Sinus surgery is a critical procedure in otolaryngology designed to treat chronic sinusitis and other sinus issues that do not respond to conventional treatments, such as oral medication. It aims to restore normal sinus function, improve airflow, and reduce the frequency and severity of sinus-related symptoms, ultimately enhancing the patient's quality of life.
Chronic sinusitis affects thousands of people in Singapore, affecting their quality of life with symptoms [1] such as nasal congestion, facial pain, headaches, and a reduced sense of smell. While medications and non-invasive treatments can provide relief, there are some patients with chronic sinus conditions that require surgical intervention to restore normal sinus function.
Over the past few decades, sinus surgery has advanced considerably, shifting from invasive procedures with lengthy recovery times to minimally invasive techniques that offer greater precision and quicker healing. Today, Endoscopic sinus surgery is the standard method [2] that uses a small camera and specialised endoscopic instruments to access and clear the sinus pathways, providing a safer and more effective solution for patients. There are no open scars and healing is quicker.
Keep reading to explore the reasons for sinus surgery, the various surgical techniques available, potential risks and complications, and the post-operative care necessary for optimal recovery. By understanding the details of sinus surgery, patients can make informed decisions to improve respiratory health and overall well-being.
First, it’s good to know the anatomy or structure of our sinuses so you can understand why sinus surgery is needed. The sinuses, which are usually air-filled cavities within the skull, are essential for filtering and humidifying the air we breathe, as well as aiding in the resonance of our voice. However, when these cavities become inflamed or blocked due to infection, allergies, or structural abnormalities, they can cause persistent discomfort, breathing difficulties, and recurrent infections.
There are four separate sinuses on each half of our face (to make up a total of 8 sinuses on both sides):
When the sinuses are affected due to inflammation, allergies, or growths, it can cause various symptoms. These sinus conditions, or associated conditions include:
Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive procedure aimed at restoring normal sinus function. An endoscope, which is a thin, rigid tube, is attached to a light source and camera. The surgeons can directly visualise and access the sinus passages. This allows for the precise removal of inflamed soft tissue such as nasal polyps, inflamed mucosa, or bone fragments.
FESS is often used to treat chronic sinusitis, a condition marked by persistent inflammation of the sinuses that does not respond to medication. By improving drainage and ventilation of the sinuses, FESS helps relieve symptoms like nasal congestion, facial pain, and recurrent infections. Typically performed under general anaesthesia, FESS offers a quicker recovery and fewer complications compared to traditional open sinus surgery.
Balloon sinuplasty is a modern, minimally invasive procedure designed to treat chronic sinusitis and other sinus-related issues. During the procedure, a small balloon catheter is inserted into the blocked sinus passage through the nasal cavity. Once in place, the balloon is inflated to gently widen the sinus opening, allowing for improved drainage and ventilation.
This expansion helps to relieve sinus pressure, reduce inflammation, and restore normal sinus function. The procedure is often performed under local or general anaesthesia. Balloon sinuplasty is particularly beneficial for patients with persistent sinus issues who have not responded well to medication or other non-surgical treatments.
Powered instrumentation in sinus surgery has significantly improved the precision and effectiveness of procedures. These tools, such as microdebriders, drills, and powered coblators, have transformed how surgeons approach sinus surgery.
Microdebriders use a rotating blade to precisely remove diseased tissue while simultaneously suctioning it away, which reduces bleeding and improves visibility. This minimises trauma to surrounding structures, leading to faster recovery and fewer complications.
Powered coblators, on the other hand, utilise low-temperature radiofrequency energy to dissolve soft tissue while minimising damage to adjacent areas, further enhancing safety and precision. This technology effectively removes nasal tumours with minimal bleeding, minimal heat damage to surrounding structures, and less scarring.
The use of these advanced tools allows for a more thorough removal of obstructions in the sinuses, such as tumours, and is crucial for the long-term success of treating conditions like chronic sinusitis. Overall, the integration of powered instrumentation, including coblation technology, represents a significant leap forward in sinus surgery, offering improved control, safety, and outcomes.
The Caldwell-Luc operation is a traditional surgical procedure that addresses chronic sinus infections and related conditions. During this surgery, a small incision is made in the upper jaw, typically through the mouth, to access the maxillary sinus. The surgeon then removes infected tissue, polyps, or other obstructions from the sinus cavity.
While effective, the Caldwell-Luc operation has mostly been replaced by modern techniques today such as Functional Endoscopic Sinus Surgery (FESS) which are less invasive with shorter recovery times.
Traditional sinus surgery is an invasive procedure requiring a large incision on the face (usually by lateral rhinotomy incision), either inside the mouth or on the face, to access and treat sinus issues. It involves removing obstructive tissue and creating new drainage pathways. This technique has largely been replaced by endoscopic sinus surgery, except in limited situations for certains tumours. This technique typically has a longer recovery time and a higher risk of complications compared to modern techniques like Functional Endoscopic Sinus Surgery (FESS), which is why it is no longer the surgical procedure of choice today.
