Sinusitis, or sinus inflammation, is diagnosed in more than 30 million people in the United States each year. It can be as annoying as it is common. Endoscopic sinus surgery is among the treatment options if the inflammation becomes chronic, or long-lasting. Because the procedure is minimally invasive, the surgery causes no discernible change to the look of a patient’s face or nose.
Yale Medicine patients who undergo the procedure, and then manage their conditions with ongoing medication, typically enjoy a reduction in the severity and frequency of their sinus infections.
How is chronic sinusitis treated?
The first step is determining that it is chronic sinusitis, rather than acute sinusitis or another medical condition.
If you come to Yale Medicine for a diagnosis, our otolaryngologists (ear, nose and throat specialists) will first perform a physical exam and then talk to you about your symptoms, which might include nasal obstruction and congestion, nasal drainage, post-nasal drip, facial discomfort, headache, and changes in smell or taste.
Doctors then perform an endoscopy, inserting a small camera into your nostrils, checking the area where the sinuses drain, looking for evidence of inflammation or infection. Sinusitis may also be diagnosed using a computerized tomography, or CT, scan.
Once a diagnosis of chronic sinusitis is made, the doctor may prescribe antibiotics, oral steroids, nasal steroids, nasal saline irrigation, or allergy treatments such as antihistamines.
Some patients come to us thinking they have simple sinusitis, but our advanced diagnostic techniques might discover nasal tumors or even an autoimmune disease. We are well-equipped to treat those conditions.
Whatever the diagnosis, if it becomes clear over time that medication is not working, our physician probably will present the option of minimally invasive endoscopic sinus surgery to you.
How does minimally invasive endoscopic sinus surgery work?
Surgery is typically performed under general anesthesia in the ambulatory operating rooms at Yale New Haven Hospital. Patients go home the same day.
During the surgery, otolaryngologists insert a slender instrument called an endoscope through the patient’s nostrils and view the natural drainage pathway of the sinuses through the endoscope's tiny camera. The sinus pathways are then enlarged by removing tissue and/or polyps, opening and ventilating the sinuses.
Anything still lingering there—pus, infected material—is drained out.
“Once the sinuses are surgically opened, medication such as nasal steroids, topical antihistamines or topical antibiotics are better able to get into the sinuses themselves, which is where the heart of the problem is," says R. Peter Manes, MD, an otolaryngologist at Yale Medicine.
In some cases, the doctor will place a small device called a stent into one of the sinuses. The stent releases a steroid that calms inflammation after the surgery. The stent lasts for about a month and typically dissolves in its own, without the need for removal.
In some situations, doctors are able to perform sinus surgery in the office utilizing a balloon dilation device, under local anesthesia.
What can patients expect after surgery?
On average, people need about five days to recover. It is likely the recovery will not disrupt everyday life.
After surgery, you might experience some bleeding from the nose for the first day or two, followed by a congested feeling for a week or so.
In the past many physicians would pack a patient’s nose with gauze after surgery, but improved methods have made that approach far less common.
What are the risks of minimally invasive endoscopic sinus surgery?
Since the surgery is performed near the eye and the bone that separates the brain from the nose, there is always a certain amount of risk, but complications are very rare.
Patients generally tolerate the surgery very well and recover without incident.
What makes Yale Medicine’s approach to minimally invasive endoscopic sinus surgery unique?
Yale Medicine physicians are accustomed to handling complex cases. Because patients with sinusitis often have other conditions such as asthma or allergies, our specialists provide a multidisciplinary team approach and the most advanced treatment.
Our focus is on providing compassionate, empathetic care for patients with a condition that can often be misunderstood.
“People can be told by others that maybe it’s not such a big deal, it’s a stuffy nose or a headache,” says Dr. Manes. “But when we look at multiple studies, chronic sinusitis significantly impacts a patient’s quality of life. It is important to provide validation and respect for a person’s symptoms and to let our patients know this is not how they have to feel moving forward.”