Sinus infections can leave you feeling drained, fatigued, and miserable. For people diagnosed with chronic sinusitis for whom prescription medications don’t bring relief, a surgical procedure may be helpful.
“In sinus surgery, we open the natural drainage passageways to allow for adequate ventilation and drainage. This also allows us to achieve better medication delivery into the sinuses,” says R. Peter Manes, MD, a Yale Medicine surgeon specializing in otolaryngology. “It also enables your doctor to perform biopsies and cultures to evaluate for the presence of bacteria or tumors.”
At Yale Medicine, we perform several types of sinus surgery not available elsewhere, and our surgeons are expert at making repairs if a previous sinus surgery was unsuccessful.
What conditions are treated with sinus surgery?
Sinus surgery may be used to treat many conditions, including:
- Chronic sinusitis (sinus infection or allergies)
- Deviated nasal septum
- Nasal polyps
- Nasal cavity and paranasal sinus cavity tumors and cancer
- Enlarged adenoids
- Enlarged turbinates
- Sleep apnea
What are the different types of nasal and sinus surgery?
There are several types of nasal and sinus surgery, including:
- Functional endoscopic sinus surgery (FESS). In FESS, a surgeon inserts an endoscope equipped with a camera and light into the nose and guides it to the sinuses. This allows the surgeon to see inside the sinuses, and use surgical instruments that fit inside the endoscope to address problems in the sinuses. This minimally invasive procedure may be used to remove polyps within the nose (called a polypectomy), tumors, or other obstructions that interfere with airflow and sinus drainage.
- Septoplasty. This procedure is used to treat problems with the septum, the thin wall of bone and cartilage that divides the nose into two chambers. Normally, the septum is straight. Sometimes, however, it is bent or crooked. This is known as a deviated septum. Septoplasty is a surgical procedure to straightens the deviated septum to improve breathing and reduce sinus infections and/or nosebleeds. It may be done using an endoscope or through an incision.
- Turbinate surgery. Turbinates are thin bones in the nose. They are covered with a mucous membrane. As air is inhaled and passes through the nose, the turbinates filter, warm, and humidify it. Allergies, sinus infections, and upper respiratory infections can cause inflammation and enlargement of the turbinate mucous membrane. Enlarged turbinates can obstruct airflow and make it harder to breath. To treat enlarged turbinates, a surgeon may remove the affected turbinates or parts of them, reposition them, or us laser or radiofrequency ablation to reduce the size of the enlarged mucous membrane. Depending on the specific procedure used, surgery may require a small incision or it may be done using an endoscope.
- Balloon sinus dilation. Also known as sinus ostial dilation or balloon ostial dilation, this minimally invasive procedure is used to treat chronic sinusitis. The surgeon inserts a thin, flexible tube called a catheter into the nose and guides it into the sinuses. At the end of the catheter is a deflated balloon. When the balloon is positioned within the blocked portion of the sinuses, the surgeon inflates it, deflates it, then reinflates it. This stretches out and opens the affected part of the sinus, which improves drainage and airflow. The balloon and catheter are removed after the procedure.
- Adenoidectomy. The adenoids are small masses of tissue in the upper pharynx (the tube the connects the mouth and nose to the esophagus). The adenoids help fight infections. In some cases, the adenoids become enlarged in children, making it harder to breathe through the nose. In these cases, a surgeon may perform an adenoidectomy, or the surgical removal of the adenoids.
What can I expect after surgery?
Sinus surgery recovery is multifaceted. Your doctor will provide detailed instructions for your post-operative care. The instructions may vary, but most people require nasal irrigations, oral antibiotics, oral steroids and pain medicine. A post-operative visit is usually needed one week after surgery. During this visit, the surgical cavity is cleaned and inspected. Your doctor may remove early scar tissue.
Some bloody discharge is common for approximately two weeks after the procedure. You should not blow your nose for at least two weeks.
You can expect to have follow-up visits over the weeks and months following surgery.
What are the risks of sinus surgery?
- Bleeding: Although the risk of bleeding is minimal with sinus surgery, in rare situations significant bleeding occurs that requires termination of the procedure. Bleeding following surgery could require placement of nasal packing and hospital admission. A blood transfusion is rarely necessary.
- Postoperative Infection: Any surgical procedure carries the risk of post-operative infection. If an infection develops after surgery, antibiotics are prescribed.
- Recurrent sinus infections: Although endoscopic sinus surgery provides significant benefits, surgery is not a cure for sinusitis. You can expect to keep taking sinus medications after surgery. The goal of surgery is a decrease in the frequency and intensity of symptoms. In some instances, additional surgery may be needed.
- Other risks: Some people experience tearing of the eye from sinus surgery or sinus inflammation. If persistent, this may require additional surgery. You may experience numbness or discomfort in the upper front teeth for a period of time. Swelling, bruising, or temporary numbness of the lip may occur, as well as swelling or bruising around the eye. Subtle changes in the sound of your voice are common.
What distinguishes Yale Medicine's approach to sinus surgery?
We perform several types of sinus surgeries not available elsewhere, and our surgeons are expert at revision sinus surgery if a previous sinus surgery was unsuccessful. In addition, our surgeons use the latest image-guidance technologies and post-operative treatments.