Once the diagnosis of chronic sinusitis is confirmed and medical therapy has proven ineffective, the conversation shifts to surgical intervention. Endoscopic Sinus Surgery (ESS) is the primary treatment option, yet it is not a universally applicable procedure. The surgery is highly customizable. Depending on which sinuses are blocked and the severity of the disease, the surgeon might perform a limited procedure on just one sinus or a comprehensive opening of all sinus cavities.
To maximize airflow and function, the surgeon often performs other related procedures at the same time as the standard ESS. The goal of any of these treatments is to restore the natural drainage pathways and improve the patient’s ability to breathe. This section details what happens during the surgery, the different tools and techniques available, and the complementary procedures that might be part of your surgical plan.
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The core procedure involves the surgeon entering the nostril with the endoscope and small, precision instruments. There are no incisions on the face. The surgeon locates the sinuses’ natural openings, frequently constricted by swelling or bone. Using instruments called “biters” or “shavers,” they carefully remove the small pieces of bone and soft tissue that are blocking the door.
The surgery is typically performed under general anesthesia. This is for the patient’s comfort and safety. The patient must stay still during surgery because the sinuses are near the eyes and brain. The anesthesiologist monitors your vital signs while you sleep. The throat is usually protected with a breathing tube to prevent any blood or fluid from draining down into the lungs.
For complex cases, especially those where the patient has had previous surgeries that altered their anatomy, surgeons use Image-Guided Surgery (IGS). This is often described as a GPS for the nose. The patient typically wears a special headset during surgery that communicates with the CT scan images on a computer screen. When the surgeon places an instrument in the nose, the computer shows exactly where it is on the patient’s CT scan map. This technology dramatically increases safety, allowing the surgeon to be thorough while avoiding critical structures.
In some cases, patients may be candidates for a less invasive option called balloon sinuplasty. This technique is similar to angioplasty used for heart arteries. Instead of cutting or removing bone and tissue, the surgeon inserts a small, flexible balloon catheter into the blocked sinus opening.
Once positioned, the balloon is inflated. The pressure of the balloon gently fractures the thin eggshell-like bone of the sinus opening and compresses the swollen tissue, widening the pathway. The balloon is then deflated and removed. This procedure causes less bleeding and trauma than traditional ESS and often has a faster recovery time. It is best suited for patients with mild to moderate blockages who do not have nasal polyps or massive bone spurs. It can sometimes be done in the office under local anesthesia.
Sinus surgery is rarely done in isolation. The surgeon often fixes other structural problems in the nose at the same time. The turbinates are the long, sausage-like structures on the side walls of the nose that warm and humidify air. In patients with chronic sinus issues, these are often chronically swollen (hypertrophic). A turbinate reduction decreases their size, usually by using radiofrequency energy or a small shaver, to create more room for airflow.
Similarly, if the patient has a deviated septum, a septoplasty is performed. The surgeon lifts the lining of the septum and removes or reshapes the crooked cartilage and bone to straighten the partition. This ensures that both sides of the nose have equal airflow and gives the surgeon better access to the sinuses during the operation.
For patients with nasal polyps, the surgery involves a “polypectomy.” The surgeon uses a specialized tool called a microdebrider. This gadget is a small, rotating suction tube that gently pulls the polyp tissue in and shaves it away, instantly suctioning it out of the nose.
The microdebrider is extremely precise. It allows the surgeon to shave away the polyps layer by layer without grabbing or tearing the underlying healthy tissue. This precision reduces bleeding and helps preserve the normal lining of the nose.
Removing the polyps is the easy part; keeping them away is the challenge. By clearing out the bulk of the polyps, the surgeon creates a wide cavity. This open space allows steroid rinses and sprays—which will be used after surgery—to reach the areas where polyps like to grow, suppressing their recurrence. In some modern treatments, surgeons may place a small, dissolvable steroid-eluting implant into the sinus during surgery. This implant slowly releases medicine directly into the healing tissue over several weeks to prevent the polyps from bouncing back immediately.
Treatment doesn’t start on the operating table. Most surgeons will employ a “preoperative optimization” plan. This plan might involve a course of oral steroids (like prednisone) for a week or two before the surgery. The steroids help to shrink the polyps and reduce inflammation and bleeding. This makes the surgery easier, faster, and safer because the The surgeon has a better view. Antibiotics might also be prescribed to calm any active infection down before the procedure.
On the day of surgery, you will meet your surgical team. Once asleep, the procedure usually takes between 1 and 3 hours, depending on complexity. The surgeon works systematically, usually starting with the maxillary (cheek) sinuses, then moving to the ethmoid (eye) sinuses, and finally the frontal (forehead) and sphenoid (deep) sinuses if needed.
At the end of the surgery, the surgeon may place specialized packing in the nose. In the past, surgeons used yards of gauze, which was painful to remove. Today, most surgeons use dissolvable spacing material. These are like gel foams or sponges that absorb blood and keep the tissues apart so they don’t scar together. They dissolve on their own with saline rinses, meaning there is often nothing to “pull out” at the follow-up visit.
Send us all your questions or requests, and our expert team will assist you.
No. Endoscopic sinus surgery and septoplasty are internal procedures. They do not break the nasal bones that give your nose its external shape (rhinoplasty). Your appearance will remain the same.
It is not necessarily “better,” but it is less invasive. It is the right choice for some patients, but it cannot remove polyps or correct severe bone problems. Standard ESS is more versatile.
Risks are rare but include bleeding, infection, and, very rarely, injury to the eye or leakage of spinal fluid (since the sinuses are next to the brain). Surgeons use detailed training and navigation systems to minimize these risks.
Most ESS procedures are outpatient, meaning you go home a few hours after surgery once you wake up. Overnight stays are only for patients with other serious medical conditions (like severe sleep apnea or heart issues).
Yes, unfortunately, polyps can return because they are caused by an underlying inflammatory condition. However, surgery resets the clock and makes medical management much more effective at controlling them
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