such as: heavy bleeding form the nose, inflammation of the cranial membrane, partial loss of sight, death
  • Success rates are above average, although the amount this type of surgery has decreased dramatically since the advent of FESS

Image Guidance used in Sinus Surgery

Image-guided surgery uses complex mathematical algorithms to create a  3-dimensional mapping system used during surgery. This is best described as combining together the basic sinus CAT scan and live, streaming information about the exact position of surgical instruments via infrared indicators.

Perhaps the most revolutionary aspect of this new type of sinus surgery is in the way that it shows the actual position of the surgical instruments in all three views of the sinus CAT scan. A live video image of the instrument is also shown. This can be invaluable when operating on nasal polyps or previously operated sinuses.  Interestingly enough, the mapping system used was taken from the missile guidance division of the United States armed forces.

This type of surgery is being increasingly used in the United States. Typically, 3-D image guidance is used for those who have sinus disease against the brain or eyes, have nasal polyps, are undergoing revision sinus surgery, or have frontal or sphenoid sinusitis.


Be Prepared for Your Office Visit. 

All three surgeries require a discussion about your past and pre-existing health conditions, as well as post-op instructions. Review the following checklist to anticipate the information you will need to give, and be provided with, leading up to, and on the day of surgery:

  • Pre and post-operative instructions
  • Common risks, possible alternatives and patient expectations
  • Collection of previous operative notes and records, including recent CAT scans
  • A complete medical history
  • Current or past nose injuries
  • Current breathing difficulties
  • A list of your current medications
  • Medication allergies

Our staff takes care of the following as far as checking your healthcare benefit eligibility and letting you know what they are so there are no surprises. We will perform and provide:

  • Scheduling of the surgery & additional follow-up visits*
  • Pre-authorization for the surgery*
  • Approximate surgical costs for you*

*Note: Typically, you will meet with your surgeon’s office manager and/or patient care coordinator to discuss these actions