Endoscopic Sinus Surgery

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If you suffer from recurrent sinus problems or are tired of repeatedly having to take sinus medications including antibiotics, nasal sprays, and decongestants, you may be a candidate for Endoscopic Sinus Surgery (ESS). Other common criteria for ESS include the presence of nasal polyps, obstructed sinus openings, fungal sinusitis, mucoceles (expanding cysts within the sinuses), and tumors.

ESS uses video micro-endoscopic guidance through the nose to access the sinuses. This technique allows the enlargement (“unblocking”) of the natural opening to the sinuses without creating “unnatural” holes in the sinus. ESS also allows the removal of polyps, scar tissue, and the infected lining of the sinuses, which may harbor bacteria or fungus. The sinuses are also “washed out” of infected debris.

The total time for this procedure may take from 45 minutes to a couple of hours depending on the complexity. ESS is performed using general anesthesia (you are asleep throughout the procedure) and you should anticipate going home the same day unless other medical conditions complicate recovery.

Dr. Pasha may also recommend a septoplasty and/or partial turbinate reduction in order to allow you to breathe better through your nose as well as making it easier to access the sinuses using endoscopic instruments.

FAQ

Following the operation there are three common complaints.

  1. Bleeding and Drainage: You will have post-operative drainage for 2-4 days. The initial drainage will be blood-tinged but will become clear.
  2. Sinus Pressure: You may have temporary sinus pressure as you heal but for the most part discomfort is minimal. Since Dr. Pasha often performs a Septoplasty with his sinus procedures, the temporary splints may block the sinus opening causing sinus pressure. After one week when the splints are removed, you should find a dramatic difference in your nasal breathing and relief of your sinus pressure.
  3. Nasal Obstruction: If you have a septoplasty or turbinate reduction with your sinus surgery you will have splints inserted. Plastic splints are temporarily placed inside your nose to support the nasal septum. Dr. Pasha rarely uses packing or cotton in the nose. If you speak to other patients who have had a nasal operation by another surgeon, they may say the worst part of the procedure is when they remove the packing. You will not have this experience unless you bleed and require traditional packing.

The second week, Dr. Pasha will take a second look at your sinuses in the office and clean out any remaining debris. This is not a cosmetic procedure and the nasal bones are not touched; only the inside of your nose is changed. No one should be able to notice that you had a nasal operation except for the fact that you breathe better!

Dr. Pasha has been trained in the most advanced techniques in sinus management. In the past, operations on the sinuses were conducted through incisions on the face, under the gums, or by placing new holes in the nose. Modern sinus surgery utilizes endoscopy (video microscopes) to guide the surgeon through the sinus through the nose without making any incisions on the face. In some complex situations Dr. Pasha may elect to use an image guidance system. Image guidance combines the use of a special CAT scan (X-ray) and a computer to generate a three-dimensional model that Dr. Pasha can use while operating.

Balloon Sinuplasty™ is Dr. Pasha’s research interest and his specialty. This less invasive methods to address the sinuses and may be considered for select patients.

Endoscopic Sinus Surgery as well as Septoplasties and Turbinate reductions are routine cases with rare complications. The most common risks of the procedure is bleeding. If this occurs you may require nasal packing that may be removed in the office or the operating room. Other rare risks include recurrence of sinusitis especially if one does not take care of his nose afterward with nasal sprays and allergy management. The risk of general anesthesia as well as other rare complications will be discussed with you in the office.

There are a number of reasons that someone may have failed sinus surgery. Some of these reasons includes the following:

  1. Allergies: if you have allergies as well as recurrent sinus disease problems and you do not address your allergies you may have recurrence. Remember – surgery does not cure allergies.
  2. Nasal Polyps: nasal polyposis has a higher rate of recurrence than sinus disease alone. Nasal polyps represent severe inflammation. Removing the polyps surgically does not address the underlying cause of the polyps in the first place. Dr. Pasha has a large patient volume of nasal polyp patients. He treats them aggressively after the operation to prevent recurrence through medical management, allergy therapy, and special nasal sprays/irrigations that are directed for severe inflammation.
  3. Scar Tissue and Closure of the Sinus Openings: healing can be unpredictable and on occasion a wound may heal in unfavorable ways. This possibility may also occur in the nose.

Dr. Pasha has a special interest in revision operations. Having performed over 2,500 nasal procedures, he is experienced in the higher skill set required for revision procedures.

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