Sinus Treatment and Surgery in Singapore

Sinusitis (or Rhinosinusitis)

What is Sinusitis (or Rhinosinusitis)?

Sinusitis is the inflammation of the tissues in your sinuses, which keeps mucous from draining, resulting in bacterial infection (Figure 1). Patients with sinusitis may display the following symptoms:

• Coloured nasal mucous, often yellow, brown or green, and sometimes blood-stained
• Blocked and congested nose
• Pain in the face
• Postnasal drip
• Reduced sense of smell

While some of these symptoms can overlap with those of a sensitive nose, a key difference is the presence of facial pain and coloured discharge, which can help a specialist distinguish between the two conditions.

Sinusitis is a diagnosis that is based on a combination of clinical history, physical examination and a flexible nasoendoscopy. Nasoendoscopic findings include swelling of the lining of the nose and sinuses and mucopus (mixture of mucous and pus). For patients whose diagnosis may be unclear or if they have not responded adequately to medical treatment, a CT scan of the sinuses may be required.

Common Causes of Sinus Infection

• Viral infections, such as the common cold or influenza, can lead to inflammation of the sinus passages.
• Bacterial infections, including Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus, can infect the sinuses.
• Allergies to pollen, dust mites, pet dander, or other allergens can cause allergic rhinitis, which can lead to sinusitis when left untreated.
• Nasal polyps are non-cancerous growths in the nasal passages that can block the sinuses and exacerbate infection.
• Structural issues within the nasal passages, such as a deviated septum or narrow sinus openings, can hinder proper drainage and airflow, and increase susceptibility to sinus infections.

Consequences of Sinusitis: Impact on Health and Well-Being

• Pain and discomfort: Sinusitis often causes facial pain and pressure, particularly around the forehead, cheeks, and eyes. This discomfort can range from mild to severe and may be accompanied by headaches.
• Difficulty breathing: Inflamed and congested sinuses can lead to difficulty breathing through the nose. This can result in mouth breathing, snoring, and disrupted sleep patterns.
• Reduced quality of life: Chronic sinusitis can lead to persistent symptoms, which may affect an individual’s daily life. These symptoms can include fatigue, reduced productivity, and a decreased overall quality of life.

Types of Sinusitis

Sinusitis refers to the inflammation or infection of the tissue that lines the sinuses, which are small cavities located in your skull. They produce mucus, which helps to keep the inside of your nose moist. This protects against dust, allergens, and pollutants.

The four sinuses we have are:

• Maxillary sinus: Located below your eyes, also known as the cheek sinus. This is also the biggest sinus cavity.
• Frontal sinus: Located above your eyes
• Ethmoid sinus: Located between your eyes
• Sphenoid sinus: Located behind your eyes

Healthy sinuses are able to drain out mucus, which creates an airflow channel, reducing the accumulation of bacteria or other germs. When our sinuses become blocked and filled with fluid, germs can grow and cause an infection, resulting in sinusitis. There are two different types of sinusitis:

• Acute sinusitis: This refers to the sudden onset of cold-like symptoms, such as a runny or stuffy nose, cough, and facial pain, that last for less than three months. Sinus treatments for acute conditions can include antibiotics and decongestants.
• Chronic sinusitis: This refers to a condition that causes more serious symptoms, such as nasal congestion, facial pain or pressure, and decreased sense of smell, that last for more than three months. Sinus treatments for chronic sinusitis can include medications, immunotherapy, or surgery.

Options for Sinus Treatment

While there is no definitive cure for many chronic sinusitis conditions, they can be effectively managed through a variety of methods, with the most suitable option depending on the specific diagnosis and severity of the condition. From non-surgical approaches to more advanced procedures, here are some of the available treatments:

For patients with sinusitis who do not respond to comprehensive medical treatment, functional endoscopic sinus surgery (FESS) may be recommended.

FESS is a minimally invasive procedure performed internally through the nostrils, eliminating the need for external incisions on the nose or face. The utilisation of an image guidance system (IGS) during the surgery significantly lowers the risk of major complications. IGS allows surgeons to confirm the position of the operating instruments within the nasal cavities and sinuses, ensuring safe navigation away from critical areas like the eye, brain or major blood vessels. This is particularly important during revision FESS (secondary or subsequent sinus surgeries), where scarring and distortion of important surgical landmarks from the previous procedures, or in cases involving complex sinus anatomy.

How Safe is Sinus Surgery

Sinus surgery, especially when utilising the minimally invasive approach of FESS, is widely recognised for its safety and effectiveness. Nonetheless, like all surgical interventions, it carries certain risks and safety concerns that are important for patients to consider. These include:

• Bleeding: As with any surgical procedure, there is a potential risk of bleeding during or after sinus surgery. However, the risk is typically low, and surgeons take meticulous steps to minimise this possibility.

• Infection: Post-surgical infections are a risk in any operation, including sinus surgery. Strict sterile techniques and sometimes preventive antibiotics are used to reduce this risk.

• Adverse reactions to anaesthesia: Some patients may experience reactions to anaesthesia, though careful preoperative assessment aims to minimise this risk.

• Damage to surrounding structures: The sinuses are located close to the eyes, brain, and major nerves, posing a risk of injury during surgery. The use of IGS during FESS has greatly reduced this risk by allowing surgeons to navigate more safely around these critical structures.

• Cerebrospinal fluid (CSF) leak: Although rare, there is a risk of creating a leak of CSF, the fluid surrounding the brain, especially in surgeries involving the sphenoid or ethmoid sinuses. The use of IGS technology and the expertise of the surgeon significantly lowers this risk.

• Changes in sense of smell or taste: Temporary or, in very rare cases, permanent changes in smell or taste can occur following sinus treatment.

To reduce the risks associated with sinus surgery, careful preparation before the operation is crucial. This process involves an in-depth review of your medical history, a thorough examination, and, if needed, imaging tests to determine the safest way to proceed with your surgery.

Choosing a highly experienced ENT surgeon is key to minimising potential complications, as their expertise is instrumental in ensuring a successful outcome. After your surgery, it is vital to follow your surgeon’s advice carefully, including taking prescribed medications, performing nasal irrigation, and attending follow-up appointments. These steps are essential for your recovery and help make sinus surgery a very safe and effective option for treating chronic sinus issues.

When Should You See An ENT Sinus Specialist in Singapore?

You should consider consulting an ENT sinus specialist in Singapore under the following scenarios:

• Persistent sinusitis symptoms that last more than 12 weeks despite medical treatment
• Recurrent sinus infections throughout the year
• Symptoms of sinusitis coupled with severe headache, facial pain, or vision problems
• Difficulty breathing through the nose is not alleviated by over-the-counter medications
• Suspected sinus-related snoring or sleep apnea

Meet Our ENT Sinus Specialist

Dr Gan is a highly esteemed ENT doctor and a recognised sinus specialist in Singapore. With extensive training and over a decade of experience in treating various sinus conditions, Dr Gan brings a wealth of knowledge and expertise to our clinic.

He specialises in minimally invasive sinus surgery techniques, including FESS, leveraging imaging technologies to ensure the highest safety and efficacy for his patients. If you are struggling with persistent or complex sinus issues, Dr Gan can provide the expert care you need to find relief.

Common Ear, Nose and Throat Conditions

Here is a list of common ENT conditions that Dr Gan provides services for: