Endoscopic Sinus Surgery for Children

Endoscopic sinus surgery is a procedure to open the passages of the nose and sinuses. It is done to treat long-term (chronic) sinus infections. An ear, nose, and throat specialist (ENT) does the surgery.

This surgery is called endoscopic because an instrument called an endoscope is used. This is a small, rigid tube with a light and a camera at the end. Small cuts are made in the nose and sinuses to allow the scope to pass. The surgeon then uses small tools to do the surgery.

Different procedures may be done. They include:

• Removal of adenoids with or without sinus wash. Adenoids are small glands behind the nose. Adenoids may cause problems with the sinuses. The sinuses may be washed (irrigated). The fluid is collected and sent to the lab to check for infection.
• Balloon sinus dilation. Small balloons are dilated to open passages in the sinuses.
• Functional endoscopic sinus surgery. The surgeon uses an endoscope during surgery to open sinus passages, remove growths, or fix other problems.

Sinus surgery is much less common in children compared with adults. In children, sinus surgery is usually done only for chronic sinusitis when medical treatment has not helped. Chronic sinusitis means the infection has lasted for at least 3 months. Medical treatment includes antibiotic and corticosteroid medicines.

Surgery for short-term (acute) sinusitis is only done when a child has other serious infections near the sinuses. 

Complications of the surgery are rare but include:

• Bleeding
• Damage to the eye or eyesight
• Complications with anesthesia
• Complications with the brain such as injury, fluid leak, or infection

The ENT will examine your child’s ears, nose, and throat. Your child may need tests such as a CT scan of the sinuses. Your child’s ENT will explain your child’s surgery.

Make sure you talk with your child’s ENT about the following:

• Any medicines that your child should not take before surgery. This includes over-the-counter medicines.
• When your child needs to stop eating and drinking. It is common not to eat or drink after midnight the night before surgery.
• When your child needs to arrive at the hospital or facility
• What to expect and how to care for your child after surgery
• When your child can get back to normal activities, including returning to day care or school

If your child gets sick before surgery, call his or her ENT. Surgery may need to be rescheduled.

The surgery usually takes from 1 to 3 hours. In general, you can expect the following:

• Your child will be given medicine to sleep (general anesthesia).
• Small cuts are made inside your child’s nose.
• Using the endoscope, the ENT opens the passages of your child’s sinuses and makes the narrow passages wider.
• At this time, the ENT may wash the sinuses. The liquid is then checked for infection.
• Your child’s adenoids may be removed. This is done through the mouth.
• If needed, other procedures may be done. For example, the ENT may fix the nasal septum that divides the nose, remove the tonsils, or place ear tubes.

Your child may stay in the hospital overnight. Or he or she may go home a few hours after surgery.

• Your child will get IV fluids until going home. Your child may be given clear liquids to drink in the recovery room.
• Your child may have a sore nose, trouble breathing through the nose, and difficulty swallowing.
• Your child may be given medicine for pain. He or she may also be given antibiotic medicine to prevent or treat infection.
• The head of the bed in the recovery room will be raised to help with swelling, breathing, and drainage. At home you should have pillows or a recliner chair available to help your child keep his or her head elevated above the level of the chest.
• There may be gauze or cotton packing in your child’s nose to prevent bleeding. The packing may dissolve on its own or the ENT may remove it.
• At first, there may be some drainage from the nose. The drainage may have a small amount of blood. Your child may cough or spit up some pink or brown mucus.
• Your child’s ENT may recommend that your child use nasal ointment, saltwater or saline spray, or nasal steroid spray after surgery. Follow instructions carefully.
• A visit with your child’s healthcare provider will be scheduled for 1 to 2 weeks after surgery. Your child will need other follow-up appointments in the months after surgery. These are to make sure that the nose and sinuses are healing as they should.

Before you agree to the test or the procedure for your child make sure you know:

• The name of the test or procedure
• The reason your child is having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• When and where your child is to have the test or procedure
• Who will do the procedure and what that person’s qualifications are
• What would happen if your child did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or your child has problems
• How much will you have to pay for the test or procedure