Functional Endoscopic Sinus Surgery (FESS) in Beverly Hills

Sinus surgery used to be invasive and painful. Today's techniques are far less invasive. Fiberoptic endoscopes and computed tomographic (CT) scanning have changed the process, lessening discomfort, recovery time, and any associated risks. Often accomplished in an outpatient procedure with local anesthetic, functional endoscopic surgery provides relief from sinus infections and sinusitis by removing any diseased or obstructive tissue. The doctor performing sinus surgery uses a fiberoptic endoscope to view the sinuses, and so can see and remove just the tissue causing the problem. This minimal removal of tissue, plus the fact that the endoscope and other instruments are passed through the nose, means reduced discomfort and faster healing.

An endoscope is a thin rigid tube carrying a fiberoptic light and a camera at its tip. Passed through the nostril, it sends a magnified view of the nasal passages and sinus openings to a monitor, so the surgeon works under direct vision rather than by feel. Nothing is cut from the outside, and no incision is made in the skin or under the lip.

The word functional is the part that matters. Each sinus drains through a narrow opening into the nose. When the tissue around that opening is inflamed, thickened, or crowded by polyps, mucus is trapped behind it and infection recurs. The aim of the procedure is not to remove healthy structures but to clear what is obstructing those drainage pathways, so the sinuses can ventilate on their own again. That is why so little tissue is taken.

CT imaging does the mapping beforehand. Sinus anatomy differs from person to person, and the scan shows Dr. Kayem which sinuses are involved and where the obstruction sits before any instrument is placed.

Though FESS is much less invasive than older traditional procedures, alternatives to sinus surgery should always be considered first. A few things to consider:

Acute vs. chronic sinusitis: Acute sinusitis typically lasts 30 days or less and is most often caused by a virus, and sometimes by bacteria or fungi. It will usually go away on its own, though over-the-counter treatments and medications may relieve symptoms. Chronic sinusitis lasts more than 90 days and/or recurs often. It's typified by persistent inflammation, and relief usually requires intervention, either medical therapy (like steroids) or a surgical procedure.

Balloon sinuplasty vs. endoscopic sinus surgery: Dr. Kayem advises that chronic sinusitis patients consider an even more minimally invasive sinus surgery first: balloon sinuplasty. This advanced FDA-approved treatment requires no cutting and has high success rates reported in clinical studies. Learn more here.

Surgery is also not always the right target. Where the obstruction is structural rather than inflammatory, a deviated septum or enlarged turbinates may be the thing to address instead. Our sinus procedures page sets out the full range in one place.

Coverage for both types of sinus surgery varies by plan; contact our office to verify your specific benefits.

Dr. Kayem will evaluate several things before recommending surgery. FESS is typically considered when:

• Chronic or recurring sinusitis has not settled with medical therapy
• Nasal endoscopy and CT imaging show obstruction at the sinus drainage pathways
• Inflamed tissue or polyps are narrowing those pathways
• A less invasive option such as balloon sinuplasty does not suit the anatomy involved, or has already been tried

None of this is decided on symptoms alone, and no single item on that list settles it. Your evaluation brings together your history, what the endoscopy shows, and what the scan shows before anything is scheduled.

Nasal obstruction can affect sleep as well as sinuses. If snoring or sleep apnea is part of the picture for you, Dr. Kayem evaluates those conditions in the same practice.