Understanding Functional Endoscopic Sinus Surgery (FESS) and Identifying Candidates

In this episode of We Nose Noses, Dr. Smith, along with Dr. Reddy and Dr. Undavia, cover Functional Endoscopic Sinus Surgery (FESS) and discusses the criteria for determining if someone is a suitable candidate for this procedure. They explore the symptoms and conditions that warrant FESS, the importance of accurate diagnosis, and the various treatment options available for sinus-related issues.

What you’ll learn

  • How to identify a candidate for Functional Endoscopic Sinus Surgery (FESS) based on criteria such as chronic rhinosinusitis diagnosis
  • What symptoms to watch for that may indicate sinus-related issues and how to distinguish them from other medical conditions during the diagnostic process
  • Why comprehensive history matters in determining the most appropriate treatment approach for sinus-related problems

If you found this episode informative and want to stay updated on all things related to sinus health and ENT care, please like and subscribe to the We Nose Noses podcast. And if you’re experiencing sinus issues and are in the Marlton, NJ area, don’t hesitate to schedule an appointment at NJENT’s Marlton office for personalized evaluation and treatment options. Your sinus health matters, and we’re here to help!

Listen to the audio version below.

Audio Transcript:

Dr. Smith:
Hello, welcome to the We Nose Noses podcast. This is NJENT, Dr. Smith here with Dr. Reddy and Dr. Undavia, and today we’re gonna be discussing what is a FESS or functional endoscopic sinus surgery, and we’ll talk a little bit about who is a good candidate for a FESS or sinus surgery, and some of the things to expect going forward after surgery. And we may cover some topics since it’s a pretty big topic in another future podcast. So stay tuned and listen for future updates and things about functional endoscopic sinus surgery. But I’ll start off with Dr. Reddy, do you wanna go over and talk to the patients about, and to our listeners about what makes a good candidate for a FESS or how do we first identify someone that they may be a sinus surgery candidate?

Dr. Reddy:
Sure, so the most common reason why we do functional endoscopic sinus surgery is for patients that have a diagnosis of chronic rhinosinusitis with or without nasal polyps. So first you have to have a diagnosis of chronic sinusitis or recurrent sinusitis, which just means you have recurrent infections of sinus infections. And you’ve… failed what we call maximal medical therapy. And maximal medical therapy is just conservative therapy, things like nasal sprays and sinus rinses and or allergy management. And if you failed all those, if you failed conservative management and you failed maximal medical therapy. And we get a CAT scan, like a CT scan of your nose and sinuses. If it shows blockages in your nose or sinuses. And so if you, if the imaging shows that there’s some blockages of your sinus pathways, then you’re potentially a good candidate for the procedure.

Dr. Smith:
And then I’ll ask Dr. Undavia here, but you know, often we see patients who think they have a major sinus problem and come in with a lot of sinus issues, but what are some other things that patients may come in? in complaining of that we’re not so sure whether it’s chronic sinus disease or whether something else is going on.

Dr. Undavia:
Yes, it goes back to the question of what are our patients coming in for? So a lot of times patients just say that they have headaches or they say that they have facial pressure or they’re just constantly tired or maybe their nose is constantly running. But it’s up to us to first figure out whether their symptoms are related to their nose. in their sinuses or they’re related to something else. And just going back to Dr. Reddy’s point, you know, we have criteria of what makes a good FAS or functional endoscopic sinus surgery candidate, but so do the insurance company. So when it comes to whether you, when you have your certain set of symptoms, we’re looking for recurrent infections within a year, how many you have, how often you documentation about what antibiotics you’ve tried, nasal sprays, sinus rinses, antihistamines like Zyrtec or Claritin, and when those things fail, then you really do become a candidate to at least explore the option for sinus surgery. But a big thing, going back to the question, is does this person really just have some other type of migraine that’s giving them this headache, or is it just a septal deviation that’s giving them the headache? Those are the things that we have to sort out during our consultation.

Dr. Smith:
Perfect. Great, yeah, there’s a lot of other conditions that overlap with too. Sometimes people come in for a chronic cough or some other allergy flare up and issues and they are diagnosed with sinus disease or they go to the neurologist for headaches and they are diagnosed with sinus disease. And so sometimes there are some overlaps where sometimes it’s a sinus plus something else, like some bad allergies, sometimes it’s sinus and headaches or migraines. And so the job of a good surgeon or a good ENT and physician is to determine this is really just the sinuses and how much of this might be some other areas as well that may overlap. So coming in, Dr. Undavia alluded to a really good history is really what we need. And you’ll hear this kind of throughout our podcast. Being a good historian is really, really helpful for both your physician and clinician to try to figure out what’s going on, but also for the insurance companies to make sure that we’re getting everything appropriately covered and taken care of. Dr. Reddy, do you want to talk a little bit about what, I know we talked about this with nasal obstruction in some of our old podcasts, but do you want to talk about the… what a patient would expect after we do this whole history thing. We’re getting ready to do the physical exam and take a look at what things may a patient expect on their visit to determine if it’s sinus related.

Dr. Reddy:
Sure. So the most important part of the physical examination is a mini procedure we do in the office called a nasal endoscopy where a thin tube about four millimeters or so in diameter that’s either rigid or flexible goes into your nose and it allows us to take a look into all the nooks and crannies of your nose. So it allows us to look obstruction, sinus disease, and those findings help us determine what next steps are, including whether you’re a candidate for the surgery.

