What is endoscopic sinus surgery?
Endoscopic sinus surgery (ESS) is a minimally invasive procedure to open your nasal passages so that your sinuses work better. Also called functional endoscopic sinus surgery (FESS), the procedure is performed to correct sinus problems that haven’t responded well to nasal sprays, medication, or other treatments.
A surgeon uses an endoscope (thin tube with a light and camera) to perform the procedure through your nostrils, so it doesn’t require any incisions in the skin around your nose. ESS has a lower complication rate than open sinus surgery, and most people recover with minimal discomfort.
Endoscopic sinus surgery can improve drainage and ease symptoms of frequent sinus infections such as:
- Congestion
- Difficulty breathing
- Drippy nose
- Headache
- Loss of taste and smell
- Sinus pain or pressure
- Sneezing
The ear, nose, and throat (ENT) specialists at Penn Medicine are well-versed in the latest minimally invasive procedures for all types of sinus and nasal problems. We’re regionally and nationally recognized in the field of rhinology for our work in developing new treatments for rhinosinusitis.
As a high-volume program, we routinely evaluate and treat complex sinus conditions with excellent results. Most importantly, we have the treatments you need to breathe easier and enjoy a better quality of life.
Who is a candidate?
Your health-care provider may recommend endoscopic sinus surgery if you have:
- Aspirin-exacerbated respiratory disease (AERD)
- Bacterial or fungal sinus infections
- Chronic sinusitis
- Deviated septum
- Nasal blockages
- Nasal polyps
- Tumors in the nose or sinuses
What to expect from endoscopic sinus surgery
Your care team will provide detailed instructions about how to prepare for ESS and what you can expect before, during, and after the procedure.
Before ESS, your healthcare provider will do a physical exam and order tests to make sure you’re healthy enough for surgery. You’ll also have a CT scan of your sinuses. A CT scan is an imaging exam that takes detailed pictures of structures inside your body. Your healthcare provider uses images of your sinuses and nasal passages to plan your procedure.
Other ways you can prepare for surgery and reduce the risk of complications include:
- Quit smoking four to six weeks before your procedure
- Stop taking certain medications and supplements, such as aspirin, two weeks before surgery
- Don’t take blood thinners for at least 10 days before surgery
- Avoid eating or drinking after midnight on the day of your surgery
Endoscopic sinus surgery is an outpatient procedure, so you go home the same day as your treatment. You may have ESS in a hospital or at an ambulatory surgery center.
ESS typically requires general anesthesia, which means you’re asleep during the operation and won’t feel any pain. Talk to your healthcare provider if you have concerns about general anesthesia and would prefer local anesthesia.
During ESS, here’s what to expect:
- Your surgeon inserts the endoscope into your nostril and examines the inside of your nose, sinuses, and nasal passages.
- They numb the inside of your nose using a medicated spray or injection.
- Your surgeon uses small instruments to remove blockages, such as inflamed tissue or nasal polyps.
- They remove the endoscope from your nose.
- They may pack your nose with foam, gauze, or sponges to control bleeding.
Endoscopic sinus surgery recovery
Recovery from endoscopic sinus surgery can take one to two months. You may have mild tenderness and swelling that can be managed with pain medication such as ibuprofen or acetaminophen.
Your care team will give you detailed instructions about how to rinse your nose out each day with nasal saline spray. Your health-care provider may prescribe antibiotics to prevent infection or corticosteroids (oral or topical) to reduce inflammation. You should avoid strenuous activity and nose-blowing for about a week after your procedure.
What are the risks of endoscopic sinus surgery?
Endoscopic sinus surgery is a relatively safe procedure. Serious complications are uncommon but can include:
- Cerebrospinal fluid leak
- Excessive bleeding
- Infection
- Injury to the skull base or eye sockets
- Vision loss due to optic nerve damage
Minimally invasive sinus surgery expertise at Penn Medicine
At Penn Medicine, our ENT doctors have specialized training in areas such as head and neck surgery, skull base surgery, facial plastic and reconstructive surgery, and sleep apnea care. They collaborate with experts in other disciplines such as ophthalmology, neurosurgery, and oncology to ensure you receive comprehensive care.
We also participate in rhinology research and clinical trials to stay at the forefront of the latest procedures and therapies for sinus and nasal conditions. Our depth and breadth of expertise is why providers across the region refer their most complex cases to our team.
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