What is the surgical procedure of choice for the treatment of chronic sinusitis?

Updated: Jul 01, 2019
  • Author: Itzhak Brook, MD, MSc; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

Recent advances in endoscopic technology and a better understanding of the importance of the ostiomeatal complex in the pathophysiology of sinusitis have led to the establishment of functional endoscopic sinus surgery (FESS) as the surgical procedure of choice for the treatment of chronic sinusitis. [57]

FESS facilitates the removal of disease in key areas, restores adequate aeration and drainage of the sinuses by establishing patency of the ostiomeatal complex, debulks severe polyposis, and causes less damage to normal nasal functioning. FESS is successful in restoring sinus health, with complete or at least moderate relief of symptoms in 80-90% of patients. Supportive medical treatment is instituted preoperatively and postoperatively. In children, surgical management is not as well established and should be reserved for complicated cases.

Occupational exposure may affect FESS outcomes. Symptoms may persist with work-related exposure to inhaled agents, and revision surgery may be required. [58]

In patients who have undergone endoscopic sinus surgery, total and direct healthcare costs, antibiotic usage, and the total number of imaging studies performed decreased after surgery for at least 3 years. However, the use of oral corticosteroids did not change. [59]

For more information, see the Medscape Reference article Functional Endoscopic Sinus Surgery.


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