For many people facing surgery, the idea of the procedure itself can be a scary prospect. This fear can be intensified if the person is experiencing additional symptoms that could make it more difficult to perform the surgery, including infections, swelling, bleeding, or other conditions. In the case of nasal endoscopic surgeries, many patients worry that their procedure cannot be performed if swelling is present in the sinus cavity.
What is nasal endoscopic surgery?
A nasal endoscopy is a routine procedure that allows the physician to get a closer, more detailed look at the nasal and sinus passages of the patient. The nasal cavity and sinuses are the air-filled spaces behind the nose and within the face, and their small size makes them difficult to access without the use of an endoscope. The endoscope, a thin, flexible tube equipped with a minuscule camera and light, is inserted into the nose and guided through the nasal and sinus passages. This camera can be used to closely examine the sinuses for bleeding or swelling of the nasal tissue or to take samples of pus or tissue used to diagnose inflammation or potentially cancerous growths. Nasal endoscopes are used to gather information about a variety of ailments, including nasal congestion and blockage, severe sinus infection, nasal polyps or tumors, cerebrospinal fluid leak, loss of ability to smell, or recurrent nosebleeds.
In some cases, the physician will determine that surgery is needed. If surgery is ordered, that same endoscope may be equipped with small tools or other instruments used to perform the needed surgery.
Why is nasal endoscopic surgery necessary?
Often, patients undergo nasal endoscopic surgeries for a condition called “chronic rhinosinusitis”, or more simply “chronic sinusitis.” Patients that suffer from this condition experience continued or long-term inflammation of the nose and sinuses that does not improve with other treatments. This continued swelling, which typically lasts for 3 or more months, may be caused by a variety of ailments, including infection, allergies or other irritants, or even non-cancerous nasal polyps. Occasionally, physicians will not be able to ascertain the root cause of the chronic sinusitis, as various other factors may cause this inflammation. Other less common conditions that may require nasal endoscopic surgery include tumors of the nasal or sinus cavities, infections that spread from the sinus to the face, eye, or brain, impaired sense of smell, tear duct blockage, and the leakage of brain fluid into the nose. Additionally, advances in endoscopic equipment and techniques now allow surgeons to address problems in the brain, pituitary glands, and eye sockets, so other conditions that affect these areas may also be addressed through a nasal endoscopic surgery.
How are nasal endoscopic surgeries performed?
Generally, these surgeries are conducted after a consultation with a physician, a discussion of symptoms and their severity, and a CT scan to identify which sinuses require enlargement. Once these criteria have been met, a physician will schedule the surgery to be performed under either local or general anesthesia. If performed under local anesthesia, the surgeon will numb the nasal and sinus cavities to prevent pain or discomfort, but the patient will remain awake during the procedure. If performed under general anesthesia, the surgeon will sedate the patient so that they are not awake during the process. Regardless of the method of anesthesia, the surgeon will insert the endoscope into the nostril to access the nasal and sinus cavities. Once inserted, the endoscope will be used to identify the nasal or sinus passages that are too narrow and enlarge them to better allow the flow of mucus through the sinuses.
Sometimes, nasal endoscopic surgeries will be performed to remove nasal polyps or tumors, or to collect pus from severely infected sinuses for further testing. In all cases, the endoscopic is fitted with small tools that assist the surgeon in accomplishing the procedure, and no additional cuts or incisions should be necessary.
Can a nasal endoscopic surgery still be performed if there is swelling in the sinuses?
Because these surgeries are often performed with the express purpose of combating inflammation within the sinus cavities, they can be performed if swelling in the sinuses in present. However, the physician will attempt to relieve as much of the inflammation as possible before the surgery is performed. In addition to advising again medications that could lead to bleeding, like aspirin or ibuprofen, the surgeon may prescribe antibiotics or steroids prior to surgery to reduce swelling. Additionally, a topical decongestant is often administered to patients in the form of a nasal spray directly before the surgery to reduce swelling even further.
What are the side effects of nasal endoscopic surgery?
While relatively safe, some side effects of this surgery include nosebleed, fainting, or other reactions due to the decongestant or anesthetic administered for the procedure. After the nasal endoscopic surgery has been performed, patients are generally sent home or allowed to go about their activities as normal. However, patients should always follow their physician’s instructions post-surgery and alert their doctor if they experience a nosebleed that does not go away.
Ultimately, each nasal endoscopic surgery is unique and should be treated as such. Patients should consult with their doctor during every step of the process and express any questions or concerns they might have. Dr. Ran Rubinstein is a highly experienced facial surgeon who is board-certified by both the American Board of Otolaryngology-Head and Neck Surgery as well as the American Board of Facial Plastic Surgery. Dr. Rubinstein is an expert in intricate facial and sinus surgeries and a prestigious American Academy of Otolaryngic Allergy Fellow. He has been practicing in New York for nearly 20 years.