Frequently Asked Questions About Endoscopic Sinus Surgery

What Is Endoscopic Sinus Surgery (ESS)?
How Can a Doctor Tell That I Need ESS?
How Do I Prepare for ESS?
What Happens on Day of Surgery?
What Will Happen After ESS?
What Can I Expect at Discharge?

Your physician has chosen to perform endoscopic sinus surgery in an effort to relieve or improve one or more of your symptoms. These may include stuffiness of nasal passages; postnasal drip; and fullness in the face, eyes, ears, and headache. Among the locations where surgeons from the Division of Sino-Nasal Disorders and Allergy perform this procedure are UPMC Montefiore and UPMC Shadyside.

The physicians and nurses who will care for you have been especially trained to help make your recovery as quick as possible. This information is only a guide. Please ask your physician and your nurse to answer any questions you may have.

What Is ESS?
Prior to the discovery of endoscopes (long instruments with a video camera at the end, which guide a surgeon) and computerized tomography (CT) scans, the cause of sinus complaints often went undiagnosed. If sinus surgery was needed, the surgeon made incisions under the lip or in the fold between the nose and eye. He or she had to cut a window into the cheek to drain the maxillary sinus. Sinus surgery was done in a hospital, and the typical hospital stay was several days.

Since the early 1970s in Europe, and since 1984 in the United States, ESS has allowed surgeons to perform sinus surgery as an outpatient procedure. In ESS, the surgeon works through the nostril only; no external incisions are needed.

Endoscopic surgery is possible because of the magnifying device, video camera, and fiberoptic light source at the end of the endoscope. These enable the surgeon to guide the other instruments by watching, on a video monitor, an image of the inside of the sinus. The endoscope is so small that the surgeon also has room to insert and manipulate the instruments needed to remove diseased or obstructing tissue.

In addition to the video provided by the endoscope, the surgeon may use CT scans to see detailed images of the air passages and air spaces (paranasal sinuses) between the nose, eyes, and brain.

It has been found that disease of the mucous membranes, especially in a critical area known as the ostiomeatal complex (a confluence of sinus passages that drain to the back of the throat), is responsible for the majority of sinus symptoms. Obstruction in this area leads to sinusitis and its symptoms. ESS has proven to be very effective in treating problems in the ostiomeatal complex, with pinpoint accuracy and minimal bleeding. One result is greatly diminished recovery time. The typical ESS patient leaves the surgery center the same day he or she has the procedure.

How Can a Doctor Tell That I Need ESS?
After questioning you about your symptoms, an ear, nose, and throat specialist will use an endoscope to examine your nose and sinuses.

He or she may order CT scans, to further assess how physical structures relate to your symptoms. The doctor will recommend ESS if your symptoms are debilitating, if the tests show that surgery would be beneficial, and if medical therapy has failed to resolve your symptoms.

Your doctor will discuss the risks, options, and benefits of ESS with you. Risks include bleeding and infection. Because ESS takes place close to the eyes and the floor of the brain, visual changes and even blindness, as well as leakage of cerebral spinal fluid and loss of the sense of smell, can occur; these complications are extremely rare.

Follow-up evaluations are required to prevent scarring. The average patient is seen two to four times after ESS, during the three- to four-week healing period.

How Do I Prepare for ESS?
Prior to ESS, you may have blood work, an electrocardiogram (EKG), or chest x-rays. The tests depend on your medical condition. Often, healthy patients require no presurgical testing.

Do not eat, drink, or smoke after midnight the night before your surgery. This includes water, gum, or lozenges.

The day before you are scheduled for ESS, a nurse will call to tell you when and where your ESS will be. Discuss with the nurse any remaining questions or concerns. To reduce the risk of bleeding, stop taking aspirin or ibuprofen 10 days prior to surgery.

What Happens on Surgery Day?
If your surgery is at UPMC Shadyside:

If you need to have additional tests, go to Outpatient Testing, first floor, East Wing.

If presurgical testing was not required or if testing is complete, go to the Ambulatory Surgery Center, second floor East Wing.

If your surgery is at UPMC Montefiore:

Report to the sixth floor. Enter the parking area for outpatient surgery patients from Darragh Street.

(Use the map and driving directions to UPMC Presbyerian if you need help finding UPMC Montefiore.)

Surgery maybe performed under local anesthesia with sedation or general anesthesia, depending on your preference as well as the extent of the disease. Patients with asthma should have general anesthesia.

What Will Happen After ESS?
After surgery you will be sent to the recovery room to awaken from the anesthesia or sedation. The nurses will take your vital signs (measure your temperature, pulse, respiration, and blood pressure). You will have intravenous (IV) fluids during surgery and postoperatively until you are taking fluids well by mouth. You will find a drip pad under your nose. This pad will absorb any drainage from your nose and will be changed as needed. Also there maybe a dressing in your nose with small pull strings attached. This dressing is usually removed while you are recovering, before you are discharged.

Do not be alarmed by red nasal drainage -- this is normal.

The head of your bed will be elevated for your comfort and to decrease nasal bleeding and nasal membrane swelling. Swallowed blood is irritating to the stomach and may cause cause nausea or vomiting; therefore, try not to swallow bloody nasal secretions. Instead, spit them out into the kidney-shaped bowl that will be available. Anesthesia can also cause nausea.

Medications will be provided for complaints of pain or nausea.

Here are some important tips to remember during your immediate postoperative period:

• Cough and sneeze with your mouth open.
• Do not blow your nose.
• If you have nasal congestion, sniff and spit into a tissue.
• Keep the head of your bed elevated.
• Do not drink through a straw.
• Alert your nurse if any sinus symptoms: excessive bleeding, nausea, vomiting, pain or vision problems arise.

Most ESS patients with sinus disease have mild to moderate pain and limited bleeding and are discharged on the day of surgery. Others who require closer observation for recovery from anesthesia, or who are having nausea/pain, may stay for 23-hour observation.

What Can I Expect at Discharge?
You can expect some nasal stuffiness and crusting for three to six weeks after surgery. Many patients are back to work or school the week following surgery and back to their regular range of activities within three weeks. Using a salt-water nose spray several times a day for two to three weeks after ESS will decrease nasal crusting.

Do not hesitate to ask your surgeon or nurse any questions you have.

Your physician will want to see you in the office, usually in one to two weeks.

At the Division of Sino-Nasal Disorders and Allergy, the primary goal is your recovery and return to good health.