Functional endoscopic sinus surgery in connection with snoring

Snoring and sinusitis (inflammation of the paranasal sinuses)

Snoring in connection with a blockage of the nasal airways can also be causally triggered by a chronic inflammation in the sinuses adjacent to the nasal cavity and influenced for a long time, sometimes even decades. If this focus of inflammation is not recognised and thus not treated, the inflammation can lead to swelling of the mucous membranes and thus to blockage of the nose. This is why it is so important to also consider the condition of the paranasal sinuses when clarifying the causes of snoring.

First of all, a specific questioning of the patient about recurring forehead or facial pain, frequent discharge of colourless or coloured nasal secretions, smelling disorders or repeated infections can indicate the presence of a chronic sinusitis.

If there are indications of such an inflammation, the next step is an examination by a specialist. This examination is carried out by means of endoscopy (examination of the interior with an endoscope), ultrasound and, if necessary, radiological diagnostics, in this case with computer tomography (CT). People often ask whether magnetic resonance imaging (MRI), which has less radiation, could not be used here. It is important to know that MRI is well suited for imaging water-containing structures, i.e. also mucous membranes. Bone is not depicted by MRI. However, this is important for us from a surgical point of view, as we have to stick to the bony boundaries and the corresponding anatomical landmarks. The navigation system also needs raw data from computed tomography to enable navigation-based and thus safer surgery.

What causes chronic sinusitis?

Anatomical variations of the bony nasal framework or pronounced mucosal swelling with and without the additional presence of mucosal polyps lead to obstructions of the natural drainage paths.

As a result, the mucus formed in the nose and sinuses can no longer drain away. New mucus continues to be formed. The paranasal sinus system comes under pressure. Headache, facial pain and also dizziness can occur spontaneously, or when bending over, for example when tying the shoelaces. By this time, the ability to smell is also already limited or even completely absent. Pathogens already present on the mucous membrane, so-called facultative pathogens, find good growth conditions. Chronic sinusitis is a common secondary disease caused by the congestion of secretions.

What are the treatment options for chronic sinusitis?

Usually, treatment is started with conservative therapy. This consists of regular salt water rinses, inhalations, which can also be combined with local cortisone therapy. Some general practitioners also prescribe a one-week systemic cortisone therapy for their patients, usually combined with macrolide antibiotic therapy.

If there is no improvement in the symptoms, the possibility of surgical remediation should be considered after a computed tomography radiological diagnosis.

What is the procedure for a sinus operation?

The first and most important step is an infundibulotomy. Here, the bony wall of the anterior ethmoid bone, which serves as a boundary for the nasal cavity, is opened or removed. The natural opening to the maxillary sinus is then revealed. Since this opening is often blocked or too small, it is widened instrumentally. A so-called "window to the maxillary sinus" is thus created. Now, with the help of special endoscopes, the mucous membrane of the maxillary sinus can be inspected and pathological changes in the mucous membrane can be specifically removed under endoscopic view. These tissue specimens are then sent to a pathology specialist who examines the samples under the microscope in detail for inflammatory or tumorous changes. In rare cases, a fungal infection or an accumulation of metal salts is also discovered. If there is still evidence of inflammation in the posterior sections of the ethmoidal cell system, this system is gradually opened up along the base of the skull under endoscopic control and the bony walls are removed to create a large space without any disturbing niches or partitions. These walls to be removed are thin plates of bone covered with mucosa on both sides. The natural opening of the sphenoid sinus can be found through the so-called ethmoidal approach, or through the nasal cavity. The frontal sinus is the most difficult to reach and therefore also the most difficult part of endoscopic sinus surgery. It is of crucial importance to locate and identify the natural drainage area of the frontal sinus. If this is not taken into account, it leads to blockages and obstructions of the drainage paths after the operation with correspondingly unpleasant consequences for the patient. In the case of pronounced polyp infestation, a shaver system is used in addition to videoendoscopic imaging. The instrument sucks in the polyps and cuts them off from the base with a rotating knife. Occasionally, various laser systems are also used.

Is sinus surgery also possible without nasal tamponades?

Since the atraumatic surgical technique and the use of epinephrine inserts allow us to operate in an area with little bleeding and good visibility, the use of postoperative nasal tamponades can often be dispensed with. A further development are also independently absorbable tamponades, which no longer have to be removed by the doctor, but can be aspirated in the course of wound care in the postoperative phase.

What pain or discomfort can occur after sinus surgery?

The professionally performed paranasal sinus operation does not usually cause any pain. However, a certain feeling of fullness is more common as a result of accumulated wound secretions. Regular care of the nose and sinuses and regular suctioning of the sinuses can largely prevent these symptoms.

Do I have to go to a clinic or hospital for sinus surgery?

A sinus operation is usually a short inpatient procedure. As a rule, 2 nights are planned in the clinic or hospital afterwards. The subsequent follow-up treatment, the suctioning of the wound secretion and thus the improvement of nasal breathing is carried out in the ENT practice for a few days, depending on individual needs.

What should be observed after the operation?

Postoperative nose care prevents the occurrence of adhesions and scarring that can jeopardise the surgical result. Local and systemic steroids and occasionally antibiotics can also be helpful in post-operative care.

We inform our patients that they will be unable to work for up to 2 weeks after the operation. Sports should not be done for more than 3 weeks because of the risk of postoperative bleeding, and air travel should also not be done until the 3rd or 4th week after surgery.

Patients with chronic sinusitis have had good experiences with sinus surgery, and the long-term results of this surgical method are very good. Approximately 10% of patients require revision surgery within the first 3 years. With follow-up periods of up to 10 years, 80-90% of patients do well.