Endoscopic Sinus Surgery (ESS)

Introduction

Endoscopic Sinus surgery is a broad description of procedures used on the nasal sinuses. Typically, they are completed using a high definition camera placed within the nostrils, thus requiring no external incisions.

Indications

Endoscopic sinus surgery is used commonly in people with sinus problems, including:

  • Nasal Polyps.
  • Sinusitis.
  • Nasal Tumours.

Risks

Endoscopic sinus surgery carries the same general risks as all operations, including:

  • Pain.
  • Bleeding.
  • Infection.
  • Scarring.
  • Failure to resolve symptoms.

Specific risks of sinus surgery include;

  • Significant bleeding.
  • Loss of taste and smell.
  • Eye injury.
  • Cerebrospinal fluid leak.

Dr Morrissey can discuss these risks and other matters specific to you and your condition should you wish to make an appointment.

Treatment Alternatives

Medical treatments are available for sinus problems and can be quite successful for some people. Options include oral and nasal steroids, salt water rinses, and in some circumstances, antibiotics.

Dr Morrissey can discuss both medical and surgical options available to meet your specific needs.

Preoperative Instructions

Endoscopic sinus surgery is performed under a general anaesthetic. You will need to fast prior to surgery and should follow the provided instructions. If you have any queries or concerns please contact your anaesthetist, admitting hospital or Dr Morrissey.

Procedure

Under a general anaesthetic, Dr Morrissey will use a high definition camera called an endoscope to assess and treat your sinuses. Involved sinuses will be opened and drainage pathways cleared. Polyps may be removed, and structural issues corrected.

Once Dr Morrissey is happy with the sinus surgery, he will ensure that bleeding is addressed and, in some cases, may place absorbable nasal packs high in the nose.

Most people wake after surgery with minimal pain and a mild ooze from the nose.

Postoperative Instructions

General

During the first 2 weeks after surgery you may feel quite tired and ‘run down’. Your nose will feel very congested as if you have a cold or flu. To maximise recovery:

  • Avoid bending, lifting, or vigorous activity for 2 weeks;
  • No work, exercise or sport for 10 days (you may do some gentle walking);
  • Avoid hot showers and baths as they can promote nose bleeding; and
  • You may gently blow your nose as needed for 2 weeks. If you do sneeze do so through an open mouth (but cover it).

Posture

Try to keep your head up as much as possible to reduce bleeding. Keep your head elevated when resting, and sleep with 2 pillows if possible. Avoid stooping over.

Bleeding

It is normal to have nasal ooze for the first 24 hours, which will reduce by around half each day. Minor bleeding is expected for 3-4 days.

If you are concerned about the amount of bleeding, then please call Dr Morrissey via his consulting rooms.

Major bleeding is rare but can occur and is typically quite profuse. If this happens present to the nearest emergency department or call an Ambulance.

Diet

There are no dietary restrictions and you may eat as soon as food is tolerated. A cool diet in the first few days helps minimise bleeding.

Fever

It is common to have a mild fever for the first 24-48 hours after the operation. Please call Dr Morrissey's rooms or see your GP if there is a persistent fever greater than 38.5 degrees.

Pain

The maximum discomfort will occur in the first couple of days to week after surgery. You may experience some headaches. Patients often describe their discomfort as similar to a head cold. Take the pain medication as prescribed.

Appearance

Minor bruising and swelling may occur around the eyes and face, which may be more obvious in the mornings.

When to call the Doctor

  • If you have any extreme swelling or bruising that is not settling;
  • If you have persistent pain not relieved by medication;
  • Elevated temperature over 38.5°C;
  • Bleeding that has not subsided after 20 minutes of applying gentle pressure to the soft part of the nose while sitting in an upright position with head bent forward (Oozing can be expected).

Medications

  • Saline nasal rinse (Flo or Sinus rinse): Please rinse your nose with the bottle prescribed 4 times a day. Continue until reviewed by Dr Morrissey. Refill sachets can be purchased from your local pharmacy.
  • Paracetemol (Panadol): Please take regularly as per manufacturer’s instructions to minimize pain after surgery.
  • Extra Pain Medication (Tramadol / Oxycodone): These should be taken as prescribed if you need them.
  • Steroids: In some cases, steroids may be used after surgery. Please take as prescribed.
  • Antibiotics: Please take as directed if prescribed. Often, they are not necessary.
  • Avoid Aspirin and Nurofen as they increase the risk of bleeding.

Follow Up appointment

At the time you book surgery a post-operative appointment will usually be organised. Please contact Dr Morrissey’s office if you are unsure as to the appointment details.

Any Nasal splints and dressings, if used in your surgery, will be removed at this visit. The nose will also be inspected with a camera and any clots or crusts will be removed to expedite healing.

How to contact Dr Morrissey

For non-emergency issues please call (07) 4646 4275. for further instructions.

Dr Morrissey shares ‘on-call’ arrangements with other ENT surgeons and one is usually available to answer questions.

Should your concerns not be addressed via a phone call please present to your nearest Emergency Department. After hours the "On Call" ENT surgeon can be contacted via the Toowoomba Base Hospital on (07) 4616 6000.

In the event of an Emergency call 000 or attend the nearest Emergency Department.

Related Information

Sinusitis