THIRUVANANTHAPURAM: Chronic sinusitis, a prevalent health condition, results from persistent inflammation in the sinuses lasting beyond 12 weeks. Factors such as allergies, deviated nasal septum or impaired cilia (small hairs in the sinuses) can impede the natural movement of nasal secretions, leading to sinusitis. This condition manifests as a congested nose that struggles to expel mucus, hindering breathing. As a result, the stagnant environment within the sinuses becomes conducive to bacterial and pathogenic growth, eventually leading to the development of nasal polyps—noncancerous growths in the nasal and sinus lining.
Nasal polyps pose significant challenges, blocking the nasal passages and causing breathing difficulties, often accompanied by a loss of the sense of smell. Initial treatments involve medications aimed at reducing or eliminating these polyps. However, surgical intervention is frequently necessary to achieve complete removal.
“We start with medical management. Nasal sprays and some tablets are used first. People who are allergic lose interest in treatment in due course and come to us after the situation worsens. We opt for minimally invasive sinus surgeries, especially the functional endoscopic sinus surgery (FESS) for such patients,” said Dr Gopikumar P, consultant ENT surgeon at CAM Hospital, Thrissur. He also cautioned that diabetic patients and other immunocompromised are at an increased risk of developing fungal sinus infection, which is a serious health condition.
Environmental factors and pollution contribute significantly to the prevalence of sinus-related issues. Technological advancements in the medical field have given rise to minimally invasive sinus surgeries, offering patients a more comfortable and efficient alternative to traditional surgical methods. FESS, in particular, has revolutionized sinus and nasal surgeries by providing doctors with access to sinus areas through advanced endoscopic instruments.
“The gold standard in minimally invasive techniques for chronic sinusitis is the functional endoscopic sinus surgery which is widely practised today. Under endoscopic vision, the natural sinus drainage pathways are made patent preserving the normal sino-nasal mucosa and removing only the diseased mucosa. It is completely scarless with many centres opting for it as a daycare surgery now,” said Dr Vinod Felix, Consultant, Department of ENT KIMSHEALTH, Thiruvananthapuram.
“With advanced bleeding control measures and the use of powered instruments like microdebrider, the recovery time is reduced to an average of 1 week. FESS gives wide access to local nasal administration of steroids and other medications in the form of nasal wash/ spray to reach the entire sino nasal mucosa to prevent further recurrence of disease in the case of nasal allergic patients,” he added.
Endoscopic Balloon dilatation of the sinus drainage pathway is another option that is performed in selected cases, Felix added.
Patients undergoing minimally invasive sinus surgery may receive either local or general anesthesia. The decision on anaesthesia is typically made after a thorough evaluation by the surgical team, taking into consideration the patient’s overall health, complexity of the surgery and the surgeon’s judgment.
The doctors have also stressed the importance of follow-up treatment to get the maximum benefit from FESS. “Treating a disease which is dynamic in nature will not end with surgery. If there is no follow up, the nasal polyps will surely reappear in 2-3 years. But we can control the chances of recurrence. Nasal spray and tablets need to be continued for some time,” said Gopikumar.
Advantages of endoscopic sinus surgery
1 Faster Recovery Time: One of the primary benefits of minimally invasive sinus surgery is the quicker recovery time. Traditional open surgeries often require more extensive healing periods due to large incisions and tissue disruption. In contrast, minimally invasive procedures involve smaller incisions, resulting in fewer traumas to surrounding tissues and faster recovery for patients.
2 Reduced Pain and Discomfort: Smaller incisions and less tissue disruption contribute to reduced postoperative pain and discomfort for patients undergoing minimally invasive sinus surgery. This makes the overall experience more tolerable and promotes a quicker return to normal daily activities.
3 Preservation of Healthy Tissue: Endoscopic sinus surgeries allow surgeons to target and treat specific sinus issues while preserving healthy surrounding tissue. This precision is crucial in minimising the risk of complications and ensuring optimal outcomes for patients.
4 Improved Visualizations: The use of high-definition endoscopes provides surgeons with enhanced visualizations of the sinus anatomy, allowing for more accurate diagnosis and precise treatment. This improved visibility contributes to better surgical outcomes and a lower risk of complications.
5 Reduced Scarring: The small incisions in minimally invasive sinus surgeries result in minimal scarring compared to traditional open procedures. This cosmetic advantage is particularly appreciated by patients, as it contributes to a more aesthetically pleasing outcome