Maximizing Results and Minimizing Complications during FESS

As for planning pre-op medical therapy, patients should be categorized into one of three presentations: nonhyperplastic chronic sinusitis, hyperplastic chronic sinusitis, or classic allergic frontal sinusitis, and medical therapy geared accordingly. He noted that sinus flora tend to change after FESS.

Patients with polyps are often pretreated with prednisone, starting three days before surgery. Patients with classic allergic frontal sinusitis may need to start earlier.

Saline irrigation is important post-op, with the mechanical cleansing effect being key. Commercial products and home recipes all seem effective. There is debate about the best delivery vehicle “but as long as it’s positive pressure I think it works well,” he said.

Topical detergents, antifungals, and steroid irrigation all have roles to play in pre-op care, depending on the patient. Not all patients are compliant with irrigations, so consider nasal sprays. The disadvantage with sprays is they don’t provide a positive pressure mechanical clean-out effect.

©2006 The Triological Society