Endoscopic Sinus Surgery (ESS): Indications, Procedure, and Outcomes

Indications for ESS

• Chronic rhinosinusitis (CRS): >12 weeks symptoms despite maximal medical therapy (intranasal steroids, saline irrigation, antibiotics).
• Nasal polyposis: Obstructive polyps unresponsive to steroids.
• Deviated septum: Causing nasal obstruction, recurrent sinusitis.
• Allergic fungal sinusitis: Allergic mucin, fungal elements on histopathology.
• Recurrent acute sinusitis: ≥4 episodes/year with documented infection.
• Selected tumors: Inverted papilloma, juvenile nasopharyngeal angiofibroma, sinonasal malignancies (selected cases).

Surgical Principles

• Performed under general anesthesia with endoscopic visualization.
• Goal: Restore sinus ventilation/drainage by opening natural ostia, removing obstructive tissue.
• Image-guided navigation used for complex anatomy/revision.

Outcomes

• Symptom improvement in 80–90% of CRS patients.
• Polyp recurrence possible; long-term topical steroids reduce risk.
• Complications rare: CSF leak (<1%), orbital injury, hemorrhage.

ESS is offered after failed medical management; shared decision-making includes CT staging (Lund-Mackay) and patient expectations.