Functional Endoscopic Sinus Surgery.... Worth it?

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I have been recommended to have sinus surgery. Something called a "FESS".... I get sinus infections a lot. But I don't know if this is really going to make a positive difference for me and I'm concerned because people tell me the procedure is so painful. Can you docs shed some light on this for me?

Gender: Female
How old are you?: 29
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Difficulty Breathing
Ear / Nose / Throat
Describe associated symptoms not listed above: You may also use this area to further explain symptoms checked above.

Just a chronic cough when I lie down at night. Headahces. Sinus drainage most of the time. Sometimes I get pain in my upper teeth which I'm sold is from the infection.
What have you done so far to remedy this condition? Please include tests and relevant studies here. ENT consult. CT sinuses. Xrays. Antibiotics. Flonase. Claritin. Mucinex. Nasal washes.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): Other than this I'm quite healthy

Check all that apply to you or your immediate family (parents, siblings, grandparents):
Cardiac Disease

Not a smoker

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: Within the next few days
So that we can serve you best, please try to tell us your top three things you wish to be addressed in our response.


How likely am I to get a good result from this?
Is it a dangerous surgery?
How long till I can resume a fairly normal life after the surgery?

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Ma'am,
Just so happens we have an ENT Surgeon here at MD STAT. I'm going to get him on this question when he can. In the meantime you may want to check out THIS LINK from the American Academy of Family Practice. It's a pretty good summary. Keep checking back with us for more. Thanks for your question.

MD STAT ERDOC !
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Endoscopic Sinus Surgery (ESS) or Functional Endoscopic Sinus Surgery (FESS) are operations performed using scopes (endoscopes), and special instruments, with the access to the sinuses being from inside the nose (without any external incisions or scars).

FESS can make a very positive difference for some sinus problems.  It can be relatively painless and very safe. The recovery can be quite short (2-3 days).  However, there are several variables that can make one person’s experience, risk, and outcome very different than another’s.  I will discuss some of these further.

First, an understanding of some basic sinus facts is necessary.  The sinuses are air-filled cavities within the bones of our face and skull.  They have a mucous membrane lining that makes mucous which then drains into the nose through very narrow openings. If these narrow openings are “blocked”, mucous will accumulate in the sinuses, and will virtually always become infected if drainage isn’t restored fairly quickly (days/weeks).  When bacterial infection is suspected or confirmed, antibiotic are usually prescribed.  Common sinus infection symptoms include, discolored nasal drainage,  nasal congestion, post-nasal drainage, sinus pressure/sinus headache, upper tooth pain, fatigue, cough, and plugged ears.  Symptoms can vary, often based on the severity of infection and which sinuses are affected.  We have 4 sets of sinuses on each side of our face/head.  These are named as follows:  Maxillary sinuses, ethmoid sinuses (anterior and posterior), frontal sinuses, and sphenoid sinuses.  An internet search of “sinus anatomy” can show you the basic locations of these sinuses.

So, what causes the sinus openings to become blocked?  Inflammation and swelling are the most common reasons for the openings to become blocked.  There are several possible sources of this inflammation.  One of the most common is a viral upper respiratory infection a.k.a. “a cold”.  Environmental allergies (“hay fever”) is another common source of excessive swelling/inflammation.  The swelling of the sinus lining that occurs with bacterial sinus infection can persist for a period of time after the bacterial infection has been treated, leaving the openings still blocked and prone to repeat or further infection.  Very severe and chronic inflammation of the lining can result in “polyps” that can block the sinus openings.  Lastly, some people are born with abnormal nose or sinus anatomy that can make the openings more narrowed or blocked.

If the use of medications (antibiotics, steroids, allergy medicines, etc.) can not successfully resolve the inflammation and get the sinuses to drain and function normally, surgery may be considered.  The basic purpose of the ESS is to create surgical openings into the sinuses so they can drain the mucous they make.  Essentially, chronic sinusitis is a medical problem (treated with medicines) in which surgery can sometime play a role.  Surgery is just one part of the treatment.  How much surgery helps is largely dependent on whether blockage of the sinus is the main problem.  Patients that have medical conditions that result in bad chronic nose/sinus inflammation, or those who have problems with their immune system, are the types of patients who may not benefit as significantly from ESS.

With the above information hopefully understood, I will try to answer you main questions and concerns.

Overall, sinus surgery is quite safe with low rates of complications.  Surgery to open the maxillary and anterior ethmoid sinuses is the easiest and safest.  This limited amount of surgery is often referred to as FESS.  

The frontal sinuses, sphenoid sinuses, and posterior ethmoid sinuses are close to several important structures such as the eye sockets, the optic nerves, and the skull base (thin bone that separates nose/sinuses from the brain.  The proximity of these things to the sinuses put them at potential risk of injury during surgery.  The risk of injury is very low, but important to consider.  Having an experienced and well trained surgeon is also an important consideration.

How much pain you have, and how quickly you can return to normal life, is largely based on how much surgery is being done.  A patient who is only having one maxillary sinus on one side operated on, will have a very brief surgery, very little pain, and a very quick recovery.  On the other hand, a patient who has every sinus, on both sides, operated on, and who also has the nasal septum fixed (septoplasty) and nasal turbinates reduced, will have a significantly longer, more painful surgery, and longer recovery (1-2 weeks, sometimes).  So, these two examples are sort of the two ends of the spectrum.  The amount of surgery performed can vary greatly, so it’s hard to compare what your doctor plans to do with something someone you know had done, unless you know exact details of the extent of surgery planned or performed.  Potential risk or “danger” of the surgery basically follows the same principle, but in the hands of a good surgeon the risk is very low for dangerous complications.

SWB (ENT Surgeon)