Endoscopic Sinus Surgery

Most sinus surgery today is performed endoscopically. This involves using tiny telescopes to look up into the nose and into the sinus cavities. These small telescopes along with small microsurgical instruments can be used to open and go into the sinus cavities and clean the sinuses out.

Puss, polyps, and the like can be removed and sent to pathology for examination. This type of sinus surgery is usually reserved for children who do not respond to conventional methods of treatment with antibiotics or allergy treatment.

The advantage of this type of surgery is that it enables the surgeon to look directly into your child’s sinus passageways and remove any abnormal findings as well as to correct any bony or anatomical abnormalities.

This type of surgery causes little pain to the patient after the procedure, and there are no incisions or black or blue marks on the face or eyes.

What conditions might require endoscopic sinus surgery?

If your child has one of the following conditions, she may need endoscopic sinus surgery:

• anatomical (bony) abnormalities of the nose or sinus cavities
• nasal polyps
• deviation of the nasal septum
• fungal infections
• tumors
• cystic fibrosis

How long does the surgery take?

This surgery can take as long as four hours, or be as short as 30 minutes, depending on the degree of sinus involvement.

What are the risks of sinus surgery?

As with most surgical procedures, sinus surgery has some associated risks. Each operation can have varying degrees of risk, depending on your child’s unique situation.

What should you expect during surgery?

• Endoscopic sinus surgery usually takes between one and three hours and is done in the operating room with the child under general anesthesia.
• Most young children spend the night in the hospital, but some older children may stay for only a couple of hours after surgery.
• Endoscopic sinus surgery may be performed at the same time as another operation such as septoplasty, tonsillectomy, adenoidectomy, or insertion of ear tubes.

What should you expect after surgery?

• Your child will have intravenous (IV) fluids until time you leave the hospital. Clear liquids for your child to drink are available in the Post Anesthesia Care Unit (PACU), also called the recovery room.
• Your child may complain of a sore nose, not being able to breathe through her nose, and difficulty swallowing.
• A pain reliever may be given for pain. An antibiotic is occasionally prescribed to prevent infection.
• The head of the bed will be raised in the PACU to help with swelling, breathing, and drainage. At home, you should have pillows or a recliner chair available to help your child stay comfortable with her head elevated above the level of her chest.
• There may be packing in the nose to prevent bleeding. Sometimes, this packing is dissolvable. The physician may remove this packing in one or two weeks or it may dissolve on its own. If the packing needs to be removed, it may be done in our office for older, cooperative children, or may be done in the operation room under anesthesia.
• If a septoplasty (straightening of the bone and cartilage in the center of the nose) is performed, then splints will be placed inside the nose at the end of the operation. These will be removed at the physician's office in one to two weeks and may cause some discomfort while they are in place.
• If packing is used, your child may be able to feel it in her nose. She should be told before surgery that she may feel like there’s something in her nose when she wakes up. If packing is not used, swelling may cause this feeling. Your child will be told that she won’t be allowed to forcefully blow her nose for a week or two.
• You may see a small piece of gauze taped under your child's nose. This is called a "drip pad." This is usually only needed for the first day, if at all. The drainage from her nose will probably be tinged with blood. Your child may cough or spit up some pink or brown mucus.
• Most children are fussy the first few hours after this procedure.
• Your child may begin normal play after several days, but may need to stay home from school until the discomfort improves.
• Your child's doctor may recommend the use of nasal ointment, salt-water spray, or nasal steroid spray after surgery. Follow instructions carefully.

When should you call your child's physician?

The following are some of the symptoms that may indicate a need for you to promptly contact your child's physician:

• bright-red bleeding from her nose or mouth
• double or impaired vision
• a persistent leak of clear fluid from her nose
• if your child vomits bright-red blood or a coffee ground-like material
• if your child develops a croupy (barky) cough/cry or wheezing
• if your child's temperature rises to more than 101.5 degrees F rectally or to more than 100.5 degrees F orally
• vomiting (or if the vomiting becomes severe)
• signs of dehydration (a child can become dehydrated when he has prolonged or severe vomiting and is not able to drink enough fluid)

Contact us

The Department of Otolaryngology and Communication Enhancement is located on the third floor of 333 Longwood Avenue, across the street from the main hospital.

Mailing address:
Boston Children's Hospital
300 Longwood Avenue
Boston, MA 02115

Phone:
617-355-6460