Richmond’s Sinus and Allergy Specialists

Endoscopic Sinus Surgery

When antibiotics and nasal steroids fail to control sinus symptoms, surgery may offer prompt and lasting relief. With current technology, the majority of patients can be treated with a simple balloon dilation in the office, much like an angioplasty.  If wider openings are required, endoscopic sinus surgery can be performed at the attached Medarva Stony Point Surgery Center.

If you answer “yes” to one or more of the following questions, you may wish to see an ENT specialist (otolaryngologist) for a thorough evaluation of your sinuses:

  • Do you have frequent facial pain or pressure?
  • Do you have chronic nasal discharge?
  • Do you have difficulty breathing through your nose?
  • Is your sense of smell or taste impaired?
  • Do you get three or more sinus infections per year?
  • Do you require more than one antibiotic to treat a sinus infection?
  • Have had polyps in your nose or sinuses?
  • Have you had swelling or fluid in your sinuses on CT scan?

What is Functional Endoscopic Sinus Surgery?

If your sinuses become frequently or permanently blocked, a surgeon can enlarge the drainage pathways by cutting out the crowded or diseased tissue surgically. Modern sinus surgery is performed using endoscopes: small telescopes that are designed to fit easily inside the nose.  These provide the surgeon with a magnified, “endoscopic” view of your nasal and sinus cavity. The term “functional” refers to the concept of removing only enough tissue to create effective drainage, while preserving as much of the normal anatomy and mucous membrane as practical. The surgical plan will be based on your symptoms, your office endoscopic examination, and your CT scan.


Figure 1: Endoscopic Sinus Surgery

What happens at surgery?

The original concept of functional endoscopic sinus surgery was to remove the honeycomb-like ethmoid sinuses so that the larger frontal, sphenoid and maxillary sinuses can drain directly into the nose. Using the endoscope for a close-up view, the surgeon removes bone and soft tissue to enlarge the natural opening of each sinus, and removes the ethmoid sinus in between.  The ethmoid sinus has been described as the keystone area, with the thought that infection and swelling in the ethmoid backs up into the larger sinuses. Over time, surgeons found that they could remove less and less tissue as long as the larger sinuses were drained.  With selected patients, such minimally invasive sinus surgery could even be performed in the office under local anesthesia.[1] The introduction of Balloon Sinuplasty has created a new way of thinking about endoscopic sinus surgery – a recent study conducted partly at Richmond ENT demonstrated that balloon dilation of the maxillary sinus alone can improve disease in the ethmoid sinus as well.[2]

[1] Armstrong, M:  Office Endoscopic Sinus Surgery.  Presented at the American Rhinologic Society, Palm Desert, CA, April 26, 1999.


Armstrong, M. Office-based Procedures in Rhinosinusitis.  Otolaryngol Clin N Am 38:1327-1338, 2005.



[2] Levine SB, Truitt T, Schwartz M, Atkins J: In-Office Stand-Alone Balloon Dilation of Maxillary Sinus Ostia and Ethmoid infundibula in Adults with Chronic or Recurrent Acute Rhinosinusitis: A Prospective, Multi-institutional Study with 1-Year Follow-Up. Ann Otol Rhinol Laryngol 122(11):665-671, 2013.