Dr. Hazenfield -- Ear, Nose, and Throat Doctor in Hawaii

Endoscopic Sinus Surgery

Hugh N. Hazenfield, M.D., F.A.C.S.

This page contains information for patients who are considering or scheduled for endoscopic sinus surgery.

• This information is specifically for my own patients. 

• If you have another otolaryngologist, this may vary.  I suggest that you ask him or her about the procedure.

• Anatomy of the sinuses

  • There are four pairs of sinuses as shown in this diagram

    • Frontal

    • Ethmoid

    • Maxillary

    • Sphenoid

The Sinuses

The Lateral Wall of the Nose

The Lateral Wall of the Nose with Turbinates Removed

1.  Frontal sinus 2.  Anterior ethmoid sinus 3.  Flow from frontal sinus 4.  Flow from middle ethmoid 5.  Posterior ethmoid sinus 6.  Middle turbinate base 7.  Sphenoid sinus 8.  Inferior turbinate base 9.  Hard palate 3.

 

•  Cause of Sinus Disease

   

  • Sinusitis may be an acute or chronic condition

  • Sinusitis may be secondary to allergies

  • Sinusitis may also cause chronic coughing or bronchitis

  • Other conditions such as polyps and tumors also occur in the sinuses

• Diagnosis of Sinusitis:

  • Physical examination, often requiring a brief office procedure called nasal endoscopy

  • Cultures from the nose close to the openings of the sinuses to determine what bacteria is causing the infection

  • Computerized tomography.  This is an X-ray study of the sinuses.

   

• Treatment of Sinusitis: 

  • Allergic management

    • Avoiding environmental factors which are causing the allergies

    • Steroid nasal sprays

    • Antihistamines

    • Occasionally, desensitization

  • Antibiotics

    • The antibiotic given preferably is indicated by the culture findings

    • Often the antibiotic is given for a longer period than usual

  • Sinus irrigations

    • These are used rarely

  • Surgery (discussed below)

• Surgery

  • Many individuals have X-ray evidence of chronic sinusitis but are asymptomatic.  "Sinusitis" on an X-ray report does not always require medical or surgical treatment. 

  • Surgery involves opening the sinuses, making the openings larger to allow better aeration, and draining any infected material and/or removing masses or polyps

  • This is usually done endoscopically through the nose

  • Rarely, it requires incisions under the lip or in or near the eyebrows

   

• Preparation for surgery:

  • I will meet with you (and possibly also with your family) before surgery to discuss what to expect, alternative treatment options, and risks.

  • It is important for you to understand that, as with all surgery, there are also risks with sinus surgery.  These include, but are not limited to, the following:

    • Bleeding. This may be significant, requiring stopping the procedure.

    • Infection.  Your sinuses most likely already are infected.  Antibiotics will usually be given within one hour of the beginning of the surgery and continue after surgery.

    • Nasal obstruction for 1-2 days after surgery due to packing in the nose.

    • These occur rarely, but I shall explain them to you prior to surgery:

      • Blindness

      • Blockage of the tear (naso-lacrimal) duct, which drains tears from the eyes into the nose

      • A hole through the middle structure of your nose (septal perforation) (very rare)

      • Brain damage or brain abscess (very rare)

  • Discontinue aspirin and/or anticoagulant medication ("blood thinners") ten days before surgery.  This will be discussed with your primary care physician and/or cardiologist.

  • Do not eat or drink anything - including water - after midnight on the day of surgery.

  • If you take antihypertensive medications (blood pressure medicine), take it the morning of surgery with a sip of water.

   

• What to expect at the hospital or surgery center:

  • You will receive medication to help you relax.

  • You will probably be given some nasal spray to shrink the nasal lining before you go to the operating room.

  • After surgery, you will be in the recovery room.

  • You will be given pain medication as necessary for your level of pain.

  • You will be discharged several hours after you awaken.

   

• In the operating room:

  • You will be put to sleep with a general anesthetic.

  • The procedure will be done through your nose without external incisions.

   

  

  Sinus endoscope inserted through nose

• Rarely, open surgery (using external incisions) will be required.

Left Caldwell-Luc Procedure

Incision under Lip

• After arriving home:

  • Mild bleeding is expected.  If there is heavy bleeding, you need to call me!

  • Take all medications which I prescribe for you after surgery.

  • If you take medications routinely, ask me when you should resume them.

  • Change any drip pad on your upper lip as necessary.

  • Do not perform any strenuous activity or heavy lifting.

  • Take one pain pill one hour before your first post-operative visit with me.

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