A contemporary review of endoscopic sinus surgery: techniques, tools, and outcomes

Chronic rhinosinusitis is estimated to nearly 25 million people annually in the United States alone. The medical management of these patients is often successful; however, when medical management fails, surgery may be indicated to bring relief. Unfortunately, surgery for chronic rhinosinusitis is not standardized and we remain without a consensus on both the extent of surgery required and the manner in which it is performed. In the past 25 years, three philosophies or schools of thought have arisen to help guide the surgical treatment of chronic rhinosinusitis. Functional endoscopic sinus surgery aims to surgically treat problem areas by ventilating the sinuses through the natural ostia and addressing all diseased sinuses when necessary. This procedure is not standardized and is patient and surgeon dependent. The minimally invasive sinus technique has been proposed as a method whereby each surgical procedure is standardized regardless of disease severity. Lastly, balloon catheter dilatation of the sinus ostia, which by itself is not truly a procedure, is also discussed as a separate philosophy since these specific tools used during endoscopic sinus surgery have quickly energized the sinus community. All three schools of thought possess benefits and drawbacks, even when used appropriately. The concepts, tools, and technologies will be reviewed here as well as outcomes in the hopes that this article will provide an understanding of the surgical options to successfully treat chronic rhinosinusitis.