What are the paranasal sinuses?
The paranasal sinuses are air-filled spaces in the bones of the face. There are four pairs. The maxillary sinuses are in the cheeks, the ethmoid sinuses between the eyes and the frontal sinuses in the forehead. The sphenoid sinuses lie deeper, behind the nose.
They are lined with mucosa, a thin layer of tissue that produces mucus. The mucus drains into the nose through small openings called ostia. If these become blocked, mucus builds up and inflammation can develop: rhinosinusitis, usually just called sinusitis.
Acute or chronic sinusitis: what is the difference?
Acute sinusitis often follows a cold. It usually clears up within a few days or weeks. When episodes come back several times in the same year, it is called recurrent acute sinusitis.
Chronic sinusitis, on the other hand, lasts 12 weeks or more. The problem does not settle and becomes part of everyday life. It is sometimes associated with nasal polyps, small benign swellings of the lining. These are the typical symptoms, but they can also have other causes: a consultation is needed to find out.
- A blocked nose, often on both sides
- Mucus running from the nose or down the back of the throat
- Pressure or pain in the face, forehead or between the eyes
- A reduced or lost sense of smell
Chronic sinusitis surgery in Bari: when is it needed?
Medical treatment almost always comes first. It usually includes saline nasal rinses and steroid nasal sprays. In selected cases the doctor adds other medicines. Many people improve with this.
Surgery is considered if symptoms persist despite appropriate treatment and the CT scan still shows diseased sinuses. It is never an automatic decision: the specialist discusses the benefits, limits and alternatives with the patient. The most common situations are:
- Chronic sinusitis that does not improve with medicines
- Recurrent acute sinusitis, with many episodes a year
- Nasal polyps that block the nose or reduce the sense of smell
- Complications, which are rare, involving the eye or nearby structures
- Fungal infections or mucoceles (collections of mucus trapped in a sinus)
Consultation, endoscopy and CT scan: how is surgery planned?
Everything starts with an ENT (ear, nose and throat) consultation. The specialist listens to the history of your symptoms and performs a nasal endoscopy. A thin probe with a light and camera is passed into the nose to show the inside of the nasal passages. The examination takes a few minutes and is done in the clinic.
If surgery is being considered, a CT scan of the sinuses is needed. This X-ray scan shows which sinuses are affected and each patient's individual anatomy. For the surgeon it is a true map: it guides planning and helps when working close to the eyes and the base of the skull.
Before the operation, blood tests and an assessment by the anaesthetist are carried out. Mention all the medicines you take, especially those that thin the blood.
How is endoscopic sinus surgery performed?
FESS stands for functional endoscopic sinus surgery. The surgeon works through the nostrils with fine instruments and an endoscope, a thin tube connected to a camera. There are no cuts on the face and no visible scars.
Diseased tissue is removed and the natural openings of the sinuses are widened. This lets mucus drain and air circulate again. It is called “functional” because it aims to preserve the healthy lining. If needed, a deviated septum can be corrected or nasal polyps removed during the same operation.
The operation is generally performed under general anaesthesia. Its length depends on how many sinuses are involved. Patients usually go home the same day or after one night. Sometimes small soft packs are left in the nose; they are removed after a day or two or dissolve on their own.
What to do after surgery: nasal rinses and check-ups
For the first few days the nose feels blocked, as with a heavy cold. Slight bleeding, crusts and a feeling of pressure in the face are normal. Pain is usually mild to moderate and is controlled with common painkillers.
Saline nasal rinses are the most important part of care at home. They clear crusts and mucus and help the lining heal. The doctor will tell you how often to do them and for how long.
A few endoscopic check-ups in the clinic follow, to clean the nasal passages, prevent adhesions (small scars joining the walls of the nose) and monitor healing. Dr De Candia gives personalised advice after the consultation. In general, it is advisable to:
- Avoid blowing your nose hard
- Sneeze with your mouth open
- Avoid strain, sport, hot baths and saunas, usually for one to two weeks
- Ask the doctor before flying
- Avoid smoking
What are the risks of FESS?
Like any operation, FESS carries some risks. The most common are generally mild and temporary: nosebleeds, crusting, infection, adhesions, a blocked nose for a while or temporary changes in the sense of smell.
More rarely, the eye or the base of the skull, which border the sinuses, can be affected. Examples include bruising around the eye, excessive watering of the eye or a leak of cerebrospinal fluid, the fluid that surrounds the brain. In addition, chronic sinusitis can come back over time. Risks, benefits and alternatives are explained carefully at the consultation before surgery.
Why see an ENT surgeon with endoscopic training?
FESS is performed close to delicate structures, such as the eyes and the base of the skull. That is why specific training in endoscopic techniques matters.
Dr Nicola De Candia is a specialist in both ENT surgery and neurosurgery. Over his career he has performed more than 1,000 operations in total. His endoscopic training includes:
- 1997: training in endoscopic sinus surgery at the University of Brescia
- 1999: 25th course in endoscopic sinus surgery in Graz (Austria)
- 2000: Andrea Vesalius course on advanced endoscopic techniques for the paranasal sinuses, Brussels
- 2003 and 2009: Masterclass in endoscopic sinus and skull base surgery, Milan
- Lecturer in “Endoscopic sinonasal techniques” on the Otolaryngology specialty training programme at the University of Bari
The information on this page is for general education and does not replace a specialist consultation: indications, recovery times and risks are assessed case by case.