Endoscopic Sinus Surgery: Everything You Need To Know

Philip Scolaro, MD

A collection of surgical instruments for endoscopic sinus surgery sit jumbled on a white tray.

If you’ve been suffering from chronic sinus congestion, it’s likely that you’ve tried a variety of decongestants, steroid sprays, neti pots, and allergy shots. Maybe your healthcare provider has even recommended endoscopic sinus surgery.

But you’re just not sure. Clearing out the sinuses through surgery? Isn’t that kind of… crude? Like “rootering” out a clogged pipe? And what if it doesn’t work?

Fortunately, the reality of endoscopic sinus surgery is much more delicate than pipe cleaning. Modern medical technology allows surgeons to clear the sinuses using tiny, sophisticated instruments. No “rootering” required!

What Causes Sinus Problems?

The sinuses are air-filled spaces in your skull. Each person has four sets of sinuses: in the forehead and cheekbones, behind the nose, and between the eyes.

Researchers are still exploring why the sinuses exist. But we do know that they lighten the skull, produce mucus that lubricates the inside of the nose, and allow your voice to resonate and carry farther.

Though the sinuses are usually filled with air, they can become blocked through inflammation, mucus, or nasal polyps, causing them to fill up with mucus and fluid. This moist environment creates an ideal breeding ground for bacteria.

Suddenly, what was once an air-filled cavity is now home to many unwelcome bacterial invaders.

Who Needs Endoscopic Sinus Surgery?

In many cases, treatments like antibiotics and steroid sprays work well to clear this sinus blockage. But even after these treatments, some people still have blocked sinuses.

Patients suffering from persistently blocked sinuses which have not responded to treatment may want to consider endoscopic sinus surgery.

Persistently blocked sinuses are more than just a nuisance. If left untreated, persistent sinus infections can potentially invade the orbital cavity, eye, or brain to cause further complications. Such cases are rare, but still a good reason not to let blocked sinuses go unchecked.

In most cases, patients simply become fed up with the inability to breathe through their nose. The facial pressure, congestion, and drainage make their lives miserable.

How To Prepare for Endoscopic Sinus Surgery

Your ENT doctor will usually perform a CT scan prior to recommending endoscopic sinus surgery. The CT scan allows them to locate the exact site of the chronic infection and inflammation.

To prepare for surgery, you’ll need clearance to stop taking any blood-thinning medications like aspirin or warfarin several days prior to surgery. Stopping these medications is vital to preventing excessive bleeding during and after the procedure.

You will also receive a prescription for a 10-day course of antibiotics and steroids before surgery. Taking these medications beforehand is important because they further decrease bleeding and help your surgeon to better see the inside of your sinuses during surgery.

What Happens During Endoscopic Sinus Surgery?

Most endoscopic sinus surgeries are performed in an outpatient surgery center. They are performed under general anesthesia, so you won’t be awake during the surgery.

The surgeon inserts an endoscope (a thin tube with a light and a tiny camera attached to the end) through your nostrils to see into your sinuses. The endoscopic camera displays an image of the sinuses onto a video monitor, while the surgeon uses computer-guided instruments to carefully remove any large blockages. Blockages may include bone, tissue, polyps, or tumors. Clearing these blockages allows for a wider opening for air to flow through the sinuses.

Although endoscopic sinus surgery can be completed in as little as 30 minutes, more involved surgeries (as in cases with extensive polyps) can last two to three hours.

A general principle that guides the extent of endoscopic sinus surgery is that the more open the sinuses, the better the patient will feel.

Experienced surgeons perform more complete surgeries so that the patient will be less likely to need a follow-up procedure in the future. So when considering endoscopic sinus surgery, it’s important to look for a high-volume surgeon who performs many procedures each year. They are unlikely to miss anything the first time around.

Recovery From Endoscopic Sinus Surgery

Your surgeon will insert packing into your nose at the end of your surgery. This packing is dissolvable, so you won’t need to worry about removing it. After surgery, you can begin using saline irrigation several times a day. Saline helps to dissolve the packing and flush out any lingering crustiness while your nasal cavity heals.

Fortunately, recovering from endoscopic sinus surgery is not usually painful. You can expect quite a bit of nasal congestion for about a week after the surgery, but it’s important to avoid blowing your nose at this time. Many patients find it helpful to sleep upright in a recliner for a few days due to the pressure and nasal obstruction from the packing.

As is the case with most surgeries, nonsmokers tend to recover faster and better than smokers, since smoking restricts blood flow to healing tissues.

Patients should avoid heavy lifting and strenuous activities such as running for a week or two after surgery to prevent excessive bleeding.

After surgery, we provide our patients with nasal irrigations that contain a combination of saline solution and steroids. When patients experience a slower-than-normal healing time, it’s almost always because they aren’t using this irrigation as prescribed. In our experience, irrigating once or twice a day significantly decreases healing time.

Curious About Endoscopic Sinus Surgery?

If symptoms of chronic sinusitis are interfering with your life and your ability to breathe, give us a call. Our entire team at ENT Associates of Lubbock loves helping our patients breathe easier, and we understand people’s fears surrounding endoscopic sinus surgery.

The surgeons at ENT Associates of Lubbock, Dr. Scolaro and Dr. Cuthbertson, are experienced in treating patients who have chronic sinusitis. We look forward to hearing from you!


Disclaimer: The content on this website is written and/or reviewed by a qualified medical doctor and great care is taken to provide accurate general information. However, it is for informational purposes only and is not to be taken as a substitute for medical advice from your own physician who is familiar with the details of your medical history. Always consult your doctor regarding health concerns before deciding any course of medical action.