SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
britishentcare@gmail.com

British Face clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
britishentcare@gmail.com

British face clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
britishentcare@gmail.com

British Face Clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
britishentcare@gmail.com

British Face Clinic

SUPRIYA

Facial Cosmetic, ENT & Thyroid Surgeon

Image is not available

Mr. Mrinal Supriya FRCS(OTOL-HNS)

01604556244
britishentcare@gmail.com

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Endoscopic Sinus Surgery /FESS

  • Sinusitis means inflammation of a sinus and is usually caused by an infection. The cheekbone (maxillary) sinuses are the most commonly affected. When this infection develops rapidly over a few days and lasts a short time, it is called Acute sinusitis. Many cases of acute sinusitis last a week or so, but it is not unusual for it to last 2-3 weeks. A mild bout of acute sinusitis is common and usually from a viral infection; most people will have some degree of sinusitis with a cold.

    Infrequently the sinusitis becomes persistent and lasts for longer than 3 months, when it is called chronic sinusitis.

  • Most cases of chronic sinusitis develop following an acute sinusitis infection.

    We divide chronic rhino sinusitis into three different categories, depending upon the features that are present.

    • Chronic rhinosinusitis without polyps — This is the most common type of rhinosinusitis where inflammation is due to poorly understood predisposing factors in an individual, allergy, irritation or structurally narrow drainage path from your sinuses.
    • Chronic rhinosinusitis with polyps —In some people, for poorly understood reasons, the lining of the nose and sinuses become so swollen that they appear like pale grapes. These common polyps are NOT cancer and do NOT develop into a cancer. The polyps can become large and numerous enough to clog the sinuses and the nasal passage, causing symptoms.
    • Chronic rhinosinusitis with fungi —Fungi is normal in air around us and most of us can breathe in air containing fungi without problems. However, in some people fungi causes the sinus lining to make thick, dense mucus that fills the sinuses and we can see fungi in the mucus under the microscope.
  • The diagnosis of chronic sinusitis is based on your symptoms along with my examination of your nose with special instruments called nasal endoscopes. They allow me to see any obvious abnormalities or deviation of the bones in your nose, sinus drainage passage and to look for any other problems, such as nasal polyps. As a general rule, X-Rays or scans are NOT used for diagnosis of chronic sinusitis. This is because studies have shown that many people who have NO sinusitis, have some findings on sinus scans! CT scan if requested, is usually done to help me plan surgery (not for sinusitis diagnosis) if medical treatment has failed.

  • Medical treatments :

    Medical treatment is the first step and this cure majority of people. However, usually a long course i.e. 4-12 week treatment is recommended for chronic sinusitis

    The medicines that are recommended include the following:

    1. Steroids applied to the nasal lining using sprays or drops to help reduce inflammation. Initially a course of steroid tablets by mouth may be suggested for 10-14 days.
    2. In patients without polyps, prolonged courses (4-8 weeks) of specific antibiotics at lower dose are sometimes helpful.
    3. A saline nasal solution is very useful to relieve congestion and blockage

    Surgical treatments:

    Surgery is used if the condition does not improve with the above medical treatment. The main purpose of surgery is to improve the drainage of the affected sinus. The most common operation is called functional endoscopic sinus surgery (FESS).

    FESS refers to surgery inside your nose and sinuses with specially designed instruments while I look inside with an endoscope. The endoscope used for this procedure is a thin rigid instrument that contains lenses that allows a detailed magnified view of inside the nose. I can see the opening of the sinus drainage channels and remove any tissues (e.g. polyps) that are blocking the drainage of the affected sinus to improve sinus drainage and ventilation and help to restore normal function to the sinus. If you have a deviated septum, I straighten it out at the same time (septoplasty). FESS does not require any cut or scar on your face/nose, is minimally invasive (causes little damage) and usually has a high success rate in relieving symptoms of chronic sinusitis.

    FESS is carried out under General Anaesthesia i.e. while you are asleep, takes a couple of hours on an average and all being well, you are discharged home the same day.

    A more recently developed operation I offer is called balloon catheter dilation of sinus openings. This involves pushing a small balloon through a flexible tube in the nostril, into the blocked sinus. The balloon is inflated which pushes wide the blocked area. The balloon is then deflated and removed. Following this procedure there is a good chance that the sinus drainage channel is widened, and the sinus can drain properly.

  • Bleeding:  It is normal to have some bloody discharge for the first 3-5 days after sinus surgery, especially after you irrigate your sinuses.  If steady bleeding occurs after surgery, tilt your head back slightly and breathe through your nose gently.  You may dab the outside of your nose with tissue but avoid any nose blowing.  If this does not stop the bleeding you may use Otrivine spray.  Several sprays will usually stop any bleeding.  If Otrivine fails to stop steady nasal bleeding, then you should call A&E.