Dr. Smith:
Perfect. So the CAT scan, which he alluded to in the past, often will give a CAT scan, and we’re looking to see some evidence. It’s a snapshot in time, so it doesn’t show us everything, but it will give us an idea if there’s some chronicity to the disease going on. and they’re often their signs of inflammation or thickening within the sinuses. And then going forward after we determine that you’re a good candidate for sinus surgery, Dr. Undavia, do you wanna talk about some of the options as far as different types of procedures and things that we can do as well?

Dr. Undavia:
So yeah, we do have lots of options. You don’t have to go to the operating room every time if you have this type of problem. It’s up to us to figure out what we can We want to get you better without having to do, with doing the least amount. Sometimes that’s not an option, but that’s what we want to try. So the first things we want to try to ascertain whether we can do is something in the office that’s quick where you don’t have a big recovery. So there’s many things that we can do in the office. Part of it depends on whether we have access to all the parts of your nose, and a big part of that depends on how crooked your septum is. So we’re trying to figure that out with the nasal endoscopy. But we have as options in office procedures reducing the size of your turbinates. We can do some septoplasties in the office as well. But if those aren’t real options, or if there’s a lot of disease where we’re going to kind of put somebody through a lot in the office, then we offer something more surgical in the operating room. And when we’re talking about that, we talk about you being fully, patients being fully asleep, that we need to open and remove the diseased tissue from there. Yeah.

Dr. Smith:
O ne thing I often talk to patients about too is, you know, going forward and we can talk more about the anatomy at another date, but we talk about, I try to give the analogy of the nose as your hallway and the rooms are all separated by that hallway by some doors. Usually in people with chronic sinus problems or sinus disease that require And so there’s a bunch of different ways we can get those doors open. We can do minimal procedures where we kind of balloon and dilate those doors open so that they’re a little more open so air can get into the sinuses. A lot of the game is trying to get more aeration into the sinuses. Those sinuses are these hollow trauma cushions around your face. And when those things get obstructed, that’s kind of when this disease process begins. And if you see one of us in the office, we’ll probably talk to you a lot more about kind of the anatomy and the physiology of the sinuses. of how these sinuses become diseased and inflamed. But the big thing is with sinus surgery, the goal is getting those sinuses open so they cannot re-obstruct. Now, a lot of time, the room is still the same room. So if I open that door and crack it open, or we take the whole door frame out and take the whole thing, so now there’s one giant opening into the sinus, the disease process may still be there. The opening up the sinuses may help halt that disease, may reverse that disease, and some of that has to do with going forward You know, allergy therapy, and that’s where, you know, one thing with medicine is that it’s not like a checkbox. It’s not one size fits all. So when you come in, we really, you know, think long and hard for each individual patient as what’s going to be the best thing. Some people, you dilate their sciences open and they’re great forever. Some people take the whole doorframe out and their sinus still needs work going forward. And so some of that is a long discussion with us about what kind of disease you have, because not all sinus disease is the same. So, you know, seeing a well-skilled sinus surgeon will help kind of determine what you need to do going, not just today, but also going forward in the future. So one thing I always want to let my patients know is sinus surgery, it may just be part of it. And we talked about headaches and migraines as being part of it as well. There are plenty of patients that we have and that will kind of educate them on like, okay, some of your disease may be sinus related, but that might be burdening and making your migraine control worse, but you still may have migraines or headache disorders after surgery too. So we need to kind of determine and figure out what the best. kind of steps going forward would be.

Dr. Reddy:
Yeah, one analogy I like to use that you were kind of describing the nose and the hallway and the rooms, is just pipes in your nose. So if you picture your nose and your sinus pathways. and you have chronic sinus disease, it’s just potentially blocked pipes. And if you just think of blocked pipes or blocked plumbing in your house, what’s the first thing you do if you get a blocked pipe in your house? Get a plumber. Before the plumber. Draino. Draino, right? So you put some Draino in there and you try to unclog the pipes. So the allergy medication, the nasal sprays, the sinus rinses, all of that’s basically like Draino for your nose. Try to unclog it. If that doesn’t work, what do you do? You call the plumber, right? We’re basically the plumbers of your nose. And the plumbing job that you can do for your nose is essentially two options. One is the in-office balloon sinuplasty, and the other is the formosinus surgery. The balloon sinuplasty is the equivalent of almost like roto-rotoring out your pipes with the plumber. And if it’s a severe blockage, sometimes the plumber has to replace your pipe and put a wider pipe in there. And that’s what sinus surgery essentially is. It’s just widening the pipes. You guys like the analogy?

Dr. Smith:
It’s okay. We’ll work on it.

Dr. Undavia:
I want to just bring back to, first for our patients who don’t know if they should come into the office. The textbook definition of somebody who is a candidate for sinus surgery or for something for their nose is somebody that’s failed medical management. So if you’re going to your doctor for a ton of antibiotics many times a year, if you’re using nasal sprays, if you’re using sinus rinses or allergy pills or even more and you still have symptoms, you are the candidate to come in and have your sinuses evaluated There’s tons of studies showing that, you know, your symptoms wear you down in ways that you don’t even comprehend with regards to sleep quality, attention, your ability to focus during the day. So we are there to help your symptoms get better and like Dr. Smith alluded, not all symptoms are just one factor. There may be many things contributing, but so long as we can chomp at each one, we can get you better for sure.

Dr. Smith:
I think that’s all we have for today. Thanks for joining us for the We Know Noses podcast. Again, this is NJENT signing off for the week. We’ll see you soon. Take care.

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