1. Balloon Sinuplasty

In severe sinusitis that has failed medical management, then surgical treatment is of choice.

Nowadays, Endoscopic sinus surgery is used and the older open technique (opening the maxillary sinuses from under the upper lips) is not used anymore as it is more traumatic to the patient.

The endoscopic minimalist technique is Balloon Sinuplasty. The Alfred Hospital have been using this technique in Australia since 2006 (it was first started in the USA with FDA approval in 2005), but it is only introduced to Hong Kong in 2012. It uses a guide wire to enter the blocked sinus cavity and a narrow balloon is then inflated to reopen the sinus passageway to allow drainage with minimal structural damage. This is particular useful for patients who has frontal sinusitis. It is akin to the angioplasty that is in widespread use today for blocked coronary arteries. The down side of Balloon Sinuplasty technique is it cannot deal with nasal polyps or ethmoid sinusitis properly.

 

If there is a lot of nasal polyps and severe sinusitis, then the traditional Functional Endoscopic Sinus Surgery (FESS) is probably more appropriate.

Commonly now I use a hybrid technique with Balloon Sinuplasty for the frontal sinuses and traditional FESS for the other sinuses as this tend to give the best result with less recurrence of sinusitis and less chance of further sinus surgery

2. Nasoendoscopy

Using a small camera, the internal lining of the nose and nasopharynx is clearly magnified on a high resolution medical monitor. All nasal conditions can be immediately diagnosed and digitally recorded.

3. Nasal Biopsy

Whenever nasal tumor or nasopharyngeal cancer is suspected, biopsy is a must. With the help of nasal endoscope, this can be safely carried out under topical anesthesia in a clinic setting.

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4. Nasal Cautery

Dilated vessels over the nasal septum can cause troublesome nose bleeding. Cauterisation under local anethesia with chemical, heat or laser includes scarring over the septum, making recurrent bleeding less likely. 

 

5. Endoscopic Polypectomy

Nasal Polyps lead to nasal blockage, postnasal drip, loss of smell and headache. Medical therapy can be tried initially. For patients with persistent symptoms, surgical removal is indicated. 

 

6. Endoscope-assisted Turbinoplasty

Hypertrophied inferior turbinate can cause persistent nasal blockage despite medical therapy. The endoscope is used to visualize the surgery of turbinate reduction. The nose can be more thoroughly unblocked using this method. 

 

7. Laser-assisted Turbinectomy (LAT)

 

Overview: Nasal obstruction not responding to medicine and nasal sprays can be very frustrating. Long-standing swelling of turbinates may cause mouth breathing, chronic pharyngitis,obstructive sleep apnoea syndrome, morning headache and sinusitis. Traditional turbinectomy with scissors may require hospitalization. LAT provides a simple, fast and painless clinic-based solution with proven success worldwide over the last 15 years.

Who needs the operation? Hypertrophic inferior turbinates causing nasal obstruction.

Why have the operation? Reduce nasal obstruction

*There is chance of incomplete relief of nasal obstruction and recurrence

 

8. Laser-assisted Polypectomy (LAP)

Overview: Nasal polyp can be safely removed with ENT Laser as outpatient. Relief of nasal obstruction is almost immediate.

Who needs the operation? Nasal polyposis

Why have the operation?

  • Improve nasal symptoms such as obstruction, postnasal dripping, facial pain, headache etc.

  • Prevent complications of rhinosinusitis

  • Remove tumour

*There is chance of incomplete relief of symptoms and recurrence

 

9. Functional Endoscopic Sinus Surgery (FESS)

​FESS restores functional drainage while preserving normal tissue of sinuses. Before nasal endoscope was introduced, the ENT surgeon worn a headlight and performed sinus surgery with naked eyes.

Nowadays, with endoscopes that can 'see' at different angles, finer equipment and advanced medical imaging, sinus surgery is safely performed under video-endoscopic control. This also minimizes the chance of injury to the eyes, blood vessels, nerve and brain.​

Who needs the operation? Those who have rhinosinusitis, nasal polyposis, tumors

Why have the operation?

  • Improve nasal symptoms such as obstruction, postnasal dripping, facial pain, headache etc.

