Nasal operations are very common in Hong Kong. In the past two weeks alone, I have performed 12 operations in private hospitals. Three were for nasal obstruction and four for recurrent sinusitis. I see many patients with allergic rhinitis, which predisposes them to sinusitis.
The indications for patients to have sinus surgery are when they have complications from sinusitis - like the infection spreading to the eye or the brain, recurrent sinusitis despite maintenance treatment to prevent it or acute sinusitis with failed medical treatment, which means it does not get better with nasal sprays, sinus washes or antibiotics.
In the old days - more than 30 years ago - it was common to have operations for sinusitis done via the oral cavity from under the upper lip, the Caldwell Luc operation.
The maxillary sinus - the cheek sinus below your eyes - was approached through the cheekbone under the lip and the pus drained that way. Although it did settle the episode of acute sinus infection effectively at the time, sinusitis often recurred again after six to 12 months.
That was because the original sinus opening that was blocked was not rectified and the sinusitis process started all over again, as the skin would cover the puncture hole of the sinus again.
The next development was then to make a puncture on the inside of the nostril to access the maxillary sinus and drain the pus.
The opening remained in the nasal cavity under the inferior turbinate. This also led to recurrent sinusitis as it caused recirculation of the sinus mucosa - that is, mucus drainage followed the natural opening of the sinus rather than the new opening created.
About 20 years ago, we started functional endoscopic sinus surgery where we used endoscopes and endoscopic instruments to operate through the nostrils.
We would enlarge and unblock the natural opening of the sinuses and this led to a cure for sinusitis and the prevention of recurrent sinusitis.
Then it is very easy to prevent sinusitis with sinus douching - rinsing of the nasal cavity and the sinuses with fluid - as all the mucus and pus gets flushed out of the sinuses.
Having in the past six years carried out more than 400 primary and revision endoscopic sinus surgeries and endoscopic skull-base surgeries, or tumor-related endoscopic nasal surgery, with no major complications, it is very important to explain to patients that sinus surgery is very safe - carrying only the very small risk that comes with any surgery.
It is a very mature technique to cure sinusitis and to prevent recurrence.
Dr David Ho is an Australian- and Hong Kong-registered ENT specialist. As consultant specialist in Melbourne, he taught trainees to perform FESS.
E-mail: davidhoent@hotmail.com
