• Home
  • Practice Focus
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
    • How I Do It
    • TRIO Best Practices
  • Business of Medicine
    • Health Policy
    • Legal Matters
    • Practice Management
    • Tech Talk
    • AI
  • Literature Reviews
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Career
    • Medical Education
    • Professional Development
    • Resident Focus
  • ENT Perspectives
    • ENT Expressions
    • Everyday Ethics
    • From TRIO
    • The Great Debate
    • Letter From the Editor
    • Rx: Wellness
    • The Voice
    • Viewpoint
  • TRIO Resources
    • Triological Society
    • The Laryngoscope
    • Laryngoscope Investigative Otolaryngology
    • TRIO Combined Sections Meetings
    • COSM
    • Related Otolaryngology Events
  • Search

Patient Selection, Counseling Can Prevent FESS Failures, Disappointments

by Paula Moyer • August 1, 2008

  • Tweet
  • Email
Print-Friendly Version

The success of functional endoscopic sinus surgery (FESS) often depends on patient selection and expectations, according to several experts.

You Might Also Like

  • Maximizing Results and Minimizing Complications during FESS
  • Tasks Required for a Correct Training Approach to FESS
  • Toward Better Outcomes: Avoid revision surgeries in chronic rhinosinusitis patients
  • Hierarchical Task Analysis Can Help Reduce Error in FESS
Explore This Issue
August 2008

As otolaryngologists know, FESS is typically not a cure for chronic sinus disease. More often, it is a tool that helps long-term medications work more effectively. The mission is to make certain that patients understand and accept the surgery’s limitations. ENT Today conducted separate phone interviews with experts who presented a panel on FESS surgery failure at recent Triological Society section meetings. In the interviews, they discussed the reasons for FESS failure, predictive factors, preventive strategies, and ways to proceed after the surgery fails.

Goals of Sinus Surgery

I define the goals as symptom improvement and improvement of the disease itself, said John DelGaudio, MD, Associate Professor of Otolaryngology and Chief of Rhinology and Sinus Surgery at Emory University School of Medicine in Atlanta. If you take those things into account, failure can occur for different reasons.

Michael J. Sillers, MD, Director of the Alabama Nasal and Sinus Center in Birmingham, said that the surgery is considered unsuccessful if the patient has persistence, recurrence, or worsening of sinus symptoms or disease after sinus surgery.

Incomplete surgery, scar tissue formation, discontinuation of medical therapy, or disease progression can be reasons for FESS failure, Dr. Sillers said. Surgery can’t halt the natural history of the disease, so the precise role of surgery needs to be clearly understood.

FESS would be considered unsuccessful if after surgery, the patient still has symptoms that influence the quality of life and still has objective disease as documented by the exam or CT scan, said Stilianos Kountakis, MD, PhD, Vice Chair of Otolaryngology at Medical College of Georgia in Augusta, where he is Co-Director of Rhinology-Sinus Surgery. The main issue is how the patient feels, though, he stressed. I’m not treating the imaging study, I’m treating the patient, he said.

Dr. Kountakis agreed with Drs. DelGaudio and Sillers that an important first step is to understand the underlying problem. There are many different reasons for chronic rhinosinusitis, he said. Most of the time it’s not an infection, but inflammation due to several causes. Allergic rhinitis in patients with chronic rhinosinusitis should be treated appropriately to minimize all sources of sinonasal inflammation. Patients with allergic fungal rhinosinusitis require surgery to remove the fungal debris, and they require aggressive medical management afterward. Bacteria in the sinuses that produce toxins can cause severe inflammation. Others may have a genetic predisposition to sinus disease, as in patients with asthma.

Brent Senior, MDExplain to patients that they are having surgery because their disease can’t be managed with medications and that the goal of surgery is to make the disease manageable with medications again.
-Brent Senior, MD

Patient Selection and Counseling

Helping patients understand the nature of [sinus] disease is a critical component of preventing their disappointment in FESS, said Brent Senior, MD, Chief of Rhinology, Allergy, and Sinus Surgery at the University of North Carolina in Chapel Hill. It’s critical for patients to understand that chronic sinus disease is a disease that is always with you, that it can wax and wane in severity. Surgery can make it a milder disease to live with, but it does not necessarily cure the sinus disease.

Pages: 1 2 3 4 | Single Page

Filed Under: Departments, Medical Education, Practice Focus, Practice Management, Rhinology Tagged With: counseling, functional endoscopic sinus surgery, outcomes, patient communication, Sinusitis, surgery, treatmentIssue: August 2008

You Might Also Like:

  • Maximizing Results and Minimizing Complications during FESS
  • Tasks Required for a Correct Training Approach to FESS
  • Toward Better Outcomes: Avoid revision surgeries in chronic rhinosinusitis patients
  • Hierarchical Task Analysis Can Help Reduce Error in FESS

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

The Triological SocietyENTtoday is a publication of The Triological Society.

Polls

Have you invented or patented something that betters the field of otolaryngology?

View Results

Loading ... Loading ...
  • Polls Archive

Top Articles for Residents

  • Applications Open for Resident Members of ENTtoday Edit Board
  • How To Provide Helpful Feedback To Residents
  • Call for Resident Bowl Questions
  • New Standardized Otolaryngology Curriculum Launching July 1 Should Be Valuable Resource For Physicians Around The World
  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • The Road Less Traveled—at Least by Otolaryngologists

    • The Best Site for Pediatric TT Placement: OR or Office?

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • Complications for When Physicians Change a Maiden Name

    • Leaky Pipes—Time to Focus on Our Foundations
    • You Are Among Friends: The Value Of Being In A Group
    • How To: Full Endoscopic Procedures of Total Parotidectomy
    • How To: Does Intralesional Steroid Injection Effectively Mitigate Vocal Fold Scarring in a Rabbit Model?
    • What Is the Optimal Anticoagulation in HGNS Surgery in Patients with High-Risk Cardiac Comorbidities?

Follow Us

  • Contact Us
  • About Us
  • Advertise
  • The Triological Society
  • The Laryngoscope
  • Laryngoscope Investigative Otolaryngology
  • Privacy Policy
  • Terms of Use
  • Cookies

Wiley

Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1559-4939