Functional Endoscopic Sinus Surgery (FESS)

Diagnostic Tests Before Endoscopic Sinus Surgery

Sinusitis can be easily diagnosed because of its distinctive symptoms such as postnasal drip, facial heaviness, pain and swelling around the eyes, cheeks, nose, or forehead, blocked nose, etc. However, a comprehensive diagnosis is necessary to determine a treatment plan, especially if the patient is not showing significant improvement through medical management. Common diagnostic tests performed for sinusitis are:

• Nasal endoscopy
• Lab analysis of nasal and sinus discharge
• Imaging tests like CT scans, X-rays, etc.

These tests help determine the cause of sinus infection and whether the patient has a deviated nasal septum or nasal polyps that may be contributing to the condition.

Preauricular Nose Sinus Surgery

Preauricular sinuses are common congenital malformations. They affect men and women, and they can be unilateral or bilateral. A preauricular sinus appears as a very small pit in front of the external ear. When a preauricular sinus becomes infected, it is an indication for surgery to remove the entire sinus tract. Removal of a preauricular sinus is done under general anesthesia, and patients usually get discharged home the same day. Sutures are removed one week later, and the scars after the surgery are very minimal.

Endoscopic Sinus Surgery

Endoscopic sinus surgery is the most commonly performed surgery for the sinus. It is usually performed to widen the passages between the nose and sinuses to remove bone-infected tissues to allow the trapped mucus to drain out. This surgery is performed with the help of an endoscope, which allows doctors to look inside the nose and sinuses and perform the surgery with precision. During the surgery, a doctor puts a decongestant and numbing solution in the nose. After that, a surgeon inserts surgical tools along with the endoscope to extract bone, damaged tissue, or polyps that may be causing the blockage in your sinuses. Finally, the doctor packs the nose with bandages to soak blood or discharge.

Benefits of Endoscopic Sinus Surgery

Sinusitis surgery provides numerous benefits for individuals facing severe or recurrent sinusitis symptoms. Here are some advantages of sinusitis surgery:

• Enhanced sinus drainage: This surgery helps in removing blockages or obstructions in the sinuses to improve mucus drainage. As a result, the frequency and severity of sinusitis symptoms get decreased.
• Relief from chronic sinusitis symptoms: Consistent sinusitis symptoms such as facial pain, pressure, congestion, headaches, and post-nasal drip can be relieved by sinus surgery. It significantly improves overall well-being and the quality of life.
• Improved response to medical treatments: Sinusitis surgery can improve the efficacy of drugs and other therapies for sinusitis by removing physical obstacles and enhancing sinus drainage. This enables more effective medicine delivery and absorption to the afflicted areas.
• Correction of structural issues: A deviated septum, nasal polyps, or a nasal bone are examples of structural abnormalities in the sinuses or nasal passageways that are treated by sinus surgery. The procedure can help avoid or lessen the onset of chronic or recurrent sinusitis by addressing these problems.

Preparation Before Endoscopic Sinus Surgery

• A healthcare provider usually suggests medications to reduce inflammation and infection of the sinuses before the surgery. Medications to reduce respiratory secretions are usually given the night before the surgery.
• Patients who routinely take aspirin, anticoagulants, or NSAIDs should cease taking them at least two weeks before surgery since they increase the risk of bleeding.
• You must avoid smoking for at least a month prior to surgery and for at least a month afterward since it prevents quick recovery.
• The night before the procedure, you need to check into the hospital. You must avoid eating or drinking after midnight to avoid the chances of anesthesia-related complications. You can occasionally need intravenous liquid to stay hydrated.

Endoscopic Sinus Surgery Recovery

You must follow all the instructions provided by your healthcare provider to promote healing after the surgery. It may include wound care, medication usage, and nasal care.

• You can expect discomfort, pain, and swelling after the surgery. But these symptoms can be managed with prescribed pain medications. Proper rest is crucial during this time to promote healing.
• You must avoid excessive exercise during the recovery period as it can delay tissue healing. 
• Nasal saline rinses or sprays can treat common nasal symptoms like congestion, discharge, or slight bleeding. 
• You must attend all the scheduled follow-up appointments with your doctor to track your recovery and resolve any issues. The recovery period after surgery can vary depending on the specific condition.
• For a successful and hassle-free recovery, it’s essential to follow all the instructions provided by your healthcare provider.

