Surgery on the nose and sinuses

What is the function of the nose?

The nose is the air conditioning system of our airways. The nose must

• clean the inhaled air mechanically,
• heat this air and
• increase the humidity for the deeper airways.

Surgical correction of deviated septum

Obstructed nasal breathing is often caused by a deviated septum, which can be corrected by surgery on the nose. People with a pronounced deviated septum suffer from a chronically blocked nose and are often forced to breathe through their mouth. Even during light exercise, they have to switch to mouth breathing in order to supply the lungs with sufficient air and therefore oxygen. Chronic sore throat and frequent infections can be the result.

Risk factors: Nasal drops and hay fever

In addition to a curvature of the nasal septum, large cavernous bodies (nasal concha) can also significantly impair nasal breathing. The inferior nasal concha are usually too large, but the middle nasal concha can also deviate anatomically and thus become very large. Chronic use of nose drops leads to enlarged, swollen nasal concha, as does an allergy to pollen and grass, for example.

Gentle surgical treatment

The treatment goals for obstructed nasal breathing are to correct the curvature of the nasal septum and to reduce the size of the enlarged cavernous bodies. The parts of the nasal septum that are displaced to the right or left are placed in the midline. A gentle surgical procedure is necessary in order to minimise the impact on the functions of the nose. The reduction of the nasal concha is performed using different techniques depending on the symptoms and the anatomical conditions. It ranges from moving the nasal concha to the side to removing the bone of the head of the nasal concha while preserving the mucous membrane that is important for the function of the nose.

At the end of the surgery, a soft foam finger pad nasal tamponade is inserted and left in place for one night. It is intended to prevent secondary bleeding. We remove this tamponade painlessly the very next morning. The inpatient stay lasts about two to three days.

Quick recovery

Sports activities such as cycling, jogging or playing tennis can usually be resumed after two to three weeks. 

We have four sinuses on each side of the nose: the maxillary sinus, the frontal sinus, the ethmoid sinus and the sphenoid sinus. Each paranasal sinus has its own excretory duct. If this excretory duct is very narrow, a sinus infection can develop. Even a harmless cold can lead to a complete blockage of this excretory duct due to swelling of the mucous membranes. As a result, the mucus produced in the sinuses can no longer drain away and remains in the affected sinus cavity: an ideal breeding ground for bacterial infections. Recurrent sinusitis can eventually develop into chronic sinusitis.

Gentle surgery for chronic sinusitis

The aim of treatment for chronic sinusitis is to specifically widen or eliminate the constrictions in the affected sinus passages. We use computer tomography to obtain an image of the individual anatomy of the sinus system before the surgery. Our experienced surgeons use an endoscope, which they insert through the nose, to widen the narrow duct. Once the constriction has been removed, the chronically altered mucous membrane in the downstream sinuses can recover.

The sinuses are anatomically very close to the eye and the brain. Therefore, only very experienced ENT specialists should perform surgery on the sinuses. 

New: Antibody therapy for nasal polyps

Even after correctly performed sinus surgery and consistent use of local steroids, some patients develop nasal polyps again. Since 2019, a new and effective treatment method has been available to those affected in the form of antibody therapy. We have had many positive experiences with these medications and will be happy to advise you.

A watery eye or recurring inflammation and swelling in the area of the tear ducts can be caused by a constriction in the area of the tear duct or the tear sac. The tear ducts are located on the nasal slope next to the inner corner of the eyelid. The location of the constriction can be determined by a medical examination with the help of an irrigation of the tear ducts.

Gentle surgery

This can be remedied by widening the tear ducts. With the exception of constrictions in the small tear ducts, the gentlest procedure for this surgery is the so-called ‘Western surgery’ or dacryocystorhinostomy (DCR). Our experienced surgeons perform the surgery through the nose under general anaesthetic. Using an endoscope, they open the tear sac from the nose and thus create a wide drainage channel for the tear fluid.

Changes in the area of the tear sac, such as tear stones or tumours, can be removed at the same time or analysed more precisely using tissue samples. In rare cases, for example after accidents, they insert a silicone stent over a period of eight to twelve weeks to splint the tear ducts. After three months, you can remove this stent painlessly during an outpatient appointment without any further anaesthetic.

Complications of the eye in children

Inflammation of the sinuses can spread to the eye socket, especially in children. This is referred to as orbital complications. Children are particularly affected, as they do not yet have a developed frontal sinus or maxillary sinus - but they do have an ethmoid sinus. The inflamed secretion can be drained by surgically opening this ethmoid sinus.

Protrusion of the eyeball

Certain diseases of the thyroid gland, such as Graves' disease, lead to tissue proliferation in the eye socket. The eyeball visibly protrudes forwards. Damage to the cornea, the eye muscles and the optic nerve is possible (endocrine orbitopathy). A decompression surgery can significantly improve this situation. We open the sinuses over a large area and remove the bony border to the eye socket. This gives the orbital tissue more space to expand and the eyeball can move back into the eye socket.

Eye injuries after accidents

Bicycle, motorbike or car accidents often lead to injury to the eye socket (orbit) and the optic nerve. To save sight, our ENT doctors can surgically expose the optic nerve and thus relieve the strain.