    Pain:  You should expect some nasal and sinus pressure and pain for the first several days after surgery.  This may feel like a sinus infection or a dull ache in your sinuses.  Extra-strength Paracetamol is often all that is needed for mild post-operative discomfort. You should avoid aspirin. If Paracetamol is not sufficient to control the pain, you should use the prescribed pain medication.

    Fatigue:  You can expect to feel very tired for the first week after surgery.  This is normal and most patients plan on taking at least 1 week off of work to recover.  Every patient is different and some return to work sooner.

    Nasal congestion and discharge:  You will have nasal congestion and discharge for the first few weeks after surgery.  Your nasal passage and breathing should return to normal 3-4 weeks after surgery.

    Postoperative visits:  You will have a certain number of postoperative visits depending on what surgery you have.  During these visits I will clean your nose and sinuses of fluid and blood left behind after surgery. There is some discomfort involved with the cleaning, so it is best to take a pain medication (described above) 45 minutes before your visit.

  • If you are a smoker, please do not smoke for at least 4 weeks after surgery.

    Nose Blowing and Straining:  You should avoid straining, heavy lifting (> 20 lbs) and nose blowing for at least 14 days after surgery.  Straining or nose blowing soon after surgery may cause bleeding.  You can resume 50% of your regular exercise regimen at 1 week after surgery and your normal routine 2 weeks after surgery.

    If you have to sneeze, do it with your mouth open to prevent nasal irritation.

    Steroid Nasal Sprays:  If you were taking nasal steroid sprays prior to surgery you should avoid using these for at least 2 weeks after sinus surgery to allow the lining of the nose and sinuses to heal.  I will tell you when it is safe to restart this medicine.

    Postoperative Care Instructions:
    The first night keep your head elevated—the higher the better. Sleeping in a recliner can help. Then keep your head elevated 30 degrees for the first week after surgery.

    Drink plenty of fluid. Use a cool-mist humidifier at your bedside to help moisturize membranes in your nose and mouth.

    Avoid any travel requiring rapid elevation changes, i.e., airline or mountain travel for 2-3 weeks.
    Please use the prescribed nasal drops as per instructions.


    Nasal Saline Spray: Nasal saline mist spray must be used every 2-3 hours after surgery and can make your nose more comfortable after surgery.  These sprays are over-the-counter medications and can be purchased in any pharmacy. 

    Sinus Irrigations:  You will start the sinus irrigations the day after surgery.  This must be performed at least twice daily.  At first they will feel strange if you haven’t done them before.  Soon, however, they will become quite soothing as they clean out the debris left behind in your sinuses after surgery.  You can expect some bloody discharge with the irrigations for the first few days after surgery.

    The “Sinus Rinse” system is available at many pharmacies with prepared packets of salt-baking soda mixture

    Alternately, you can make up the mixture using this recipe: mix ¼ teaspoon of non-iodised salt with ¼ teaspoon of baking soda in 250mL of room temperature tap water – Use a squeeze bottle to flush the solution gently through one nostril and allow it to come out through the other nostril or from your mouth.

    These saline sprays and saline irrigations are critical for success after sinus surgery! You can not over do this!

  • All operations carry some element of risk in the form of possible side effects. There are some risks that you must know about before giving consent to this treatment. These potential complications are very uncommon.

    • Bleeding is a risk of any operation. It is very common for small amounts of bleeding to come from the nose in the days following the operation. Major bleeding is extremely uncommon and it is very rare for a transfusion to be required.
    • Eye problems – The sinuses are very close to the wall of the eye socket. Sometimes minor bleeding can occur into the eye socket and this is usually noticed as some bruising around the eye. This usually gets better without any special treatment, although it is important that you do not blow your nose. More serious bleeding into the eye socket sometimes can occur, however this is very rare. This can cause severe swelling of the eye and can even cause double vision or in very rare cases loss of sight. If such a serious eye complication did occur, you would be seen by an eye specialist and may require further operations.
    • Spinal Fluid Leak – The sinuses are very close to the bone at the base of the brain. All sinus operations carry a small risk of damage to this thin bone with leakage of fluid from around the brain into the nose, or other related injuries. If this rare complication does happen, you will have to stay in hospital longer and may require another operation to stop the leak. On very rare occasions infection can spread from the sinuses into the spinal fluid causing meningitis but this is extremely uncommon.
  • Fever after the day of surgery higher than 101°F

    Constant clear watery discharge after the first week of surgery

    Sudden visual changes or eye swelling

    Severe headache or neck stiffness

    Severe diarrhea

    Steady, brisk nose bleeding that doesn’t get better after using Otrivine