Sinusitis-Functional Endoscopic sinus surgery

What is Sinus?

Human skull contains four pairs of hollow air filled cavities connected to the space between nostril and nasal passage; these are called Sinuses (or Para Nasal Sinuses). Sinuses help insulate the skull, reduce its weight and add resonance to voice.

There is 4 major pair of Sinuses

  • Frontal (in the forehead)
  • Maxillary (behind the cheek bones)
  • Ethmoid (between the eyes)
  • Sphenoid (behind the eyes)

Most of the sinuses drain into a key area (Osteo-Meatal complex). Thus treatment of sinusitis is focused on this area.

What is Sinusitis

Infection of Sinuses is called Sinusitis–acute or chronic based on the time span. Sinusitis may be caused by anything that interfere with airflow into the sinuses and mucous drainage out of the sinuses, usually follow a viral infection, allergy, or irritants. Most common bacteria involved are streptococcus pneumonae, Haemophilus influenzae, and moraxella catarhalis.

How to Diagnose Sinusitis? Symptoms of Sinusitis

Symptoms depend on which sinus is involved–usually present with
  • Nasal congestion and discharge or post nasal drip

  • Headache, or facial pain/pressure , or pain under or around the eyes

  • Fever

Chronic sinusitis may present with

  • Reduced /absent smeel sensation (anosmea)

  • Fever and bad smeel from mouth (halitosis)

  • Cough (worse when lying down)

How to Treat Sinusitis
Maxillary sinus is most commonly involved followed by ethmoid,frontal and sphenoid.

Aims of management are:
  • To achieve normal healthy sinuses

  • To decrease duration of the symptom

  • To prevent complications

  • To prevent development of acute sinusitis

Most patients of acute sinusitis can be benefitted without many investigations as diagnosis is mainly clinical.

Nasal Endoscopy for proper visualization of nose and sinuses is important for appropriate management. Endoscopic assessment of nose guide therapy and at the same time accurate pus-swab can be obtained for bacteriological examination.

Sometimes if symptoms persist for longer duration further investigation may be required like examination of mucocilliary mechanism, allergic and immune status of patient and computerized tomography (CT scan) of sinuses.
Medical Management of Sinusitis
Surgical Management of Sinusitis
Indications for Sinus Surgery- FESS
Preparation for Sinus Surgery
Post op FESS What to expect?

Complication of FESS (Endoscopic Sinus Surgery)

Bleeding- Risk of bleeding though less then conventional but it may be there at times. Failure or Recurrent disease: Disease may not be cured by the operation or may re occur at later date. Subsequent medical management may be required. Cerebrospinal fluid (CSF) leak: rare complication, but it may extend hospital stay and require further surgery to repair leak Loss of vision: extremely rare