Surgical Treatment for Chronic Sinusitis

Sinus surgery using a nasal endoscope is the most commonly recommended procedure for people with chronic sinusitis. The surgeon uses the same type of thin endoscope used during the diagnostic exam. This procedure requires no visible incisions, is performed under general anesthesia.

The endoscope, which is inserted by a surgeon through the nostrils, is attached to a miniature camera and light source. During surgery, high-resolution images of the nasal passages and sinuses are transmitted from the endoscope to a high-definition monitor in the operating room. The surgeon uses images from a CT scan as a roadmap to help guide the surgery based on your sinus anatomy.

When the endoscope is in place, the surgeon uses tiny surgical instruments to remove unwanted tissue or polyps or to correct a deviated septum. If the turbinates—bony structures that line the nasal passages, cleaning and humidifying air as it passes—are enlarged and blocking your nasal passages, your surgeon may reduce them to improve breathing. 

Endoscopic sinus surgery typically takes about two hours and does not require an overnight hospital stay. There is no swelling or bruising of the face as a result of surgery.

Endoscopic sinus surgery requires extreme precision due to the location of the sinuses near the eyes and brain. Because of this, surgeons at NYU Langone may suggest image-guided or computer-assisted endoscopic sinus surgery to allow for a more safe and thorough procedure. 

Before this procedure, data from a sinus CT scan is uploaded to a computer and displayed on a high-definition monitor. After the endoscope has been inserted through the nostrils and is in place in the sinuses, microinstruments used by the surgeon are connected to the same computer, allowing the surgeon to see the location of the instruments in your sinuses with an accuracy of one to two millimeters. Data about the location of the microinstruments is continually updated.

Computer guidance allows surgeons to precisely identify and remove tissue or bone while preserving surrounding structures. Computer-assisted sinus surgery is performed under general anesthesia and takes about two hours.

Balloon sinuplasty allows the surgeon to dilate a blocked sinus, creating open space, which allows the sinus to drain normally. The surgeon uses a flexible endoscope with a light to guide the insertion of a thin wire. The wire is then moved through the nasal passages toward the opening of the blocked sinus. 

When the location of the blockage is confirmed and the wire is in place, a thin catheter with a small balloon attached is guided along the wire to the blocked sinus and positioned at its opening. Then the balloon is slowly inflated, gently dilating the sinus opening and allowing normal draining to occur, which usually resolves the blockage. 

Balloon sinuplasty takes about an hour and is performed under general anesthesia. If the sinus blockage is not responsive to balloon sinuplasty, or if symptoms of chronic sinusitis are severe, doctors may choose to perform this procedure in combination with endoscopic or image-guided sinus surgery. 

After surgery, NYU Langone doctors schedule several follow-up appointments in order to monitor your recovery. Our doctors also provide continued support to ensure that symptoms of chronic sinusitis are effectively managed.