  • Prevent complications of rhinosinusitis

  • Remove tumor

 

10. Septoplasty

​Additional Septoplasty technique involves surgical removal of deviated bony and cartilaginous portions of nasal septum. Complete healing is expected within 2 weeks.

Who needs the operation?

People who have nasal obstruction with deviated nasal septum, Obstruction of sinus opening leading to sinusitis, Epistaxis and septal spur headache needs the surgery.

Why have the operation?

  • Reduce nasal obstruction

  • Reduce obstruction of sinus opening leading to sinusitis

  • Reduce epistaxis

  • Reduce septal spur headache

 

11. Turbinectomy 

​Overview: Reduction of enlarged nasal mucosa and turbinate bone relieves nose block while preserving the normal nasal function of warming, humidifying and filtering. Best results are achieved when combined with Septoplasty for coexisting deviated nasal septum. Turbinectomy is the transnasal resection of inferior turbinates.

Who needs the operation? Hypertrophic inferior turbinates causing nasal obstruction

Why have the operation?

Reduce nasal obstruction

*There is chance of incomplete relief of nasal obstruction and recurrence.

 

12. Adenoidectomy (or Endoscope-assisted Suction Diathermy Adenoidectomy)

​Heavy snoring in children is a warning sign for the dangerous Obstructive Sleep Apnoea Syndrome (OSAS). Removal of enlarged tonsils and adenoids provides dramatic relief.

Adenoid is a tissue located at nasopharynx.​

Who needs the operation?

  • NOSE: nose block, snoring, sleep apnea, chronic or recurrent rhinosinusitis

  • EAR: otitis media with effusion, recurrent acute otitis media

 

Why have the surgery?

  • NOSE: Reduce airway obstruction, reduce snoring and sleep apnea, reduce chronic or recurrent rhinosinusitis

  • EAR: Relief otitis media with effusion, Reduce recurrent acute otitis media.

 

There is chance of incomplete relief of symptoms and recurrence.

Endoscope-assisted suction diathermy adenoidectomy is the latest technology which helps to minimize the risk of bleeding in this type of surgery.

13. Endoscope-assisted Sphenopalatine Artery Ligation

Troublesome nosebleed at the back of the nose is commoner in older patients. A lot of time, the bleeding is not controlled by packing. Endoscopic Sphenopalatine artery ligation stops nosebleed from back of the nose. This procedure avoids the hazards of repeatedly packing the nose in a nosebleed.

14. Endoscope-assisted Dacrocystorhinostomy (DCR)

​Teary eye (epiphora) is the primary symptom of nasolacrimal duct (tear duct) blockage. Syringing of the tear duct should be attempted to clear the blockage. Endoscopic Dacrocystorhinostomy would be done if syringing fails. The advantage of this type of surgery is that it avoids facial scar.

 
 
 

15. Endoscope-assisted Repair of Cerebrospinal Fluid Leakage

​​The leakage of cerebral spinal fluid is due to trauma and subsequently fractures of the anterior skull base. If the leakage does not stop itself, surgery is needed. The uses of endoscope through the nostril can avoid major neurosurgical procedure.

 

16. Endoscope-assisted Decompression of Orbit for Dysthyroid Eye Disease

Protruding of eyeballs due to dysfunction of thyroid glands can lead to patches of pigments forming on eyes. Decompression should be done with the aid of endoscope to improve eye closure.

17. Endoscope-assisted Medial Maxillectomy for Benign Nasal Tumor

The most common benign tumor of the maxillary sinus being inverted Papilloma. The symptoms include nosebleed and nasal obstruction. There is a small chance of it turning into cancer if left untreated. Surgery with the aid of endoscope avoids the facial scar while removing the tumor.

 
 

18. Rhinoplasty (Nose Job)

The nose, being at the centre, defines the beauty of a face. Unfavorable nose including crooked nose, deviated nose, big nose, nose hump, short nose and hooked nose. Rhinoplasty (Nose Job) is offered to patients who are unhappy with their nose profile.

19. Antral Washout

​​Under local anesthesia, the infected maxillary sinus is punctured with a strong needle and trocar. The sinus is then flushed with sterile fluid until clear of infective material. With the advent of more potent antibiotics and decongestant, this once popular procedure is rarely performed nowadays.