Functional Endoscopic Sinus Surgery in Polyps: Breath Easy! #BlogchatterA2Z

Dr.Amrita Basu(MBBS,MS)

5 years ago

Endoscopic sinus surgery in nasal polyps

FESS is a short form for functional endoscopic sinus surgery. It’s a minimally invasive method of removing nasal mucosal disease, most often polyps. One of my first surgical cases as a private practitioner was a FESS patient.

It’s a graceful surgery. The surgeon uses endoscopes(Metallic tubes with special magnifying lens at the end) attached to the camera, to look deep into the nasal cavity, the sinuses. A good visual field helps in preserving normal tissues and selective removal of the disease. This helps the nose breathe again.

When adults have polypoidal masses coming out of both nasal cavity, its often ethmoidal polyposis. In case it’s in a child and involves one nasal cavity, its often Antro choanal polyp.

Ethmoidal polyps :How do they look

The appearnce is classic.Swollen, hypertrophied nasal and sinus mucosa, which looks like a bunch of bluish-grey grapes, is the commonest presenting feature in my practice.

It is smooth, mobile, generally painless, and doesn’t bleed on touch. These are the nasal and sinus membrane, filled with discharge, secretions and inflammatory cells, causing it t become swollen.

It is common in males. It can be infective, allergic, or a combination of both. It has an association with cystic fibrosis.

Kartagener’s syndrome

Kartagener’s syndrome is a disease of immotile cilia(primary ciliary dyskinesia). It often presents with ENT symptoms like chronic sinusitis polyposis, bronchiectasis, cystic fibrosis, infertility and situs inversus. It is a rare autosomal recessive genetic disease. That means both your parents must carry this genetic trait for you to have this syndrome.

Cilia is the fine hair cells in your mucosa which helps to clear up secretions. Cilia also help sperms move and reach the ova during fertilization. One cause of male infertility is Kartagener’s syndrome.

Symptoms of sinusitis with polyposis

Nasal obstruction nasal discharge

History of snoring and poor sleep

History of nose blowing

Decreases sense of smell hyposmia

Sneezing and symptoms like allergic rhinitis

Hyponasal voice

Mouth breathing

It can be associated with a deviated septum and inferior turbinate hypertrophy

Nasal bleeding in case of infection and forceful nasal cleaning.

Tests you need before Sinus Surgery

Routine blood test including checkup for blood sugar and absolute eosinophil count, coagulation profile and more as needed.

The investigation includes CECT Nose and PNS,a diagnostic Nasal endoscopy.

A biopsy is done sometimes if your doctor suspects a fungal polyp or neoplastic lesion.

Computed Tomography or a CT scan is needed before Sinus Surgery

Is Surgery the only treatment for Sinusitis?

Treatment involves medical management, which can consist of oral and /or intranasal steroids with or without antibiotics and antihistamines. Both preoperatively and postoperatively medicines and nasal sprays help improve nasal functions.

After maximal medical therapy of three months, if the response is not adequate, FESS is done. In the case of allergies being the cause behind polyps, there is a need for continuing proper precaution for allergic rhinitis and Sinusitis.

FESS: Functional Endoscopic Sinus surgery

Functional Endoscopic Sinus surgery is the endoscopic approach to nasal surgery. Its commonly used to treat nasal polyposis and Sinusitis not improving with medicines.FESS is also used to do many other nasal surgeries, which I have mentioned later in this post.

A series of fine endoscopes with different angulation to their lens, like zero thirty degrees, forty-five degrees, is used for surgeries of the nose. The size of the adult and pediatric endoscopes are different. A full Endoscopic setup is needed, including a camera, monitor and a trained anesthetist.

The best part about FESS is it’s minimally invasive.No external cuts are made, and no sutures are needed. Tissue removal is done to improve the physiological pathways of nasal drainage.No aggressive debridement is done. Histopathological test of tissue is done and also stained for fungal debris.

In the case of fungal polyposis, systemic Antifungals may be needed and is a potentially severe condition.

Postoperatively patient needs a nasal pack, most often Merocel to prevent bleeding. Strict bed rest for some time, depending on the extent of disease and surgery.

What are the Risks of Endoscopic Sinus Surgery?

It depends on the extent of disease and patient conditions. But major complications include persistent nasal bleeding, visual disturbances, and intracranial complications.

Will the polyps come back?

Recurrence is far less in the case of FESS and 90% of patients have improved quality of life. Postoperative follow up with medicines is often needed for long term disease-free life.

Other indications of Sinus Surgery

Chronic rhinosinusitis not improving with medicines,

Sinus mucocele,

Allergic fungal sinusitis,

Nasolacrimal duct obstrution,

Cerebrospinal fluid leak,

Severe nasal bleeding,

Tumors of the mose and sinuses,

Transnasal surgical approack for skull base lesions .Have you heard about this type of surgery ?Let me know in the comments below.

How can I permanently cure Sinusitis?

DiabetesThe treatment depends on the type of sinusitis allergic,bacterial or fungal .It also depends on whether its of a long duration of less than 3 months (acute) or prolonged duration (chronic).Whether patient has Diabetes will affect the course of disease