Lifestyle Changes After Endoscopic Sinus Surgery

After undergoing sinusitis surgery, a doctor usually suggests making certain lifestyle changes to promote healing and lower the chance of problems. Some common lifestyle changes are as follows:

• Adopting a healthy lifestyle can help your immune system and sinuses overall. This involves managing stress, getting regular exercise, eating a balanced diet, and getting enough rest.
• To keep the nasal passages moist, remove mucus, and avoid crusting following surgery. Examples include gentle saline rinses or prescribed nasal sprays.
• Avoiding irritants that aggravate sinus symptoms or slow down healing. You must avoid allergens, smoking, potent odors, and environmental contaminants that can irritate and inflame the nasal passages.
• A healthcare provider usually advises using a saline solution for sinus irrigation to clear mucus and promote healing. To ensure safe and efficient sinus irrigation, it’s crucial to employ the right method and sterile tools.
• It is important to adhere to the detailed post-operative instructions that your healthcare provider gives you. 
• Avoid recognized triggers and maintain an allergen-free environment.

Risk & Complications Associated with Endoscopic Sinus Surgery

Some common risks and complications associated with endoscopic sinus surgery are as follows:

• Bleeding: You can expect some bleeding for the first three to five days following sinus surgery. If you suffer continuous bleeding, gently inhale through your nose while tilting your head back slightly. You can use oxymetazoline nasal spray if the bleeding does not stop. 
• Infection: Like any surgical procedure, endoscopic sinus surgery also carries a risk of infection There is a possibility of developing an infection at the surgical site or within the sinuses after the surgery. To minimize the risk of infection, a doctor usually prescribes antibiotics. 
• Fatigue: You can feel tired for the first week after surgery. A doctor usually suggests taking proper rest for at least one week to promote recovery. 
• Changes in smell or taste: There is a risk of temporary or permanent changes in the sense of smell or taste that can occur following sinus surgery. This can be due to disruption of the olfactory nerves or swelling of the nasal tissues.
• Facial pain or pressure: You can expect facial pain or pressure immediately after surgery. This discomfort typically subsides with time, but in rare instances, it may persist.
• Eye or vision problems: In some rare instances, sinusitis surgery can potentially lead to eye-related complications such as double vision, vision loss, or injury to the eye. Prompt medical attention is required in such cases.

Questions to Ask Your Doctor Before Endoscopic Sinus Surgery

Before undergoing endoscopic sinus surgery, you must ask the following questions to have a better understanding of the procedure and the risks and complications associated with it

• What are the risks and complications of endoscopic sinus surgery?
• What are the other alternative options?
• What is the recovery period after endoscopic sinus surgery?
• How can I reduce the chances of complications during the endoscopic sinus surgery?
• How can I prepare myself for endoscopic sinus surgery?
• Is endoscopic sinus surgery painful?
• How long does endoscopic sinus surgery take?
• Is endoscopic sinus surgery expensive?
• Can sinusitis come back after sinus surgery?
• What is the success rate of endoscopic sinus surgery?
• Who needs endoscopic sinus surgery?

Endoscopic Sinus Surgery Cost

The cost of endoscopic sinus surgery typically ranges from Rs. 45,000 to Rs. 70,000.  However, this is the estimated cost of sinusitis surgery, the final cost of surgery depends on various factors. Some common factors that can affect the cost of the surgery are:

• City of the treatment
• Choice of hospital
• Total hospitalization cost
• Severity of the condition
• Diagnosis and evaluation cost
• Post-surgery care 
• Patient’s age and overall health condition
• Surgeon’s fees
• Insurance coverage

Does Insurance Cover the Cost of Endoscopic Sinus Surgery?

Yes, most companies in India cover the cost of sinusitis surgery. However, the specifics can vary from policy to policy. There are a few healthcare insurance providers in India that may cover sinusitis treatment:

• Star Health Insurance
• New Health Insurance
• Bajaj Allianz
• Religare
• ICICI Lombard