Chronic sinusitis and nasal polyps are among Singapore's most common reasons for sinus surgery. Sinus surgery is typically recommended when:
In Singapore, the diagnosis of sinusitis typically involves a comprehensive evaluation by an ENT (Ear, Nose, and Throat) specialist. The process usually includes:
Based on these evaluations, the specialist will determine if sinus surgery is necessary and which surgical approach would be most appropriate for the condition.
Preparing for sinus surgery in Singapore involves a few important steps to ensure a successful procedure and recovery. You will start by undergoing a comprehensive evaluation by an ENT specialist, as explained above, which includes reviewing your medical history, conducting a physical examination, and performing imaging studies such as CT scans. It is essential to discuss any existing health conditions, medications, or allergies with your doctor.
Preoperative instructions usually include dietary guidelines and instructions for the day of the surgery. Additionally, arranging transportation and post-surgery support, as well as understanding the recovery process and potential side effects, will also facilitate a comfortable and smooth recovery.
Immediately after the procedure, patients are monitored in a recovery room before being discharged, typically on the same day or the day after. Pain is typically managed with over-the-counter pain relievers, though stronger medications may be prescribed if needed. Sinus surgery is normally not a painful procedure and does not require significant pain medications.
Recovery and aftercare following sinus surgery are crucial for optimal healing and to ensure the best results. Immediately after the procedure, you may experience some nasal congestion, occasional bleeding spots, and discomfort, which are common and typically manageable with prescribed pain relievers and nasal medications. It’s important to follow your ENT surgeon’s instructions regarding rest and avoiding strenuous activities.
Regular follow-up appointments are also necessary to monitor your progress and remove residual packing or debris. You should also follow guidelines for nasal care, such as gentle nasal irrigation and avoiding blowing your nose forcefully. Maintaining good hydration, using a humidifier, and avoiding irritants like smoke can further aid in your recovery. If you have any concerns during the recovery period, contact your doctor.
The outcomes and success rates following sinus surgery are typically very positive, with many patients experiencing notable relief from symptoms such as nasal congestion, sinus pressure, and frequent infections. The effectiveness of the surgery can vary based on the type of procedure, the specific sinus condition being treated, and individual patient factors. Techniques like Functional Endoscopic Sinus Surgery (FESS) generally have high success rates, leading to improved sinus drainage and function with minimal complications.
Most patients report significant improvements in their quality of life and a decrease in the frequency and severity of sinus infections. Achieving the best results also relies on following postoperative care instructions and making necessary lifestyle adjustments. Overall, sinus surgery is a highly effective treatment option for chronic sinus problems, offering positive outcomes for many individuals.
Now that you know what to expect from a sinus surgery, it’s important to be sure that you’ll be undergoing it with an experienced and qualified ENT surgeon. Look for surgeons who are fellowship trained in sinus surgery and have extensive experience in performing sinus surgeries. When you book a consultation, bring a list of questions so you can clarify any concerns you have about the surgery.
Dr Soma is a well-known ENT surgeon in Singapore who plays an active role in the local ENT community as well as Nationally and around the region. Dr Soma is USA fellowship trained in sinus surgery and is an expert in performing sinus surgery, having published numerous papers and been invited to multiple countries as an invited guest speaker and to teach other doctors how to perform sinus surgery. Book an appointment for a consultation to find out more.
Costs can vary widely depending on the type of surgery, the surgeon’s fees, and the facility where the surgery is performed.
Many insurance plans in Singapore cover sinus surgery, though patients should verify the extent of coverage and any out-of-pocket expenses.
Singapore offers subsidies for residents through public healthcare institutions, and various financial assistance programs are available for those in need.
Sinus surgery in Singapore is generally more affordable than in many Western countries, while maintaining high standards of care.
Sinus surgery can offer significant relief for those suffering from chronic sinus issues, particularly in a country like Singapore where environmental factors can exacerbate these conditions. By understanding the various aspects of sinus surgery, from preparation to recovery, and choosing the right specialist, you can make informed decisions to achieve the best possible outcomes.
Sinus surgery is known to be effective at treating chronic sinus issues by reducing symptoms and improving sinus function. Most patients report significant improvement in their quality of life and a decrease in the frequency of sinus infections.
Many patients experience symptom relief within a few weeks after surgery. Full benefits and healing may take 1-2 months following surgery.
You may need sinus surgery if you have chronic sinusitis or other sinus issues that persist despite medication and other non-surgical treatments. An ENT specialist can evaluate your condition through medical history, physical examination, and imaging studies to determine if surgery is necessary.