Endoscopic Sinus Surgery in Singapore

Endoscopic sinus surgery (ESS) is a minimally invasive procedure that uses a thin, flexible tube with a camera (an endoscope) to examine and treat conditions such as chronic sinusitis, nasal polyps, and sinus infections.

The surgeon accesses the sinuses through the nostrils, avoiding external incisions, to remove diseased tissue or bone and improve sinus drainage and function.

Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

Benefits Techniques Preparation Procedure Recovery Risks FAQ

Indications for Surgery

Endoscopic sinus surgery may be considered for the following conditions when medical treatments have not provided adequate relief.

Chronic Sinusitis: Persistent inflammation of the sinuses lasting more than 12 weeks, often accompanied by recurring infections.
Nasal Polyps: Soft tissue growths that develop in the nasal passages or sinuses, causing obstruction and breathing difficulties.
Deviated Septum: A significant displacement of the wall between the nasal passages that affects breathing and sinus drainage.
Fungal Sinusitis: Fungal infections in the sinuses that may require removal of infected material and improved ventilation.
Tumours: Benign or malignant growths in the nasal or sinus cavities requiring surgical removal.

Benefits of the Procedure

Endoscopic sinus surgery offers several advantages that can enhance patient outcomes and quality of life. These include:

Improved Breathing: Surgery creates wider sinus passages, allowing for better airflow and easier breathing through the nose.
Reduced Infections: Better sinus drainage decreases the likelihood of recurring sinus infections and related symptoms.
Minimal Scarring: The endoscopic approach eliminates external incisions, resulting in no visible scarring.
Enhanced Smell and Taste: Clearing blocked sinuses can restore or improve these sensory functions.

Types of Surgical Techniques

Different techniques may be employed during endoscopic sinus surgery, depending on the specific condition and anatomical considerations.

Functional Endoscopic Sinus Surgery (FESS)

The standard approach involves using an endoscope and specialised instruments to remove diseased tissue and bone. The surgeon carefully preserves the natural drainage pathways of the sinuses whilst creating wider openings. This technique allows for precise removal of targeted tissue with minimal impact on surrounding structures.

Balloon Sinuplasty

This technique uses a small balloon catheter that is inserted into the sinus passages and inflated to expand narrow or blocked sinus pathways. The balloon restructures and widens the walls of the passageways while maintaining the integrity of the sinus lining. After deflation and removal, the sinuses remain open.

Image-Guided Surgery

Specialised imaging technology creates a detailed three-dimensional map of the sinuses, which the surgeon uses for navigation during the procedure. This method provides enhanced accuracy when operating near critical structures such as the brain, eyes, and major blood vessels. The system tracks the position of surgical instruments in real-time.

Medical Evaluation of patient's condition

Preparing for Surgery

Medical Evaluation: A comprehensive assessment includes CT scanning of the sinuses, blood tests, and general health screening. The ENT surgeon reviews previous treatments, medications, and any underlying conditions that may affect surgery outcomes.
Medication Adjustments: Blood-thinning medications must be stopped according to specific guidelines before surgery. Certain medications for chronic conditions may need adjustment or temporary discontinuation.
Pre-operative Guidelines: Patients must fast for 6 hours before surgery, avoiding all food and liquids. Smoking cessation is required for at least two weeks prior to surgery.
Nasal Preparation: Special nasal sprays or medications may be prescribed in the days leading up to surgery. These help reduce inflammation and prepare the nasal tissues for the procedure.

Step-by-Step Procedure

Anaesthesia Administration

General anaesthesia is administered by an anaesthetist who monitors vital signs throughout the procedure. The patient is positioned with the head slightly elevated and secured to prevent movement.

Endoscope Insertion

The surgeon inserts the endoscope through the nostril to visualise the nasal passages and sinuses. Surgical instruments are introduced alongside the endoscope through the same pathway.

Tissue Removal and Reconstruction

Diseased tissue, polyps, or bone are carefully removed using specialised instruments. The natural drainage pathways are widened while preserving healthy tissue and mucous membranes. Any bleeding is controlled using various techniques.

Final Inspection

The surgeon thoroughly examines all treated areas to ensure complete removal of diseased tissue and adequate drainage pathways. Dissolvable packing material may be placed to control bleeding and support healing.

Post-Surgical Care and Recovery

Immediate Post-operative Care: After surgery, patients are monitored in a recovery area for several hours. Mild bleeding and nasal drainage are expected. Pain relief medication and antibiotics may be prescribed, and the head is kept elevated to reduce swelling and bleeding.
Home Care Instructions: Nasal irrigation with a saline solution typically starts 24-48 hours after surgery. Physical activity should be limited for two weeks, and nose blowing must be avoided to prevent complications. Patients should use prescribed nasal sprays and oral medications as instructed.
Follow-up Appointments: Regular clinic follow-ups are scheduled during the first few weeks to monitor healing and remove crusting or debris. The surgeon examines the surgical sites and may perform gentle cleaning. Complete healing usually occurs within 4-6 weeks.

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Potential Risks and Complications

Endoscopic sinus surgery carries risks including bleeding, infection, and changes in sense of smell. Rare complications can include damage to surrounding structures such as the eye muscles, tear ducts, or cerebrospinal fluid leakage. Vision changes, numbness in the upper teeth or lip, and scarring within the sinuses may occur.

For Singaporeans & Singapore Permanent Residents

Medisave & Insurance Shield Plan approved

Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.

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Frequently Asked Questions (FAQ)

Are there alternatives to surgery?

Yes, alternatives include medications such as antibiotics, antihistamines, or corticosteroid sprays, as well as nasal irrigation with saline solutions to reduce symptoms and improve sinus function. Surgery is considered only when these options fail to provide sufficient or lasting relief.

Can sinus problems return after surgery?

Yes, symptoms may recur if underlying issues such as unmanaged allergies, ongoing environmental irritants, or chronic conditions are not addressed. Adhering to post-surgical care instructions and managing these factors can help reduce the likelihood of recurrence.

Are there lifestyle changes that can prevent recurrence of sinus problems?

Yes, effective management of allergies, quitting smoking, and maintaining a routine of regular nasal irrigation with saline can help keep the sinuses healthy and reduce the risk of future issues.

Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.

Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.

2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
2016 – Best Educator Award (Eastern Health Alliance)
2016 – “Wow” Award (Patient Compliment)

2014 – Eastern Health Alliance Caring Award – Silver
2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
2012 – Human Manpower Development Award (Ministry of Health, Singapore)
2007 – Singhealth Best Doctor Award

Qualifications

MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
FAMS – Fellow of the Academy of Medicine Singapore

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